Cohort Project Report - British Columbia · The Cohort Project Report A Longitudinal Analysis of New Claims Registered with the WCB of BC, 1994 - 1996 Prepared for the Royal Commission

The Cohort Project Report

A Longitudinal Analysis of New ClaimsRegistered with the WCB of BC,

1994 - 1996

Prepared forthe Royal Commission on Workers’ Compensation

Karen A. Ryan

November 13, 1998

Karen A. Ryan i

TABLE OF CONTENTS

Executive Summary............................................................................................................................. 4Introduction.......................................................................................................................................... 19Methodology........................................................................................................................................ 20

Selection of Study Claims ........................................................................................................... 20Data Sources ................................................................................................................................ 23Data Quality Issues...................................................................................................................... 28Data Integration Issues ................................................................................................................ 30

Results.................................................................................................................................................. 32Fatal vs. Non-Fatal Cohort Claims ..............................................................................................32Characteristics of 1994 Non-Fatal Claims................................................................................... 33

Worker Characteristics.........................................................................................................33Claim Characteristics........................................................................................................... 35Injury ................................................................................................................................... 37Historical Claims ................................................................................................................. 40Pensions ............................................................................................................................... 40Disclosure of Claim Files .................................................................................................... 43Workers’ Compensation Review Board Appeals................................................................. 44Workers’ Compensation Board Appeal Division Appeals .................................................. 50Medical Review Panels........................................................................................................ 54

Adjudication of 1994 Non-Fatal Claims...................................................................................... 57Initial Adjudication by WCB............................................................................................... 58Workers’ Compensation Review Board Adjudication......................................................... 58Workers’ Compensation Board Appeal Division Adjudication........................................... 59Medical Review Panel Adjudication ................................................................................... 60Summary.............................................................................................................................. 62

Characteristics of 1995 Non-Fatal Claims................................................................................... 62Worker Characteristics.........................................................................................................62Claim Characteristics........................................................................................................... 65Injury ................................................................................................................................... 67Historical Claims ................................................................................................................. 69Pensions ............................................................................................................................... 69Disclosure of Claim Files .................................................................................................... 72Workers’ Compensation Review Board Appeals................................................................. 73Workers’ Compensation Board Appeal Division Appeals .................................................. 78Medical Review Panel Appeals ........................................................................................... 83


Characteristics of 1996 Non-Fatal Claims................................................................................... 89Worker Characteristics.........................................................................................................89Claim Characteristics........................................................................................................... 92Injury ................................................................................................................................... 94Historical Claims ................................................................................................................. 96Pensions ............................................................................................................................... 96

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Disclosure of Claim Files .................................................................................................... 98Workers’ Compensation Review Board Appeals................................................................. 99Workers’ Compensation Board Appeal Division Appeals .................................................. 104Medical Review Panels........................................................................................................ 108


Summary and Conclusions .................................................................................................................. 112References............................................................................................................................................ 119Appendix 1Appendix 2Appendix 3

Karen A. Ryan 1

EXECUTIVE SUMMARY

Introduction

The development of the royal commission’s research agenda was guided by principles of effectivemonitoring and evaluation, including: clear definition of organizational goals; clear definition and doc-umentation of methods for achieving organizational goals; identification of measures that are indicativeof process effectiveness and efficiency; collection of quality data, including client outcomes in the longterm; inclusion of client feedback concerning the level of satisfaction with the process; and, routine pro-vision of meaningful information to management for consideration and response.

In the area of administrative claims adjudication and in particular, appeals arising from claimsadjudication decisions, a research plan comprised of several components was developed. Taken togetherthese components provided a descriptive overview of the adjudicative business of the workers’ compen-sation system from legal or theoretical, procedural, and empirical or evidence-based standpoints. Thisresearch allowed for an assessment of the quality and performance of the decision-making process.

The empirical component in the research plan sought to examine the operation of adjudication andappeals system and to answer the question, how well does this process produce decisions? There is nomechanism to assess the quality of the adjudication process. The closest indicator of quality assuranceis the number of claimants who are so dissatisfied with decisions made on their claims that they pursueappeals of those decisions. Information concerning the content, outcome and timeliness of appeals is,therefore, vital to effective monitoring of the decision-making process and informed responses to prob-lem areas.

