Cézanne Charlebois, M.A., LL.B, Guest Speaker
Adjudication of Occupational Disease Claims and PTSD Claims by the WSIB
Tuesday November 17 at the Casablanca Winery Inn in Grimsby Ontario.
Although you would think that the Adjudication of Occupational Disease claims at the WSIB would be completed by some medically and/or legally trained Claims Adjudicators due to the complexity of both the legal and medical issues that must be assessed. They are not. One Ontario employer’s experiences with three terribly adjudicated Occupational Disease claims causing death is shocking. Read about how Charlebois Associates overturned these three claims and how vigorously the Board resisted even acknowledging their errors. In fact they never did. Now, there appears to be a similar trend of inadequate adjudication regarding PTSD claims by the WSIB. Clinically, these claims are very easy for doctors to misdiagnose because they are based exclusively on the symptomology presented by patients. There is no objective medical test to refute or confirm the diagnosis. The WSIB fails to provide the assessing doctors with sufficient information, concerns raised by the employer, or enough valid accurate collateral information upon which feigning and malingering could even be considered. In one of our recent cases, a Psychiatrist who had been seeing an injured worker for the past two years noted one year earlier in a written report that the worker was involved in a ‘fatal MVA’ and was suffering from PTSD since then. Not a single person from the Board noticed this important piece of incorrect and highly relevant mis-information provided by the worker. The worker had been in a single vehicle, at-fault incident and there were no fatalities. The worker had also been in numerous other at-fault incidents and was already told that he would be dismissed from employment if there were any more. This information was never provided to any of the many assessing health care professionals over the two years that the worker had been receiving full LOE benefits. PTSD claims adjudication at the WSIB needs much improvement and costs employers in Ontario hundreds of thousands of dollars. Skilled surveillance is just about the only tool available to employers for refuting these diagnoses. Even then, the employer will likely be met with more bureaucratic resistance. The Claim’s Manager is very likely to tell the employer that he or she is not willing to reverse all the previous decisions made in the claim despite the overwhelming evidence the employer presented because he or she is not allowed to create such an “unrecoverable overpayment or debt”. Of course this is unacceptable and contrary to Board Policy.
Cézanne Charlebois, M.A., LL.B
Certified Specialist, Workplace Safety and Insurance Law
4026 Meadowbrook Drive, Unit 126 , London, On N6L 1C7
Phone: (519) 203-4400 Fax: (519) 203-4401 Toll Free: (877) 925-7070 Cell: (519) 317-5970 | (24 hours)
