May 30, 2016

Injured workers with chronic pain: the serious human costs of the WorkSafeBC system


I have been a specialist in physical medicine and rehabilitation for over 30 years. A significant portion of my practice involves injured workers who have developed chronic pain and have been denied compensation by WorkSafeBC (WCB).

Workers with injuries that heal in weeks or a few months are usually treated well by WCB and get wage loss benefits while they are undergoing rehabilitation.

Workers with chronic pain, however, invariably have their benefits terminated and then wait months or years to have their appeals heard. These workers are often unable to get help from the government or WCB until the case is resolved and usually their only resort is the family doctor or medical specialist. Needless to say, it is next to impossible to successfully apply medical treatment to a patient who is carrying this type of stress.

This untenable situation for injured workers with chronic pain has been present in our society for decades. Our collective response to a worker complaining of chronic pain, more often than not, is that the complaint is made up or exaggerated in an attempt to “milk” the system. This is the default position of the insurance industry and has led to the development of a deep-rooted societal bias against people with chronic pain. This bias even taints members of the medical profession.

It relies on the fact that chronic pain is “invisible” and difficult to understand or treat. If you have never had chronic pain, you cannot understand how anyone could be afflicted in this fashion. This is often compounded by the fact that conventional imaging of the human body and blood tests are, more often than not, normal in situations of chronic pain.

The removal of wage-loss benefits and unfair prolonged delays prior to resolution of a claim not only results in extreme stress, it too often leads to suicidal thoughts and actions. This sad reality has been confirmed by WCB’s own internal statistics.

Not only that, the extreme stress has profound deleterious effects on medical treatment.

After 30 years working in the field of chronic pain, I’ve reached a stage where I need to be more active in pointing out this injustice.

I am no longer prepared to ignore the elephant in the room.

My own reports and letters to WCB on behalf of a work-injured patient in chronic pain usually go unheeded or are refuted by medical officers who have examined only the paperwork (not the actual patient) before coming to a conclusion. This conclusion is invariably not in favour of maintaining benefits. Non-medical “managers” make decisions regarding treatment, return-to-work programs, and benefit termination without understanding the social or medical implications of these decisions.

It is difficult to come to any conclusion other than that decisions of this nature are based on economic grounds that benefit WCB and not the needs of the patient. This results in enormous human costs, which are certainly not tracked in any systematic or public way.

My colleague Kia Salomons and I recently completed a pilot study and published a paper based on our findings: Work injuries, chronic pain and the harmful effects of WorksafeBC /WCB compensation denial.

Our study reports on the experiences of a sample of patients with chronic pain resulting from workplace injuries. In our pilot study, 4/9 injured workers expressed suicidal ideation as a result of the stress from delays in the appeal process and 2/9 made suicide attempts. Delays in having cases resolved by WCB varied from months to years. Based on my many years treating patients with chronic pain, I know their experiences are not unusual – they are the norm.

In our paper, we offer concrete suggestions on how to remedy this critical situation including the following recommendations.

  1. Injured workers in chronic pain should receive uninterrupted compensation until the end of the appeal process.
  2. In situations of chronic pain, the treatment suggestions and opinions of the worker’s regular physician and medical specialist must be the primary basis for care. This should be for a designated length of time (evidence-based) and the WCB should abide by the treatment recommendations.
  3. If workers experience a deterioration in their clinical condition, during a work–return program, then the claim should be re-opened and wage-loss benefits re-instituted.

These suggestions, although important, are only the start of a process. We need to create a panel that brings relevant parties together around a table to work on further policy recommendations. These recommendations should be implemented as soon as is reasonably possible.

We owe this to our society.

Let’s take the elephant out of the room.

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