In the past, much of the empirical understanding of the adjudication and appeals process has beenbased on cross-sectional data generated by the business activity of the system’s players during a one-year period. Annual reports and other statistics published by the relevant agencies are based on the flowof work generated in a given year by claims that were first registered in any year. For example, it isreported that a certain number of claims are disallowed1 or rejected2 each year by the board, but thenumber of claims subject to this decision during the year (i.e., the denominator) is unknown becausethese decisions may be made on claims first registered in any year. It is misleading then to report thepercentage of claims that were disallowed or rejected in a particular year based on the number of claimsfirst registered in the reporting year only. The “Claims Flow Statistics” chart published in the 1996administrative inventory “The Workers’ Compensation System of British Columbia: Still in Transition”3

reflects this cross-sectional view of the flow of business in 1994 and also commits the error of assigningpercentages to the numbers reported. In fact, the calculation of rates based on figures that have no directrelationship to each other appears to be the acceptable standard for statistical information about theinter-relationship between decision-making bodies within the workers’ compensation system. What ismissing from this perspective is the experience of individual injured workers who must negotiate thissystem and for whom there is a progression through the assorted stages of the process. For injuredworkers the claims they register have a life cycle that may span several or more business years.

In order to gain a more comprehensive understanding of the workers’ compensation system adjudi-cation and appeals process, the royal commission requested that the WCB create an integrated set ofdata which would allow for the tracking of claims from registration through each of the stages of adjudi-cation and appeal. This project came to be known as the cohort project because it’s purpose was to fol-

1 A claim is disallowed when it is determined that the injury is not covered under the Workers Compensation Act.2 A claim is rejected when it is determined that either the worker or the employer is not covered under the Workers Com-

pensation Act.3 Hunt HA, Barth PS, Leahy, MJ. The workers’ compensation system of British Columbia: Still in transition. Richmond

(BC): WCB of British Columbia; 1996.

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low the longitudinal progress of a cohort (a group sharing a common, defining characteristic) ofclaimants who registered a new claim in either 1994, 1995 or 1996. The progress of these nearly600,000 claims was followed through to the end of 1997. The analysis of this data allowed for anassessment of the efficiency of the system to cope with its business; that is, decisions regarding compen-sation for injured workers.

The WCB committed a great deal of staff time and effort to identifying, locating and extracting theinformation relating to three cohort groups of injury claims from board information systems that werenot designed to provide an integrated view of the life of a claim. The various individuals, departmentsand agencies involved with different stages of the claim’s life cycle collect information as needed fortheir own purposes and there is often little consistency or integrity between the various data sets. Inshort, the available data mirrored the compartmentalized, snap-shot perspective of the business.Approximately one year after initial discussions with the Workers’ Compensation Board took place, theboard delivered several large databases containing over 100 tables and millions of records. Additionaldata relating to Workers’ Compensation Review Board appeals were obtained from the Review Board.These multiple data sources allowed for the linkage of claims and appeals data; however, they do notrepresent integrated data. The development of the cohorts of claimants, the identification and extractionof data records, and the data analysis were each enormous and complex tasks that required months ofco-operative effort on the parts of the royal commission and the WCB.

Although records concerning both fatal and non-fatal claims were included in the cohort databases,the analysis focused on non-fatal claims. The small number of fatal claims, less than one-tenth of a per-cent of new claims filed in a year, limited the potential of these claims to illuminate the operation of theadjudication and appeals systems. Nevertheless, an understanding of decision-making surrounding fatalclaims is non-trivial and would benefit from a longitudinal research approach. In addition, ten to twentyof the workers killed in a study year had filed compensation claims for non-fatal injuries within the sameyear and a similar number of workers succumbed to initially non-fatal (but perhaps terminal) injurieswithin the next four years. The relationship between non-fatal and fatal claims needs further explorationbut the persistent pattern seen in the cohort data suggests the value of focused analysis of longitudinal,as opposed to cross-sectional, data for prevention/intervention purposes.

The results of the analysis of non-fatal claims filed in 1994, 1995, or 1996 fall into two areas. Onearea includes descriptive information about the volume and characteristics of claims and appeals arisingfrom those claims during the study period. The second area provides evidence of the inter-related oper-ation of the adjudication and appeals system by tracing the progression of events and outcomes in rela-tion to a single type of adjudication decision during the same time period.

