Jun 212018
 

By Gerald

WCB policy 03-01 Part II Application 7 specific to chronic pain and chronic pain syndrome is broken down into two parts, one part of the policy is specific to chronic pain and the other part of the policy is specific to chronic pain syndrome. According to the policies and how they are interpreted by WCB, DRDRB and the Appeals Commission, workers diagnosed with chronic pain will not receive full compensation benefits as would other workers who are diagnosed with discernible organic diagnosis. Workers diagnosed with chronic pain may receive treatment only as per WCB policy, with no monetary benefits or any rehabilitation benefits. Clearly, this is discrimination. WCB policy 03-01 Part II Question 2 states in part: “WCB may consider treatment for chronic pain” but only if chronic pain has the prescribed characteristics found in question 2. WCB Policy 03-01 Part II Question 3 states in part; “chronic pain syndrome may be compensable” meaning that chronic pain syndrome is compensable ( Compensation is based on loss of earnings,  if a worker meets all the prescribed conditions as well as marked life disruption

If a worker is diagnosed with chronic pain syndrome, according to WCB policy, they will receive full compensation which would include monetary benefits and vocational rehabilitation which also results in discrimination against workers diagnosed with chronic pain who only receive treatment for chronic pain and is contrary to to Alberta Human Rights Legislation and Section 15.1 of the Charter. This is not rocket science and questions what convinced Smallwood and Mason to  dismiss my complaint despite being upheld by the Southern Regional Director (Pardeep Gundara), the Southern Regional Investigator, Shirleen McGovern( Lawyer) and the Director’s Legal Counsel, Jim Foster. Questionably is if WCB paid Mason and Smallwood to dismiss the complaint because the overwhelming cost of having to rehear all claims involving chronic pain and having to pay workers hundreds of millions of dollars in restitution along with interest for the benefits workers are supposed to be entitled to. The complaint was so simple that any moron should have been able to understand, yet Smallwood and Mason dismissed the complaint based on what they considered to be lack of prima facie evidence to support the complaint. Clearly if workers diagnosed with chronic pain  would only receive treatment, no monetary benefits, no vocational rehabilitation, they are not being treated equally but clearly being treated differently than other workers who received full monetary benefit.

As every one knows or should know, Section 56 of the WCA provides a lifelong pension for an impairment rating that WCB were using illegally as a direct method of rating a disability. That has been factually proven by the Alberta C of QB and the Alberta Court of Appeals, the courts in Nova Scotia and the Courts in the Yukon. This means that in order to be assessed a PPD in compliance with Section 56,  a worker must receive a PCI rating. If a worker does not receive a PCI rating, a worker would not be entitled to a PPD and life time pension meaning that all workers diagnosed with chronic pain would not receive a PCI rating, no PPD rating and no lifetime pension. PCI ratings are derived from the Alberta Guides and if the Alberta Guides are silent or deficient, then a physician in order to provide a PCI rating may use the AMA Guides latest edition. The Alberta Guides do not and and to this day never have provided a PCI rating for chronic pain which leaves only the AMA Guides that did not provide a PCI rating for chronic pain until 2007 when the AMA Guides 6th Edition were published. Questionably then if all workers must be assessed a PCI rating, what “Guides” did WCB use to assess a PCI rating prior to 2007.  Impairment ratings cannot fluctuate by any more than 10% which would mean that physicians had to have some sort of guidelines to ensure consistency. No one in WCB can answer this question as no one knows how they could have assessed a PCI rating without any “Guides” Further questioning is, “can foreign doctors who have no standings in Alberta or Canada determine on behalf of WCB what compensation workers in Alberta will receive. In my legal opinion, this would be illegal. No one at this time knows who provided the impairment ratings for the Alberta Guides and we know that American physicians provided impairment ratings for the AMA Guides meaning that foreign physician are in fact determining what benefits workers in Alberta would receive.

