In a recent internal publication the WCB encouraged the use of the appeals advisors. Many people have asked our office our opinion and the difference between the internal office and the external resources to assist with your appeal.

Firstly, If WCB had done a good job on the claim and pay all entitelement fairly there would not be a need for representation internally or externally. WCB does acknowledge a need for representatives given the creation of the Office of the Appeal's Advisors (OAA).

The WCB publication in part stated: " unlike their private sector competitors, the OAA is under  a form of regulation. Advisors must meet service standards set by their  employer, receive training in both oral and written advocacy, adhere to a published code of conduct, and, as part of the Secretary & General Counsel  Division, are subject to oversight by a lawyer (that would be me).

The WCB is reassuring you that the WCB has control over the Appeals Advisor's and they are trained by WCB.

Secondly, the WCB  Appeals Advisors goal is to address the issue brought forward to them by you not review the file to determine other entitlement and errors on the claim.

Thirdly, the WCB Appeals Advisors do not have the ability to work outside what they have been directed by the Board and they have no right to challenge the interpetation of the policies, the performance and customer service of the WCB and involve other advocacy assistance through the the Ombudsmens office, Ministers office, MLA'S and media.

Fourthly, the WCB publication states: "Apart from qualifying for a business license, there are no prescribed standards for education, training, ethics or service. For the consumer choosing to use these providers, it is strictly Buyer Beware."  I do agree that there is a need for are education, training, ethics and service. I am pleased that the WCB acknowledges this and I am glad that the staff in my office have all the WCB qualifications and our business has proven to be strong at representing the workers needs.

Don't be discourage to seek out advise and be aware that in the real world that I live in you only "pay for what you get" and "anything free usually comes with a price tag." Make sure the price tag is not your future and be comfortable with your choices. In WCB appeal process you only get one chance.

Call us if you have any questions we do not charge for the initial call and intake evaluation.   

Gail Cumming

It costs all of us public, employers and workers when the system fails a worker. Where do injuired workers go for financial assistance when benefits end at WCB? WCB indicates in their annual report:
81.2% of workers are satisfied with fairness of the decisions.
78.2% of workers are satisfied with WCB service.  

Are the surveys focusing on stubbed toes,finger slivers and back strains that do not loss time from work? We will never know. 
135,024 is the number of new claims noted in the report and 25,000 claims for loss time from work resulted. Why so low?
How many of the 25,000 claims were surveyed and seriously injuried. We will never know.

   
   

The end of the year and still WCB does not take a break from customer service issues. WCB does not seem to reflect on the worst year of customer service in history and the problems that they create for the injured working people. Rather WCB justifies the bad customer service and acts like a victim almost every time.

I thought I would make it through the year without a word on my blog about the disappointments I had with the WCB customer service but I can't.

On December 21, 2011 a  WCB Supervisor and Manager were on the phone with me in a three way conversation. The supervisor threatened to hang up because she felt I yelled at her when I challenged her to discuss what I believe was outside her comfort zone, which was policy and legislation. Hanging up was an easy way not to discuss the facts of legislatiolnl I thought maybe management would deal with the customer service issue. Instead I received a warning that she was going to hand up and 'click' she was gone. The manager emailed me justifying the action of the supervisor instead of an apology. I expect an apology.

The frustration and disappointments that workers feel, I can't truly relate to and I try to stay positive as there are good people at WCB.

The WCB interpetation and application of policy and legislation I disagree with most of the time. I believe the customer service problems from the good people at WCB is reflective of the management and pressures to have focus on money not injuries and services. "Common sense" is not a policy or law.
 
The management needs to review the decisions being made, the inability of staff to make decisions without being micro managed. 
 
Workers have told me that they are yelled at, feel WCB staff threaten to end their benefits, staff talk down to them and hang up for no reasons.

Many apologies from WCB have been warranted this year and have not been given as WCB will never admit they are wrong. I apologize to my workers for not demanding apologies, there are so many that it would be a full time job. Know that you have the right to customer service and demand it. The best way is to write to the WCB and voice your complaints to the attention of the C.E.O. Guy Kerr and send a copy to the ministers office.    


Gail Cumming       

The focus of WCB always appears to be "claims costs" not "customer service" for injured workers. Employers are not aware that claim costs and push for return to work does not always save them money on their premium rating. The  premium rating is what employers should be concerned about. My opinion is that the customer service department should not even know the claims costs as it is not needed in the case management of a claim, but in my opinion becomes the focus.

A representative from Cumming Consulting attended the annual Alberta Health and Safety Conference last week in Calgary. The conference is a two-fold event, combining educational sessions, and a trade fair. This year’s theme was 10 YEARS AND BUILDING, where they emphasized that “building on the previous successes in industry, new technologies, economic factors, the changing face of the workforce and changes to the environment create new health and safety challenges. Employers must continuously be striving to meet and overcome these new challenges and ensure that workers have a safe and healthy workplace now and in the future.”