This second area was of particular interest to the commission because it reflected the experience ofclaimants as their claim is adjudicated by the WCB and up to three separate appellate bodies - the Work-ers’ Compensation Review Board, the WCB Appeal Division and the Medical Review Panel. The inte-gration of data from these four sources provides a unique opportunity to answer questions about theoverall system such as the volume of claims that flow through the network of decision-makers, the out-comes achieved, and the length of time it takes.

Results

With few exceptions, the three cohorts of claims present a very consistent picture of the character-istics of claims registered in a given year and the appeals generated by decisions made on those claims.What follows then is a summary of the results of the separate analyses of the three cohorts of claims.Where time is a factor due to the varying lengths of exposure to the phases of adjudication, particularlyexposure to the later stages of adjudication, reference is made to specific cohort years.

Roughly 185,000 to 195,000 new non-fatal injury claims were registered in each of the cohortyears. The number of workers filing these claims ranged from 159,000 to 165,000. Registration of mul-

Karen A. Ryan 3

tiple injury claims within a year was not uncommon. Up to ten claims were registered by a single claim-ant within a one-year period.

In addition, many (70%) claimants had filed previous workers’ compensation claims. Where thestudy claim was not the worker’s first claim, the median number of previous claims is four.

Worker characteristics are largely unknown for the approximately 60% of claims that receive onlymedical benefits or are not paid benefits. Where the information is recorded (short-term or long-termbenefit claims), claimants are mostly (75%) male with an average age in the mid-30’s. Female claim-ants tended to be slightly older than male claimants. Occupationally, the largest groups of claimants arehealth care workers and truck drivers. Almost half of claims arise within light manufacturing, serviceand trade industries.

There is little change in the type of benefits received for claims that are two, three or four years old.Approximately half of claims receive only health care benefits. Two in five claims receive short-termdisability benefits (wage loss and/or vocational rehabilitation). Less than 2% of claims receive long-term disability benefits. One in eight claims registered in a given year are not paid any benefits.

For claims that receive only health care benefits, the average value of the benefits received to theend of the study period is approximately $130. Health care benefits paid on claims that also receivedshort-term disability benefits averaged about $820. Health care benefits paid on claims that alsoreceived long-term disability benefits varied according to the age of the claim and ranged from an aver-age of $8,300 for the 1994 cohort to $4,400 for the 1996 cohort.

For claims that receive wage loss benefits, an average of 3-4 weeks pass from the date the claim isregistered until the first wage loss payment is made, however 50% of first payments are made within 12days. Wage loss recipients receive an average of 32-37 days of wage loss payments, but again themedian number of days of wage loss is much lower at nine days. The average value of short-term dis-ability benefits received (including vocational rehabilitation benefits) by claimants who received thesebenefits but not long-term disability benefits is $2,840.

Over 50% of claims involve sprain and strain type injuries. However, these injuries rarely lead tolong-term disability benefits. Conversely, nearly all hearing loss or impairment claims (less than 1% ofclaims) receive long-term disability benefits.

Few pensions (less than 2% of claims) are awarded within two, three or four years of the registra-tion of the claim. Most pensions (95-99%) that have been established in these time periods are based onan assessment of permanent functional impairment. This type of pension award is, in general, estab-lished more quickly and is awarded to younger claimants than loss of earnings pension awards. For 1994cohort claims, permanent functional impairment awards were established an average of ten months ear-lier than loss of earnings pension awards and were established for claimants an average of ten yearsyounger.

The average value of the short-term disability benefits received by claimants who also receivedlong-term disability benefits varies according to the age of the claim and ranges from $10,300 for the1996 cohort to $25,400 for the 1994 cohort. The average reserve amount set aside to pay disabilityawards for permanent functional impairment ranges from $20,700 for the 1996 cohort to $26,000 for the1994 cohort. For loss of earnings pensions, the average reserve amount ranges from $163,700 for the1996 cohort to $196,900 for the 1994 cohort.

During the period of tracking, approximately 3% of a cohort’s claim files are fully disclosed toworkers or employers. Almost 90% of full disclosures are completed within 90 days of when they arerequested.