Worse yet because impairment ratings do not measure a workers ability to work, workers who were diagnosed with erectile dysfunctions, had difficulty reaching an orgasm, brushing their teeth, defecating, urinating prior to Jan 1, 1995 would receive up to a 15% PPD rating for the rest of their lives when WCB were illegally using impairment ratings as a direct method to determine a PPD rating and after Jan 1, 1995 would receive a 15% lump sum payment for a NELP as opposed to workers diagnosed with chronic pain who received nothing  but treatment  How then could Mason and Smallwood determine that workers diagnosed with chronic pain were being treated equally. Receiving no benefits other than treatment for chronic pain while other workers receive full benefits such as a loss of earnings, vocational rehabilitation and as well medical treatment would not be considered to be equal treatment.

Any one who claims that the administrative law system is far better than having claims heard in the courts has to have rocks in their head. Administrative law systems and adjudication by morons who have no training in medicine, no training in law, have no idea how to interpret legislation, regulations or WCB policy should not be adjudicating claims when no one has a clue what they are doing has no advantage over having claims heard in the courts under civil law. Administrative systems could work if we had a Justice Minister who was an expert in administrative law as it pertains to workers compensation, a minister in charge of WCB who knew the system inside out and a premier who also was an expert in administrative law as it pertains to workers compensation. Unfortunately this is not the case with all of the a fore named people having as much of a clue as the people adjudicating claims. If administrative law  was better why is it that claims that go back nearly 50 years are still being disputed and there are thousands of disputed claims with many workers simply giving up or committing suicide. The same crap that existed when the Conservative Government were in power is the same crap that will continue during the time the NDP Government is in power with very minor changes being made to a corrupt and badly managed system to the detriment of workers. Anything worth doing is worth doing right and if you cannot do it right, scrap the entire system, entitle workers to social services benefits and allow workers to sue the employer under the rules of civil procedure and not give workers the false sense of security that this is an inquiry based system and all they have to do is file a claim if they are injured and WCB will look after them. This is nothing more than a crock of shit and not realized by workers until they are injured, only to find they are on the outside looking in.

The whole system is convoluted and ambiguous with no one including the Office of the Ombudsman. I requested that the Office of the Ombudsman make this determination as to whether the system is an Inquiry system or an Adversarial system. The answer to this was that when a claim is filed, it is an Inquiry system and the burden of proof is on the “Board” It becomes an Adversarial system when a worker appeals the decision of the Case Manager  according to the Office of the Ombudsman. According to Justice Millar who presided over a Judicial Review which we won, the system is based on an Inquiry system and remains an Inquiry system throughout a claim. Question is, does any one really know how the system works. You would think that after over 100 years that the system would be a smooth running system rather than a system that no one can explain the purpose and philosophy of workers compensation and if it is even required being that the majority of workers wind up on Social Services or CPP Disability.

Jun 082018
 

The following is from painmuse.org, a pain management discussion forum:

It Just Depression Scam

This a moot point because with the deterioration seen in the dorsolateral prefrontal cortex as a result of chronic pain, the mood problems could just a secondary phenomenon.

abstract here

Damage to that area can be induced through Interferon drug therapy; half the cases will develop depression. It has been suggested that those more “predisposed” to depression seem more susceptible to depression from this brain damage. This does not discount its role anymore than a thin boned person getting a hip fracture from a fall just because his/her bones are thin.

There has been much debate over the fact much so called depression in chronic pain is actually just what you would expect – distress over an illness pain sufferers are ill equipped to handle.

This is reflected by a review of the following article:

Fishbain DA, Cutler R, Rosomoff HL, Steele Rosomoff R. Chronic pain associated depression: antecedent or consequence of chronic pain? A Review.

Clin J Pain 1997;13(2):116±136.

Fishbain et al. (1997) recently reviewed the pain-depression literature in order to determine

whether depression precedes or follows the development of chronic pain. Forty-one studies were found which supported the concept of pain leading to depression and many of these studies indicated that depression improved following improvement in pain. Pain may, therefore have a very powerful `state’ effect in terms of leading to and modulating depression.”

It would make sense that chronic pain would wear someone down, but that does not necessarily stop insurers trying to conclude it is all in claimant’s head.

