Ontario’s workers compensation board is standing by its controversial practice of using consultants to provide medical opinions on injured workers without actually examining them, saying the doctors it contracts to weigh in on benefits claims are being used “appropriately.”

Top officials at the Workplace Safety and Insurance Board recently concluded an internal review of the practice following widespread criticism from injured worker advocates.

A November report by the Ontario Federation of Labour and advocacy groups alleged the board was systematically disregarding the advice of injured workers’ own physicians in favour of so-called “paper doctors” — physicians who review medical evidence on a workers’ file without even meeting them. As first reported by the Star, a group of injured workers, labour groups, and health professionals subsequently launched a formal request to Ontario’s ombudsman to investigate the WSIB for that and a range of other practices they say are unfairly kicking workers off benefits.

But the WSIB’s internal review, whose conclusions were seen by the Star, says consultants and workers’ own doctors disagreed in just 15 per cent of the cases it analyzed. The review “did not find any evidence of systemic disregard for the opinion of a worker’s medical practitioners.”

The results of the audit have been shared with the provincial ombudsman, which has yet to decide whether it will investigate the WSIB. In a meeting Tuesday with the Star’s editorial board, WSIB president Tom Teahen said he was open to working with injured worker advocates to make improvements, but defended the board’s record on its use of medical consultants.

“We do not have a systemic problem,” Teahen said.

The review was conducted by top executives at the board, including its chief statistician who reviewed a random sample of 376 cases from 2014. Its findings were also assessed by the board’s internal auditors.

David Newberry, an advocate with Toronto-based legal clinic the Injured Workers Consultants and co-author of the initial report raising numerous issues with the worker compensation system, said he was disappointed with the scope of the board’s internal review.

“The WSIB has unfortunately chosen to investigate only one symptom of a much broader problem, and is now attempting to use the results of its narrow investigation to discredit the system-wide critique,” he said. “The WSIB document appears to be a deliberate attempt to deflect the conversation and avoid engaging with a very serious set of allegations that were brought forward by a lot of concerned doctors and advocates.”

In an ongoing investigation, the Star has covered wide-ranging concerns about board practice, including allegations that the WSIB has sought to unfairly cut benefit payments to injured workers as it seeks to reduce its unfunded liability, which sat at $12 billion in 2010. That figure now sits at $6.42 billion.

Teahen told the Star the reduction has been driven by better recovery and return to work programs for injured workers. Some 92 per cent of injured workers now get back to meaningful employment after an accident, according to WSIB statistics. Fiscal responsibility means more stability for employer premiums and worker benefits, Teahen added.

But critics argue the board has cut costs by “failing to heed medical advice regarding readiness to return to work, insufficient treatment, blaming ‘pre-existing’ conditions for ongoing disability, all despite the evidence of treating practitioners,” Newberry said.

The board’s internal review focused exclusively on its use of medical consultants, who it says are engaged in about 12,000 claims a year — around 2 per cent — to provide additional medical opinions to help case managers make decisions about files. Case managers are supposed to take the consultants’ advice into account, along with any other evidence provided by injured workers’ own health-care providers.

“In only 8 per cent of cases, the claim file documentation revealed that the decision maker did not consider and assess the (medical consultant) reviewer’s opinion along with all other relevant information in the file in order to make the decision,” the review said.

Newberry said that figure suggested that around one in 10 claims referred to medical consultants every year were “still decided in full disregard of the additional information on file, and that conclusions are drawn in these cases using nothing but a report from someone who has never met the worker.”

“At least some of these medical consultant firms used by the WSIB, including the one referenced above, also function as ‘claims management firms’ that work with employers to reduce their WSIB claims costs. This means that they have a conflict of interest resulting from their business orientation to employers seeking to oppose WSIB claims,” he added.

As previously reported by the Star, a Hamilton-area doctor is currently suing the board and one of its private health-services contractors, claiming she was terminated after delivering a medical opinion that did not suit the WSIB. For its part, the WSIB said “there’s no truth” to the allegations and denied “acting wrongfully in any way.”

Teahen said he had shared the results of the board’s internal review with Ontario Federation of Labour head Chris Buckley and they would meet soon to discuss its finding.

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“The WSIB was designed to be a safety net for workers and the OFL is going to continue to ensure that safety net is there,” Buckley said.

The November report criticizing the board cited 40 case studies of workers who were allegedly cut off benefits after medical advice was ignored. Teahen said he had requested the details of those files and was open to reviewing them.

“Being open and transparent is important and part of my job,” Teahen said. “I think most things we get right. But that doesn’t mean we get everything right.”