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By the end of 1997, Review Board appeals had been filed in relation to less than 3% of claims reg-istered in a given cohort year. Workers initiate many of these appeals. At most, employers initiate onein ten appeals. The most common appeal issue for both worker and employer initiated appeals concernsentitlement to compensation. Other common issues concern the duration of wage loss benefits and deci-sions on claim reopening.

Less than 10% of Review Board appeals have an extension of time problem. These appeals areoften two to three months beyond the 90-day time limit. Most extension of time requests are granted.

One-quarter of issues appealed by workers and nearly one-half of issues appealed by employers inrelation to cohort claims are withdrawn or abandoned.

Most (75%) worker initiated Review Board appeals are dealt with by way of oral hearing. Oralhearings are held for approximately 40% of employer initiated appeals. Three-person panels conductmost oral hearings, although the proportion of three-member panels fell from over 90% for the 1994cohort to just over 70% for the 1996 cohort. Workers are represented at oral hearings 65% (1996) to75% (1994 and 1995) of the time while employers are represented at oral hearings 50% (1994) to 75%(1996) of the time.

The Review Board allows from 37% (1994) to 45% (1996) of worker initiated appeals. Employerappeals are allowed in 26% (1996) to 37% (1994) of cases. The allow rate is somewhat higher forworker appeals that proceed by way of oral hearing (38-49%) rather than read and review. For employerappeals, the allow rate for oral hearing appeals is also somewhat higher than for read and review appealsbut only in relation to the 1994 cohort (48%). The 1995 and 1996 results did not vary according to thetype of appeal.

It generally takes at least one year from the date the Review Board appeal is filed until a finding isrendered.

By the end of 1997, Appeal Division appeals had been filed in relation to less than 1% of claimsregistered in a given cohort year. Over 80% of these appeals are worker initiated.

About 10% of worker appeals are withdrawn or abandoned. One in five employer appeals gener-ated by the 1994 or 1995 cohorts were withdrawn or abandoned but this proportion drops to 11% for the1996 cohort.

Less than 10% of Appeal Division appeals have an extension of time problem and over 60% ofthose that do are granted the extension of time to appeal.

The most common appeal issue for both workers and employers involves the initial adjudication ofpersonal injury. The next more frequent issue involves temporary disability payments.

Less than 5% of Appeal Division appeals proceed by way of oral hearing. Approximately half ofthe panels hearing worker initiated appeals arising from 1994 cohort claims were composed of threemembers, but this percentage fell to less than 40% for the 1995 cohort. In relation to the 1994 cohort,two-thirds of the panels hearing employer initiated appeals were composed of three members.

Most workers (83% in 1994) are represented for the Appeal Division appeal; especially thoseappeals that proceed by way of read and review. The most frequent representative type is a trade unionrepresentative. One-half of employers (52% in 1994) are represented. The most common representativetype for employers is a consultant.

Approximately one-half of worker initiated read and review appeals were dealt with by three-per-son panels. Three member panels dealt with 70-80% employer initiated read and review appeals.

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Approximately one in three worker appeals to the Appeal Division are allowed, although this num-ber rose to 49% for the 1996 cohort. An additional 5-10% of worker appeals are partially allowed.Roughly one in eight employer appeals arising from the 1994 cohort are allowed, however in relation tothe 1995 cohort this percentage fell to 8% and then rose to 22% for the 1996 cohort. Another 5% ofemployer appeals are partially allowed.

Allow rates did not vary for worker or employer appeals that proceeded by way of oral hearing ver-sus read and review.

About 50% of Appeal Division appeals are completed within 90 days of the date the appeal wascommenced. The overall time from the date the appeal is filed until a decision is rendered is roughlyfive months.

Workers initiate the vast majority (95-100%) of Medical Review Panel appeals in each of the threecohorts.

The largest source of the decisions appealed to an MRP depends on the age of the claim. For theoldest cohort (1994), the largest source of appealable decisions is the Appeal Division. In each of theother two cohort years the largest source of appealable decisions is the WCB.

Initial adjudication of personal injury is the decision type that is most frequently appealed to anMRP. The most common type of injury referred to a Medical Review Panel is strains and sprains.