The usual tests scales for depression were never designed to be used in chronic pain cases. The concern is articulated here:

All the reviews describe difficulty in accurate and appropriate measurement of negative mood in pain patients. Whether research uses self-report questionnaires or clinician-administered inventories and diagnostic interviews; whether depression or anxiety is the sole subject of the questionnaire or constitutes a subscale within a generic questionnaire; and whether the scale was developed in psychiatric or medical populations, there is still no measure

  1. designed for (non-psychiatric) pain populations and

  2. which measures emotional well-being, in the form of positive affect, alongside negative mood.

In addition, many self-report instruments contain somatic items, which are known to inflate scores in pain populations (Bradley, 1994; Morley et al., 2002; Pincus and Williams, 1999; Pincus et al., 1996; Vahle et al., 2000).”….” As with depression questionnaires, anxiety questionnaires have been developed and validated on normal and psychiatric populations and their application in pain populations may be misleading.”

the widely used Beck Depression Inventory (BDI: Beck et al., 1961) suffers from all the problems outlined in our introduction (Morley et al., 2002): it contains items on sleep, fatigue, appetite, weight, and health concerns, and on work and sexual activity, which may be more related to pain problems than to mood (Wesley et al., 1991, 1999; Williams and Richardson, 1993); it was developed in psychiatric populations from which those with physical illness were explicitly excluded; and respondents can score no better than not depressed.”

Asking Psychological Questions that people will have just because they are in pain is called “criterion contamination”. This will lead to erroneous diagnoses or worse psychological labeling of someone who is just sick. Some questions in depression with questionable accuracy from:

Pain 109 (2004) 181–188

The development and testing of the depression, anxiety,

and positive outlook scale (DAPOS)

Tamar Pincusa, Amanda C. de C. Williams, Steven Vogel, Andy Field

abstract here

Beck Depression Score Inaccurate questions:

Weight loss

Lack of appetite

Difficulty sleeping

Feeling Irritable

Feeling Tired

Uncontrolled crying

Concerns about health

Loss interest in sex

Able to work

Loss of Interest in others

Answering high positive to all these “questionably accurate” questions would place someone in a severely depressed range where it may only mean they are in severe pain.

The Official Criteria for depression cannot be easily applied to someone in chronic pain:

For a proper diagnosis one is required to have:

  1. must have either answer 1 or 2 below and

  2. five items altogether

They include:

1) Depressed mood most of the day, nearly every day
(2) Markedly diminished interest or pleasure in all, or almost all, activities
(3) Significant weight loss NOT VALID
(4) Sleep disturbance NOT VALID
(5) Psychomotor agitation or retardation nearly every day
(6) Fatigue NOT VALID
(7)Feelings of worthlessness or excessive or inappropriate guilt
(8) Diminished ability to think or concentrate, or indecisiveness
(9) Recurrent suicidal ideation

With 3 of the 9 criteria invalid, one is left with 6 items of which 5 are needed for a diagnosis. A similar problem was encountered with cancer patients where items concerning weight loss and fatigue had to be automatically eliminated.

There are a few caveats required in interpreting the remaining depression criteria questions.

  1. People with chronic pain don’t enjoy life like the used to. Life can be very boring without money, and energy; and the pain can prevent many prior pleasurable activities. With poverty, they are often can no longer afford a car so getting out becomes a major undertaking. Depression scores finding lack of enjoyment need to take that into account.

  2. If you were to take normal subjects and deprive them of 15% of their sleep a day, within a short time, their optimism and sociability lessen and irritability increases. I am always amazed how much “depression” can disappear with proper sleep.

  3. Concentration does decline in chronic pain. Pain, lack of sleep, and medications can all majorly impact of this. One anticonvulsant used in chronic pain has been nicknamed by some “the stupid pill” because it can blunt mental functioning. Finding decreased concentration has to take that into account.