The conference was a great experience and it is inspiring to see that not only so much time, effort, and money is being invested into the health and safety industry but to see that so many employers are devoted to providing safe workplaces for their employees.

At the conference many of the courses taken by our representative focused on preventative measures to avoid accidents- ergonomics, watching threshold limit values, using social media to update safety issues, how to relieve stress, avoiding fatigue, building effective health and safety plans, and so on. Few classes dealt with the reactive side of the injury being what happens after an individual is injured. There were a few panels and discussions on how organizations and policies were affected post severe workplace injuries and how they changed their health and safety plans to avoid incidents in the future. They discussed how something big must happen to procure change in legislation and even then this is not always true. But let’s face it accidents do still inevitably happen no matter how many safety measures are put into place and I think that there should be more attention placed on this fact and how we can help injured workers where the damage was already done- the reactive side of an injury.

Health and safety is a huge focus this day and age but what happens to the workers who these measures we take fail or fall short? This must be hand in hand with health and safety and the discussions revolving around the issue of improving the workplace for workers. The workers must also know that there is appropriate recourse for when legitimate accidents do happen- not that they will get their wrist slapped for ruining perfect safety records. WCB speaks of the decrease in claims but we want to make sure that they aren’t just focused on the preventative and how to lower claim numbers but think too of how best to handle the injuries that do happen- not just get them out of the system so their safety statistics look admirable. Furthermore, it must be ensured that employers are actually building safe workplaces and not just avoiding filing claims so their reputations along with their rates and premiums stay acceptable. A number of individuals I talked with expressed this as a common problem in the workforce still. They didn’t even want to discuss WCB and when they did they almost seemed mad at workers because their accidents and claims caused their safety numbers and WCB rates to be altered. The system of basing rates on accidents is good in theory but flawed for this main reason that it causes manipulation,  and ignorance of claims sometimes.

The conference was educational and it was definitely refreshing to see the focus and continuous improvements being made in the health and safety industry. Cumming Consulting will be attending such conferences in the future so that we too can stay abreast with the health and safety industry that consequently affects our clients as well.

Let’s look at some facts regarding appeals. The average number of days of processing time required by the Appeals Commission from the date the appeal is received until the appeal is finalized (for standard appeals)  has gone from 144 days in 2008, to 172 days in 2009, and back down to 153 days in 2010.  This decrease in the average amount of days is insignificant when observing that this process still takes almost half a year, not including the time before the appeal is brought forth to the AC. Claimants are waiting for unreasonable lengths of times for their problems to be resolved and some of the time without compensation while waiting for their appeal.

Over the past several years initial appeals received at the AC have been increasing as are the number of issues received within these appeals. Over the last several years, appeals concluded and issues finalized are decreasing which tell us that although there are more appeals being submitted less is getting resolved within the year. Although the AC is very busy this is not helping workers get their issues resolved. Perhaps this decrease is due to a lack of employees within the system? Regardless less people are being helped in not a very timely manner. 2006 saw a higher number of appeals and thus a decrease in 2007 however let us remember that 2006 was a year of high economic success and employment so this high number makes sense. It is the increase in times of lower claims that piques the curiosity.

Now let’s discuss appeals. It was reported at the 2009 Annual General Meeting that there were 15% fewer appeals in 2008 than in 1999. The WCB argued that this decrease in appeals meant that fair and fairly communicated decisions were happening. However, perhaps it is that the system is more difficult to master and injured workers are not taking advantage of all entitlements available to them due to not understanding this system or what they are truly entitled to. These numbers do not include issues that were resolved at desk level with the case manager or supervisor nor does it include the issues resolved at the DRDRB level, if any. The AC has limited bookings and long timelines so the onus is on them to get appeals processed and hearings happening. Appeals Officers and representatives are backlogged with clients and they only have so much time and resources in getting each client to the AC. With more time and resources of workers advocates along with more stringent and effective processing times, I am sure appeals would be higher. Nor does it address the fact that unsatisfied claimants may just take what they can get and rely on other sources of compensation such as social services or spousal/ familial support unaware of appeal as an option. I would be curious to see the average number of days it takes for an Appeals Advisor to get a claimant through the process. Or how much fewer representatives are for hire to help injured workers or what their timeframes are for getting workers to the AC. Or above all how many workers know they can appeal and actually go ahead with taking action. It would be beneficial to the WCB to make sure there are not any extraneous factors affecting the results of these statistics. Regardless of these statistics, initial appeals received at the AC have been increasing over the past several years and the number of issues is also increasing.  Claimants are having problems and concerns with the Alberta WCB and even though the numbers do not assuredly prove what has been stated, the WCB must address every possiblility that may affect the results before stating that this is black and white and objective.