Approximately 10% of worker applications for an MRP are rejected due to a determination by theMedical Review Panel Department that the appeal lacks a bona fide medical dispute. Another 10% arewithdrawn.

In relation to worker initiated MRP appeals, 25% (1996) to 67% (1995) of Medical Review panelcertificates do not confirm the decision under appeal.

In total, one to one and a half years pass from the date the appellant provided an enabling certificateto the date the panel issued its certificate. Approximately five months pass from the date the enablingcertificate is provided until the Medical Review Panel Department determines whether the appealinvolves a bona fide medical dispute. From the date this decision is made to the date the panel issues itscertificate another year elapses.

A variety of decisions or issues may be appealed to one or more appeal body, however, because theWCB does not generally record many types adjudication decisions, it is impossible to know exactly howmany decisions have been made on a claim and therefore the proportion of board decisions that areappealed. One type of decision is made on the majority of claims and is usually recorded; that is the ini-tial decision to reject or disallow the claim. These decisions concerning entitlement to compensationaccount for the largest proportion of appeals filed with any of the appeal bodies. For these reasons, non-fatal claims were followed through the adjudicative phases as they relate to this single issue - the com-pensability of the claim. The initial adjudication of 1994 cohort claims by the WCB and the flow ofthese claims through appeals initiated by both workers and employers are depicted in Figure 1.

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With reference to the three cohorts, 9,000 to 11,000 claims (5% to 6%) registered in a given yearare rejected or disallowed by the WCB. The majority of these claims, over 80%, are disallowed. Work-ers appeal about 15% of these decisions to the Review Board. The Review Board allows 35% to 45% ofthese worker appeals. Employers appeal roughly 10% of these Review Board decisions to the AppealDivision which allows less than 20% of the employer appeals.

Figure 1: Appeals of Claim Compensability (Reject/Disallow) Decisions1994 Non-Fatal Cohort

+ one referral

1994Cohort

195,060

ClaimsR/D

9,2365%

ClaimsNotR/D

185,52495%

ReviewBoard1,39515%

ReviewBoard142

.08%

Allow45

38%

Deny74

62%

Allow43836%

Deny79764%

AppealDiv'n33041%

AppealDiv'n

4410%

Allow7

18%

Deny31

82%

Deny14150%

Allow12243%

P-Allow186%

MRP1

3%

MRP2

11%

MRP51

36%

Confirm1

100%

Confirm7

50%

NotConfirm

750%

AppealDiv'n

1318%

Allow6

67%

Deny3

33%

AppealDiv'n

1520%

Allow1

8%

Deny12

92%

MRP1

33%

8% W3% IP

14%W

100%IP

7% W7% IP

50%IP

20% R4% W

49% IP

15% W1% IP

23% W8% IP

13% W8% IP

100%IP

MRP2

.00001%

Confirm1

100%

50% IP

MRP192%

MRP19

0.2%

37% R5% W

5% W53% IP

NotConfirm

436%

Confirm6

55%

PartialConfirm

19%

Confirm2

25%

NotConfirm

675%

Legend

Worker Appeals

Empl. Appeals

W=Withdrawn/ Abandoned/ Suspended

IP= In ProgressR= Rejected

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The Review Board denies 55% to 65% of worker appeals involving entitlement to compensation.Approximately 40% of these decisions are appealed by workers to the Appeal Division, which allowsabout 40% of the appeals.

With reference to the 1994 cohort, where workers are denied at both the Review Board and theAppeal Division, approximately one in three appeal the Appeal Division decision to the MRP.

Roughly 95% to 96% of claims are not rejected or disallowed by the WCB. Employers rarelyappeal these decisions (less than 0.1%). At the Review Board, one in three employer appeals areallowed. Workers appeal about 20% of these Review Board findings to the Appeal Division, whichallows at least 60% of the appeals. Employers appeal from 10% to 20% of the Review Board decisionsto deny their appeals to the Appeal Division, which allows less than 10% of these appeals.

With reference to the 1994 cohort, 42% of the 1,414 workers who appealed a WCB decision toreject or disallow their claim to one or more appellate body were successful in getting their claimaccepted for compensation by the end of 1997. These 594 cases represent 6.4% of the 9,236 claims thatwere originally rejected or disallowed by the WCB.