  4. The life of someone with pain is one of victimization. It is called the “invisible disability”; they look fine but suffer. This causes considerable scorn from friends, co-workers, employers, insurers, physicians and family. Life in effect can be hell. Workman’s Compensation Victims were followed for 1 year in this Ontario study called:
    “Victims twice over” – not only are they victims of an injury, they are victims of a punitive process.
    “Interviewees believed that the process victimizes them and renders them powerless and dependent on others.”
    Qual Health Res. 2005 Jan;15(1):30-48. Victims twice over: perceptions and experiences of injured workers. Beardwood BA, Kirsh B, Clark NJ.

abstract here

This in itself is going to be distressing and this can erroneously interpreted as depression. This cannot help but also engender feelings of guilt. I had one lady state, that with her religious background, she does not feel she can allow herself to enjoy life until she is well enough to go back to work. Attitudes to chronic pain and the inability to work create feelings of guilt so it can be difficult to know what the guilt question is actually measuring.

  1. It has been documented that the KEY cause of depression in chronic pain is the “subjective future” – that is – future dread
    European Journal of Pain (1999) 3: 221-233
    Subjective future as a mediating factor in the relation between pain, pain-related distress and depression
    Christina Hellstrijm, Bengt Jansson and Sven G. Carlsson
    “Helping patients to establish more positive thinking about the future would lead to therapeutic gains.”

    – a future in which a WCB victim deals with employers who only want him/her back if s/he is 100%, and case workers whose only real interest it seems is to contain costs by any means – which means getting him/her off WCB by any trick they can muster. This engendered future dread cannot help but thoroughly perpetuate any depressive distress symptoms

One finding demonstrating how inaccurate diagnosis of depression in chronic pain stems from the finding that a negative view of the future is considered very important, particularly in the Beck Depression Inventory. Surprisingly, may chronic pain patients however, do not necessarily share that idea. This has lead to new scales that strip out many of the useless questions that are used in grading depression.

abstract here

I think it is pretty obvious that 100% of chronic pain patients can be diagnosed depressed if you so wish, using criteria not designed for that population. Hence it is not valid to ever terminate coverage on a patient just because someone found them “depressed”.

The most elegant of scans uses the combination of lack of objective findings and depression to legitimize termination. The former is now an illegal maneuver, the latter immaterial. Neither can be used legitimately.

Anxiety Diagnostic Testing Unreliable

Anxiety questionnaires can rely heavily on “somatizations” – body pains and symptoms:

  • headaches

  • chest pains

  • stomach pains

  • constipation

  • tight tense muscles

  • dizzy, off balance (side effect of opioids)

  • tired, weak

  • palpitations (side effect of Amitriptyline used for chronic pain)

These can be invalid and can result from the medications the patient is on. Using above criteria, 100% of people with pain can be diagnosed as anxious. This problem arises from the fact these tests were not designed to be used on chronic pain patients – they were only normalized for use in psychiatric populations.

Anxiety is a common finding in the “normal population”. It does not render them chronic pain patients. Studies that have found anxiety in chronic pain populations have still had to face the fact the number one issue was still the level of pain.

Personality Typing Unreliable

Personality type-fitting is another tactic used to discredit claimants.

Yet. early analysis demonstrated chronic pain sufferers had relatively normal personality structure:

abstract here

The largest personality test is the MMPI. The biggest joke was findings on MMPI psychological test which showed elevations of depression, hysteria, and hypochondriasis – “triple V profile”.

Its presence in Rheumatoid Arthritis is just caused by extent of disease:

Arthritis Rheum. 1986 Dec;29(12):1456-66. Elevated MMPI scores for hypochondriasis, depression, and hysteria in patients with rheumatoid arthritis reflect disease rather than psychological status.

Pincus T, Callahan LF, Bradley LA, Vaughn WK, Wolfe F.

abstract here

This Triple profile can, however, label someone a personality case. Importantly, it has been demonstrated it is possible for this profile to disappear after successful treatment of the patient’s pain condition. This means that finding these personality factors cannot be reliably used to discount a patient’s pain.

Personality characteristics do not change over time – they are supposed to be stable. Yet, chronic pain sufferers personality profiles do change, again suggesting these evaluations are not valid. This study showed how abnormal personality characteristics and depression normalized after treatment was one involving pain relieving whiplash injuries with burning of neck nerves.

Wallis BJ, Lords SM, Bogduk N.