“You have to put numbers in perspective, WCB right now processes approximately 300 000 claims every year. Approximately 90% of those are accepted so 10% are rejected. Of those accepted only .01 of a percent actually are appealed. So if you look at statistically at the track record and when you look at their client satisfaction levels they’re actually pretty good.”- Thomas Lukaszuk

I am concerned with the somewhat skewed statistics that the Alberta WCB presents to the media, and consequently the public, in an attempt to hide the truth. Inflating the number of claims processed annually is a blatant attempt to exaggerate the workload of the Alberta WCB and downplay the impact of appeals on the system.

Mr. Lukaszuk has overshot how many claims are denied and there are actually fewer being denied each year then he reported. However, he was incorrect in the number of claims administered by the WCB each year and in some cases over exaggerated this number by more than 87 000 claims.

In fact new claims reported have been decreasing over the past several years from 167 896 in 2008 to 140 198 in 2009 and 135 024 in 2010.  Overall, claims are down even though unemployment rates have gone down and employment rates in Alberta have increased since 2009. Over this past year Alberta has had employment growth above the national average at 4.2% (+86 000) and the number of claims reported has dropped even further. This could mean fewer accidents, although in the past higher employment rates signalled more accidents (even as reported in WCB’s 2006 Report). This could also be connected to fewer individuals being covered by the WCB whether it be from employers neglecting to provide their employees with coverage or more exempt industries. It would be interesting to see what truly interacts with these statistics to affect them.

Please note that this statistic states the number of claims “reported”. This decrease may signal that workers that are injured in the course of employment do not always report the injury whether it is from peer pressure from employers not to do so or from ignorance to the injury and working through it fearing for their jobs and livelihoods. Employers receive lower premiums with lower accident rates, a poor performance surcharge if they have too many accidents, and they may even be entitled to receive money back if they are able to avoid injuries in the workplace. This type of reinforcement unfortunately may persuade some employers to hide accident rates and encourage employees to not report injuries. For example, employer premiums have dropped 7.6% to $1.22 per $100 of insurable earnings and employer partners and COR participants have increased so that they may be entitled to lower WCB charges. This seems obvious that of course employer satisfaction remains stable at 85% + since 1999 because they received $1.4 billion back- employers are happy and of course they may try to lie about accidents to ensure they receive this status and the premiums associated with it.

WCB statistics from 2002 to 2006 show a general increase in claims administered each year. Please note that in September 2006 Stats Canada reported that Alberta was in the midst of the strongest period of growth economically ever recorded by any Canadian province. As a result of this unprecedented boom, Alberta had the highest share of its population employed and the lowest unemployment rate of any province or state in North America. Overall there was a 12.7% average annual growth of Alberta since 2002 and profits in Alberta more than doubled from 2002 ($23.5 billion) to 2005 ($53.1 billion).  So of course during this period of economic growth the number of claims was increasing as can be expected (there were more people working and inevitably more injuries especially being that Alberta hosts some of the most dangerous jobs in its gas and oil industry).

Although over 90% of claims have been accepted over the past three years, it still means that over 11 000 people are having their claims denied each year possibly leaving them hopeless and with no other means to fair entitlement. Add to this that one of the top five issues of appeal is the acceptability of the claim so people do feel as though their claim is legitimate. Furthermore, ineligible lost time claims continue to rise from 2008 where it was at 7.5%, 2009 at 8.4 %, and 2010 at 9.6%. More and more severe claims are being denied. Is this appropriate or a cost saving scheme?

The number of recurrent claims have gone from 16 696 in 2008 almost doubling to 34 758 in 2009 then it dropped to 24 283 in 2010. Although there has been a decrease from 2009 to 2010 this is still a high number and an overall increase from 2008. This would lead me to suspect that the push for workers’ to return to work so soon is causing recurrent injuries and this even if it is down 30% one year this is still a large number.

Here is another interesting statistic: The severity rate of injuries is going up which would usually mean more time for the injury to heal itself but the claim duration time continues to decrease. This supports the hypothesis that the Alberta WCB is rushing injured claimants to return to work. Using the disabling injury rate to assess severity of injuries may be deceiving because it adds time lost claims to the claims of those that return to modified work- it is the possibility of being a lost time claim.  Having less modified returns to work then may decrease this number. Lost time claims alone are still not a perfect measure of severity of injury because this could mean a claim that was off for just several days.

Additionally, not only has employment within the health care and social assistance fields increased by 2.9% over the past year (continuing on a long term upward trend), social assistance has increased in millions by $3167 in 2004 to $4201 in 2008 and continues to do so. Social assistance income maintenance has also increased from $6 788 000 in 2004 to $7 821 000 in 2008. According to Statistics Canada more recently, the number of Albertans living below the Market Basket Measure of Low Income increased from 210,000 in 2008 to 353,000 in 2009, a 68% increase. This does not necessarily translate to the WCB since WCB benefits have increased as well from 2004 to 2008 from $5 083 000 to $5 749 000. However it does say more and more people are relying on social services and this correlates with the fact that there are less claims per year over the past several years and more claims being denied recently.