Again with reference to the 1994 cohort, 28% of the 144 employers who appealed a WCB decisionto not reject or disallow a claim to one or more appellate bodies were successful in having the claimrejected or disallowed for compensation. These 40 cases represent .02%, or one in 5,000, of the 185,824claims that were originally not rejected or disallowed by the WCB.

Conclusions

All of this decision-making activity and the processes that support it consume considerable time.Figure 2 below shows the average and median length of time for each stage of the process for workerswho pursued one or more appeals of the WCB decision to reject or disallow their 1994 cohort claims.For those workers who had this issue adjudicated by all three appellate bodies, the average length oftime from the Review Board notice of appeal to the MRP certificate is nearly three years. This totalincludes roughly one year for the Review Board to make its decision, about 4 months for the AppealDivision to make its decision and about eighteen months for the MRP to make its decision. In addition,several dozen appeals arising from cohort claims were still in progress at the end of 1997. It should bekept in mind that this analysis followed a single, routine type of adjudication decision that is made onnearly every claim filed with the WCB and which involves presumptions favouring the acceptance of theclaim. Yet, as demonstrated by Figures 1 and 2, the decision-making process is neither straightforwardnor efficient.

Tracking the flow of claims through the adjudication and appeals process was a difficult and time-consuming task. Time constraints precluded a more in-depth follow up of appeals resulting from claimsadjudication decisions, however, the adjudication of entitlement to compensation is only the first deci-sion type that may potentially be adjudicated for a claim. Successful worker appeals (to one or moreappeal bodies) of a WCB decision to reject or disallow a claim may be followed by further appeals, by

Avg=47 Avg=208 Avg=228 Avg=28 Avg=40 Avg=129 Avg=62 Avg=61 Avg=166 Avg=325

Med=38 Med=187 Med=200 Med=27 Med=33 Med=112 Med=65 Med=0 Med=178 Med=288

Avg # of days from RB Pt 1 to MRP Certificate=1020; Median # of days=1040

AD Com-mencem'tDate

MRPApplicat'nDate

EnablingCert. Rec'dDate

Lengthof Timein Days

Figure 2Time Elapsed Between Appeal Stages for Worker Appeals of Decisions to Reject/Disallow Claims

1994 Non-Fatal Cohort

WCBDecisionDate

RB Part 1Date

RB Part 2Date

AD ReceivedDate

BFMDDecisionDate

MRPCertificateDate

RB FindingDate

AD FinalResult Date

8 Karen A. Ryan

both workers and employers, of claims decisions involving medical, wage loss, vocational rehabilita-tion, and long-term disability benefits. Of course, decisions in these areas for claims that are “accepted”are also subject to multiple levels and iterations of appeals. Additionally, some appeals may result fromdissatisfaction with the implementation of an appellate body’s decision as suggested by submissions tothe royal commission.

Instead of doing their (WCB) job properly and making me, the injured worker feel as ifthe WCB is doing something for me they: turn down my request for help and make meappeal (usually up to a year); turn down my appeal and make me appeal again (usuallyanother year); turn me down and make me appeal to the MRP (about 6-8 months); com-pletely screw up the MRP findings and start the sloooooooow process of doing something(usually a year and a half); give me some money and cut me off; start at appeal overagain (about a year); turn down my appeal etc. etc. etc.4

Worker and employer submissions to the royal commission are in agreement that the current appealsystem is too slow and the delays cause claimants emotional and financial hardship. In addition, “theadversarial nature of the WCB, the lack of information provided to employees and employers, the com-plexity of the process, administrative inefficiency, and inconsistency and delay in decision-making con-tribute to backlogs and delays in the process.”5 The evidence provided by the cohort data analysissupports these concerns.

The results presented in this paper will undoubtedly be the subject of interpretation and debate.The data is weak in some areas and allowances had to be made. The development of quality, integrateddata that captures worker and injury characteristics as well as positive and negative adjudication deci-sions would certainly enhance understanding. However, debate may also arise because the perspectiveon claims, claimants and process presented here is unique in that it is not muddied by business activityconducted on any claim ever registered. By following a specific group of claims over a several yearperiod it is possible to calculate accurate percentages, whether they be the allow rate of an appeal bodyor the disallow rate of the WCB. This makes it possible to discern and follow trends that are notobscured by other business.