Resolution of psychological distress of whiplash patients following treatment by radiofrequency neurotomy: a randomized, double-blind, placebo-controlled trial. Pain 1997;73:15 – 22.

psychological gone with RX here

Another arduous 20 year study found that personality abnormalities in chronic back pain started after the injury:

Spine. 1995 Dec 15;20(24):2716-20.

Minnesota Multiphasic Personality Inventory profiles in persons with or without low back pain. A 20-year follow-up study.

Hansen FR, Biering-Sorensen F, Schroll M.

The results indicated that low back pain is preceded by elevated Minnesota Multiphasic Personality Inventory scales was not supported.”

abstract here

Another found psychological factors included STAI anxiety scores in head pain disappeared with pain treatment:

Head pain normalization MMPI here

Cephalalgia. 1994 Oct;14(5):368-73; discussion 319.

Personality characteristics before and after treatment of different head pain syndromes.

Mongini F, Ibertis F, Ferla E.

Clinical improvement leads to normalization of MMPI profiles and STAI scores in women. The psychometric data before treatment were not predictive for treatment outcome.”

Again here is a study showing successful treatment of pain removes the psychological problems:

With pain reduction here

Pain. 1975 Jun;1(2):177-81.

Personality changes associated with reduction of pain.

Sternbach RA, Timmermans G.

The results support the hypothesis that the neuroticism associated with chronic pain is the result of it, and may be reversible when the pain is reduced or abolished.”

Women seem to get the worst appraisals that their problems are psychological. The worse would have had to be pelvic pain.

Blaming the victim – The psychologizing of endometriosis

Ballweg ML

OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA 24 (2): 441- 444 JUN 1997

abstract here

Yet a recent study demonstrates that proper pelvic pain treatment can make “psychological problems” improve.

J Am Assoc Gynecol Laparosc. 1998 Nov;5(4):389-95.

Changes in personality profile associated with laparoscopic surgery for chronic pelvic pain.

Duleba AJ, Jubanyik KJ, Greenfeld DA, Olive DL

abstract here

The biggest joke have to be genital skin pain. This has been extensively discussed as psychological, yet now found potentially curable by Botox injects, or by treating a previously unrecognized external infection.

Lichen abstract here

Vestibulitis abstract here

The depression of Fibromyalgia, a primarily woman’s disease, improves with successful treatment as well, again suggesting it is pain that drives the symptoms.

Efficacy and adverse effects of intravenous lignocaine therapy in fibromyalgia syndrome
JH Raphael et al 2002

abstract here

CONCLUSION

A review of MMPI results in chronic pain makes the following very clear:

Clinical Psychology Review, Vol. 20, No. 5, pp. 533–559, 2000

THE MINNESOTA MULTIPHASIC PERSONALITY INVENTORY

CHRONIC PAIN: A CONCEPTUAL ANALYSIS OF A LONG-STANDING

BUT COMPLICATED RELATIONSHIP

Alexander A. Vendrig

it has simply been applied inappropriately (i.e., for determination of pain etiology or underlying personality structure “explaining” the chronic pain).”

Given that this is the most comprehensive psychological profiling tests, its comments are very chilling:

Psychological testing is inappropriate for determining if “personality” is the cause of pain. It must be clear from above that:

  1. Personality, depression and anxiety issues are much more likely to be caused by chronic pain.
  2. The diagnosis of anxiety, depression, or personality disorders cannot be used to discredit someone with chronic pain. Nor can they be used to terminate coverage.
  3. As reiterated earlier, the most elegant of scans uses the combination of lack of objective findings and depression (or “personality disorder”) to legitimize termination. The former is now an illegal maneuver, the latter immaterial. Neither can be used legitimately.
Jun 192012
 

 

Click on the following link: Re-thinking Workers’ Compensation-The Human Rights Perspective

Re-thinking Workers’ Compensation-The Human Rights Perspective, the June 2012 special open-access issue of the American Journal of Industrial Medicine, is now available online. These articles emerged from background papers prepared for the national meeting, “Rethinking Workers’ Compensation: Developing Strategies to Protect Injured/Ill Workers’ Basic Human Rights” convened by NESRI in 2010. Authors include Emily Spieler, John Burton, Jeffrey Hilgert, Katherine Lippel, Rebecca Smith and Martha McCluskey.