WCB also reports that worker satisfaction has been mostly stable at 75% since 1999. What is the population that has been surveyed? Injured workers that are in rehabilitation or have open claims are not surveyed- only closed claims receive the questionnaires. Those individuals with closed claims are probably happier than the ones still dealing with WCB. These are also most likely claimants that do not have lost time claims and rather have easily resolved claims and no outstanding issues with the WCB. The total population of workers with claims is not analyzed. There are also many claimants who receive these surveys and either do not answer them or answer them in a favourable manner to avoid any problems with the WCB. Many workers fear the WCB and do not rate them poorly so they do not get cut off. These factors make the surveys and client satisfaction rates very inaccurate.

Cumming Consulting has been going through some exciting events in our constant pursuit of justice for injured workers dealing with the Alberta WCB. We have recently been on a panel discussing concerns with the Alberta WCB on Alberta Primetime and we have been consistently sending correspondence with our concerns to the government and management within the Alberta WCB. We have also just started a petition in hopes of getting enough support to encourage the government to implement necessary changes within the Alberta WCB. We are constantly striving to promote positive changes in the Alberta WCB while helping injured workers appeal inappropriate decisions on their claims and regain their lives as best they can.

It has been very difficult at times for us to make the transition from working at the Board to representing worker’s independently. Often we come under negative criticism and scrutiny from a number of parties including former friends and colleagues. Being that we were once a part of the Board it is at times thought that we may have bad intentions concerning our clients. It is often argued that we were the very same case managers that we deal with now in trying to get injured worker’s entitlements and we are accused of formerly being the very case managers who denied the workers we now help. Have we changed our ways?

The truth is we have always acted as we do now even when the roles were reversed. We feel as though we have always acted with integrity and honesty whether we worked at the Board or independently. To this day we are still unable to assist some injured worker’s with their claims because they are not entitled to certain benefits whether it be due to missed timelines or lack of medical evidence or some of the other criteria that has not been met to qualify for assistance from the Alberta WCB. We unfortunately do not make the rules and are unable to alter or manipulate WCB’s standards and policies to help all workers get what they feel they are entitled to. We are always honest with workers in informing them of what they are entitled to and what they are not. The Alberta WCB often does not give worker’s all entitlements and not out of malice but out of oversight and misconstrued interpretation of policy. However it is this very policy that allows us to argue this interpretation to try and get the worker what we feel they are entitled to. We have always wanted what’s best for injured workers and now being outside of the Board we are able to strive for that openly. It is our previous experience and knowledge obtained from working for the Alberta WCB that now enables us to see the other side of the coin and best assist injured workers.

Please do not think that case managers and the Alberta WCB are an “enemy” of ours. It is just unfortunate that our interpretations of WCB legislation are not always what the WCB interprets them as; hence the issue with such a broad Act open to subjective analysis. Our actions are not always perceived as we would like them to be and I guess it is just difficult to make everyone happy while staying true to our corporate culture and policies not to mention our own personal code of conduct and ethics. 

We wish that we could help all injured workers, remain in good standing with former relationships we had, and avoid being criticized for our previous associations with the Alberta WCB but the fact of the matter is we cannot change our pasts and we cannot help everyone or make everyone happy. We can only do our best to try and help as many people as possible and continue to strive for positive changes within the Alberta WCB.  The focus is on the future and how best to get justice for injured workers- we hope you see this and join us for the journey.

I was having an interview with the CBC french radio and tv station, and an injured worker who has loss everything including his home, family and job I noticed atleast 8 people at the garbage can taking out not putting in stuff. As I sat today in that park at 105th street and Jasper Avenue in Edmonton, my thought was how many of the homeless people have been put on the streets due to systems and agency failures. How many WCB and other agencies failures have contributed to the homeless? Also, how much does it cost other financial systems when WCB fails?

Every province is affected by the Alberta WCB decisions when benefits end and workers need services. Social services, cpp, disability benefits, medicare all pick up the pieces when injured workers need help and do not get the help from WCB.

If anyone thinks for a minute that the problem is not a community problem and that it is isolated to employers and workers, then they should ask; who picks up the pieces? The answer is; everyone does except for WCB.

Sit in a park and watch the homeless in a province this rich and ask; why are they there?   

Everyone uses the garbage can, are you the person putting in or taking out? Today I saw more people taking out of the can then putting in. I did not like the picture. Will I look at people different at a garbage can? I hope so as it will keep me humbled.
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