Although the royal commission’s cohort project accomplished a great deal, it only began to exploitthe analytical possibilities of cohort-style data, particularly if such data spans a longer history of adjudi-cation than any of these cohorts do. An important element of the cohort concept is the tracking of a pro-gression of events to the end product or outcome. With respect to claims adjudication and appeals it isnot known when the process will end or how long the “tail” is, but it is certainly longer than four years.In addition, longitudinal data from several cohorts could be compared to assess the impact of legislative,policy and practice changes within the system. Ideally such analyses would compare several cohorts ofclaims that have aged to the same point in time (i.e, five years or ten years from claim registration).These and other avenues to a better understanding of the operation and performance of the claims adju-dication and appeals system should be pursued. Longitudinal data has much to offer in the context ofinforming managers, executives and legislators by providing meaningful measures of effectiveness andefficiency.

Preface

The development of the royal commission’s research agenda was guided by principles of effectivemonitoring and evaluation, including: clear definition of organizational goals; clear definition and doc-umentation of methods for achieving organizational goals; identification of measures that are indicativeof process effectiveness and efficiency; collection of quality data, including client outcomes in the long

4 Injured worker’s submission, INJ-030.5 PRAXIS Background Paper, 6.0 Appeals, September 16, 1998 Draft One, pp. 1-2.

Karen A. Ryan 9

term; inclusion of client feedback concerning the level of satisfaction with the process; and, routine pro-vision of meaningful information to management for consideration and response.

In the area of administrative claims adjudication and in particular, appeals arising from claimsadjudication decisions, a research plan comprised of several components was developed. Taken togetherthese components provided a descriptive overview of the adjudicative business of the workers’ compen-sation system from legal or theoretical, procedural, and empirical or evidence-based standpoints. Thisresearch allowed for an assessment of the quality and performance of the decision-making process.

As a first step in addressing the global question – how does this system operate? – the current pro-cesses of administrative claims adjudication and appeals as defined in law (Workers Compensation Act),the “published” policy of the Workers’ Compensation Board (WCB), and the policies of the Workers’Compensation Review Board (WCRB) were studied and synthesized. This research was hindered bythe multiple levels of unevenly developed “policy” generated by the WCB. The absence of an existinghigh-level view of the overall process was indicative of the system’s lack of transparency. One result ofthis review was a set of flow charts that depict the legal or theoretical framework for decision-making bythe four adjudicative bodies – the WCB, the WCRB, the WCB Appeal Division, and the MedicalReview Panels.

The production of the first set of flow charts highlighted gaps in the “published”, and to a certaindegree accessible, policies of the agencies involved. The understanding provided by the legal frame-work was supplemented by interviews with key players in the system’s three appellate bodies6 and withreference to “unpublished”, and in some cases draft, policies within the agencies. This additionalknowledge of the understood practice of the system was appended to the above-noted flow charts to pro-duce a second set of charts that depicted the appeals processes in more detail.

The results of this research are provided in the paper “Appeals From WCB Claims Adjudication”by Sharon Samuels. The paper also incorporates other sources of information, including writtendescriptions of the adjudication and appeals processes7 and submissions concerning these processes.

The final component in the research plan was to empirically examine the operation of this systemand to answer the question, how well does this process produce decisions? There is no mechanism toassess the quality of the adjudication process. The closest indicator of quality assurance is the numberof claimants who are so dissatisfied with decisions made on their claims that they pursue appeals ofthose decisions. Information concerning the content, outcome and timeliness of appeals is, therefore,vital to effective monitoring of the decision-making process and informed responses to problem areas.

The volume of injury claims that are registered in any given year preclude a large sample qualita-tive review of decision-making. Instead, electronic data concerning claims registered during a three-year period were obtained from the WCB and the WCRB for analysis. The longitudinal analysis of thisdata allowed for an assessment of the efficiency of the system to cope with its business; that is, decisionsregarding compensation for injured workers.