In the journal commentary, guest editor Les Boden writes, “The articles in this special issue propose an alternate framework and analysis, a human rights approach that values the dignity and economic security of injured workers and their families.” Mainstream debates around workers’ compensation are very technical, market-driven and cost oriented. The focus is rarely on meeting the needs of injured/ ill workers. This discourse ignores the plight of the injured/ill workers and their grave suffering as they navigate workers’ compensation systems that often function poorly on multiple levels. A human rights framework mandates that those most directly and negatively impacted by a system, in this case injured/ill workers, be at the center of any discussion concerning system reform. Contributors to the AJIM special issue accordingly highlight the many failures of workers’ compensation and explore pro-worker strategies, solutions and alternatives that are grounded in the experiences of injured/ill workers and designed to advance their rights. For a brief overview of the journal articles, click here. To access the articles directly, click here.

Many of you who receive my e-mails may recognize the name of Dr. Emily Spieler who I have had the privilege of corresponding with and being supported by her during my 7 year fight with the American Medical Association and the Alberta WCB. With her assistance and the co-operation of Dr. Brigham (Editing Chair of the AMA Guides 6th Edition), the AMA Guides were changed to reflect my criticism of the previous “Guides” prior to the release of the AMA Guides 6th Edition which changed significantly from the 5th to the 6th Edition. Many of you also know that the Alberta WCB were forced to admit that they were wrong as to their understanding of how to assess impairment when using the AMA Guides and rather than assess an impairment rating using the AMA Guides as directed by Dr. Talmage (AMA Medical Consultant) reverted to the use of the Alberta Guides which were the old meat charts used by all workers compensation systems in Canada who have abandoned the use of those antiquated earlier guides put together by Dr. Bell in 1960 which are still being used by the Alberta WCB. The Alberta Guides do not recognize chronic pain in any of their impairment ratings whereas the AMA Guides do. Legally, based on the Martin decision, the Alberta WCB is not in compliance with the Supreme court’s decision to recognize chronic pain as being a compensable condition. The Alberta WCB recognizes chronic pain only if it results in an earning loss but does not assess an impairment rating for a discernible diagnosed medical condition. The Alberta WCB must provide an impairment rating for chronic pain just as the Nova Scotia WCB had to and noticeably also is that the BC workers compensation board amongst others provide an impairment rating for chronic pain. A chronic pain rating must also be assessed for conventional impairment ratings and must be added to or combined with other assessed impairment ratings. Not doing this is a human rights violation or a violation of Section 15.1 of the Charter.

Dr. Spieler and her colleagues continue to be a thorn in the sides of workers compensation systems and as well as the Government’s involvement in creating legislation that strips workers of their rights and loss of dignity after suffering a work related injury. The system was and is not meant to be adversarial and was the reason why the system went to an administrative system instead of having claims heard before the courts. As it stands now, the system as it stands now was better 100 years ago then what it is today because of legislation brought in by Governments over the years to protect the “Boards” at the detriment of workers.

I would suggest that you click on all the links within the article to read the full versions of the studies and comments of the authors of the studies.

 

Gerry Miller

Jun 172012
 

November 23, 2006
Faith Shattered State Of Denial Injured Workers Fight For Their Rights
By JEREMY LOOME — Edmonton Sun

Coffee with Betty Chong is like meeting everyone’s favourite grandparent. She’s a stereotypically sweet little old lady – although she might politely argue the old bit.

Though she’s petite and in her mid-sixties, Chong was, until about five years ago, a care attendant for people with disabilities, mostly seniors and kids with severe handicaps.

Then she hurt herself in a fall. Then she went to the Workers’ Compensation Board for help. Then a WCB rehab testing session broke her back. Then the board wrote a letter to her employer and got her fired. Five years later, she is forcibly retired, lonely, and utterly disgusted.

“They degraded me,” she says. “It was a very degrading process. Every way you look at it you’re just a number to them, you’re not important enough to be treated like a person.”

While working at a seniors centre in 2001, she was knocked over by a client, leaving her with a nasty bump on the head and a broken bone in her foot. Earlier that same year, her wrist was damaged in another care-related incident.

She went on temporary disability for less than a year as she rehabilitated and was happy. In fact, she had faith in the WCB because of its rapid and effective help for her husband when he’d broken a foot two years earlier.

By June 2002, the WCB sent Chong to its Millard Centre for a two-day examination of her ability to work. On the second day, she was instructed by a physiotherapist to lift a 45-pound weight to above shoulder height.

Suddenly, Chong felt pain shoot through her side. She told the therapist, who wrote the incident down. Before the second day of testing was completed, she was sent home.

After her husband took her for x-rays, Chong was shocked to find she had a compression fracture in her back and ribs. She called the WCB and told her case manager – only to have the physiotherapist deny there was an incident.

“I’m not a demanding person. I try to get along. I’m not looking for their money, I just want to prove that they’re wrong and that they lied. The woman who hurt me was so scared about losing her job that she didn’t care, she didn’t care about my back, she didn’t care that it was hurting. And she just didn’t write the report up on it.”

In fact, there was no reference to the incident in Chong’s WCB file. So her advocate, Theresa Roper, checked Chong’s other file, at the Millard Centre. Sure enough, there were handwritten notes indicating she’d complained of a “knife-like” pain and was unable to finish the second day of testing.

Roper was stunned when the case manager rejected her submission for coverage of a second accident. She demanded a medical consultant review the file. When the medical consultant found no evidence of a new injury, Roper checked with the doctor, only to discover the WCB had not sent him the Millard Centre file.

Not that it mattered. Even with that information, the WCB not only turned Chong down, it then sent a letter to her employer, Strathcona County, saying she was no longer fit to work in home support due to her age and medical history.

Chong was terminated by the county, and the WCB then decided she was able to return to work at a “medium level” of employment. “The WCB suggested I go to work as a cleaning lady at a motel at the very west end of the Yellowhead. So even though it was right across the city and work that my back pain would make difficult to do, I thought I’d go look at the place. And it’s a dive. And I’m wondering, ‘Who do they think I am, exactly, that I would take this?’ ”

By now, Roper was becoming incensed. They’d not only proven a WCB therapist severely injured her client, they’d also proven the same worker lied to cover up the incident, only to see Chong’s case manager side with the worker, then gotten her fired, then tried to force her back to work.

Roper went over the case manager’s head to a supervisor, who noted on Chong’s file that he felt the therapist was being fraudulent.

Finally, after two years, the WCB relented and paid retroactive disability and home maintenance benefits.

A year later, in 2004, the agency decided that, despite her chronic pain, Chong was fit to return to sedentary work. It took another year for Roper to get that decision overturned and Chong was awarded a lump sum for the back injury.

But she has never returned to work, and the pain in her back rules it out. The people Betty helped were her social circle, so she doesn’t get out much. Besides, she’s afraid that if she slips and falls, she’ll need help from the WCB.

– – –

Betty Chong’s story might sound horrifying. But it’s relevant for more than its shock factor: All of her problems came after the government promised to appoint a contentious claims tribunal, then reneged.

She wouldn’t have qualified for it, of course, because the tribunal – a result of two damning studies in 2000 of how the WCB treats injured workers – was supposed to address a “culture of denial” that led to unfair rejections of disability claims back to 1988. What Chong represents, however, is proof that injured workers still face such a culture, according to workers’ advocate Theresa Roper.

Roper gets paid a flat fee per case, and it’s low. Her income wouldn’t pay a part-time custodian’s salary. She isn’t in it “for the money.”

“Ultimately, if there’s a system set up to take care of people, it should actually happen,” says Roper. “And what it comes down to is that I have hundreds of claims I’ve handled where there is something seriously wrong with the behaviour and conduct of the board.”

Advocate Kevin Becker sees the same. “Case after case after case. They’re not even hard to find.”

It’s a lack of accuracy in case management that wouldn’t be acceptable to private insurers, says Rick Vermette, the former chairman of the WCB appeals commission.

When asked why he thinks the WCB has routinely over the last two decades had 50% or more of its decisions rejected on appeal – despite an appeal system Vermette and others argue is already biased against workers – he is perplexed.

“You know what? That’s a really good question that I don’t recall anyone ever asking before.”

Former WCB case managers, who spoke on condition of anonymity, blame a bureaucratic climate within the WCB. Case management is done in a repressive and fearful atmosphere, where it is made clear daily that the objective of the WCB is to save money, and staff bonuses are in part structured around how quickly files can be closed. Despite being named by one group as one of Alberta’s ‘Top 25 Employers’ of 2006 for offering a multitude of innovative benefits, staff paint a far different picture.

“Staff put up with this stuff because it’s their career, it’s their livelihood. It’s their mortgage,” said David, who spent years in the organization. “When I worked there, internally staff called it ‘The Workers’ Compensation Borg: You will assimilate.’

“As it became more and more of a statistical environment, it became more and more difficult to ‘creatively’ manage these individual cases. And under that intense internal pressure, a lot of people would just break down. The turnover rate there is unreal, and I would say there wasn’t a day go by when I couldn’t walk around and find someone crying at their desk.

“And now that it’s all about numbers, instead of people, it’s just about impossible for an advocate or a claimant to call a case manager without it automatically being adversarial.”

The average blue-collar guy would have no chance taking on the system, David said. “Justice shouldn’t be better for people who have more knowledge than someone else, or tougher on a simple journeyman than on a wealthy executive.

“But the truth is, they skim the surface and they weed out anyone they think they can beat pretty easily.”

– – –

Workers’ Compensation Boards were established nearly a century ago across Canada under the Meredith Principles, which are guidelines to reduce potential liability facing employers and to guarantee workers fair coverage.

The most fundamental is that of natural justice: it must not only be done, it must be seen to be done. But another former WCB staffer says between the internal jostling for advancement and heavy-handed management, justice doesn’t get much consideration.

“If you’re good at what you do or do what’s best for your client, then you’re seen as a troublemaker or a threat. You’re supposed to just shut up and do what you’re told,” says John, who also requested anonymity.

“The way it operates goes against the legislation, it goes against policies and it goes against the Meredith Principles. The most experienced case managers there were the ones who didn’t get promoted, because they weren’t willing to do anything to help the WCB’s position and to hurt clients. That’s why so few of the experienced case managers had cases going to the appeals commission.”

Often, says Roper, the case file is “closed” simply by sending the person back to work prematurely. She has three copies of one worker’s labour market description – a supposedly unchangeable list of a worker’s qualifications and abilities. It has been changed three times, including twice in one day, to reflect decisions that have gone against the worker.

“It’s just crazy. He simply can’t do a basic requirement of the work, and yet they’ve gone to great lengths to demonstrate he can.”

After one too many complaints, John was fired from his case manager job “without cause” and given a settlement. At the time, he was upset. “But now I look back and think it was the best thing that could have happened to me. Most people just quit eventually, because once you have any degree of experience, why would you stay in that environment?”

But many do because the WCB is a great place to work, said spokesman Jacqueline Varga. “Every year, WCB Alberta employees participate in an anonymous employee satisfaction survey, which measures employees’ overall satisfaction with their work environment and internal support services,” she said.

“In 2005, 93% of employees said the WCB was a good place to work. We don’t have this year’s numbers yet but are confident they will be equally as strong.”

The agency retained 90% of its staff last year, Varga said, “an impressive statistic given the opportunities that abound in Alberta’s workscape.”

During his many years working for the board, John says he never once heard management discuss the need to help injured workers or the importance of what they were doing.

“Never. Never once. All I heard from management is: ‘We need to cut costs, we need to cut claims.’ We never heard anything positive about what we did or why we were doing it.

“When I looked at the WCB, I always figured there was that 10% of people who wanted something they just didn’t deserve, something that they just hadn’t earned. But the other 90% really did need the help. And they just weren’t getting it.”