The results of the analysis of electronic claims and appeals data are presented in the followingpaper. The cohort project provides comprehensive descriptive information about the volume and char-acteristics of claims and appeals, but more importantly, provides evidence of the overall operation of theadjudication and appeals system that goes beyond the departmental based “business year approach”prevalent in the published statistical information about the workers’ compensation system. This evi-dence may undermine or add credibility to the perceptions expressed by interested parties who made

6 From the WCRB: P. Michael O’Brien (Chair) and Susan Polsky-Shamash (Registrar). From the WCB Appeal Divi-sion: Maureen Nichols (Chief Appeal Commissioner), Eugene Jamieson (Assistant to the Chief Appeal Commis-sioner), Bonnie Eisworth (Appeals Officer). From the MRP Department: Dave Martin (Registrar at time of interview)and Judy Olson (Medical Appeals Officer).

7 Including Administrative Inventories, operational status reports and WCB briefing papers.

10 Karen A. Ryan

submissions to the royal commission. Accountability within the system requires adequate observationand monitoring of its inter-related functions.

The vast amount of quantitative data was supplemented by a small file review involving 98 claimsthat were registered in one of the three study years. This review offered a qualitative insight into WCBadjudication decisions that could not be gained from the electronic information recorded for claims.The results of the file review are provided in the paper “Report of the Non-Fatal File Review” preparedby Susan Furlong.

Karen A. Ryan 11

Introduction

In support of its empirical examination of the workers’ compensation system adjudication andappeals process, the royal commission requested that the WCB create an integrated set of data whichwould allow for the tracking of claims from registration through each of the stages of adjudication and

appeal. Data relating to WCRB appeals was obtained from the Workers’ Compensation Review Board.8

This project came to be known as the cohort project because it’s purpose was to follow the longitudinalprogress of a cohort (a group sharing a common, defining characteristic) of claimants who registered anew claim in either 1994, 1995 or 1996.

In the past, much of the empirical understanding of the adjudication and appeals process has beenbased on cross-sectional data generated by the business activity of the system’s players during a one-year period. Annual reports and other statistics published by the relevant agencies are based on the flowof work generated in a given year by claims that were first registered in any year. For example, it isreported that a certain number of claims are disallowed or rejected each year by the board, but the num-ber of claims subject to this decision during the year (i.e., the denominator) is unknown because thesedecisions may be made on claims first registered in any year. It is misleading then to report the percent-age of claims that were disallowed or rejected in a particular year based on the number of claims firstregistered in the reporting year only. The “Claims Flow Statistics” chart published in the 1996 adminis-

trative inventory “The Workers’ Compensation System of British Columbia: Still in Transition”9 reflectsthis cross-sectional view of the flow of business in 1994 and also commits the error of assigning per-centages to the numbers reported. In fact, the calculation of rates based on figures that have no directrelationship to each other appears to be the acceptable standard for statistical information about theinter-relationship between decision-making bodies within workers’ compensation system. What ismissing from this perspective is the experience of individual injured workers who must negotiate thissystem and for whom there is a progression through the assorted stages of the process. For injuredworkers the claims they register have a life cycle that may span several or more business years. Thecohort databases were developed to provide answers about the long-term status of claims that enter thesystem at a specific point in time.

The WCB committed a great deal of staff time and effort to identifying, locating and extracting theinformation relating to three cohort groups of injury claims from board information systems that were

not designed to provide an integrated view of the life of a claim.10 The various individuals, departmentsand agencies involved with different stages of the claim’s life cycle collect information as needed fortheir own purposes and there is often little consistency or integrity between the various data sets. Inshort, the available data mirrored the compartmentalized, snap-shot perspective of the business.Approximately one year after initial discussions with the WCB took place the WCB delivered severallarge databases containing over 100 tables and millions of records. Additional data relating to Workers’Compensation Review Board appeals were obtained from the Review Board. These multiple datasources allowed for the linkage of claims and appeals data; however, they do not represent integrateddata. Some of the implications of using data that is not integrated are discussed under data qualityissues.

8 The researcher wishes to thank Michael O’Brien, Susan Polsky-Shamash and Linda Scott of the Workers’ Compensa-tion Review Board for their assistance.

9 Hunt HA, Barth PS, Leahy, MJ. The workers’ compensation system of British Columbia: Still in transition. Richmond(BC): WCB of British Columbia; 1996.

10 The researcher acknowledges the support of Brian Cooper, Richard Tench, Maureen Charron, Colleen Wade, PeterPokorny and other WCB ISD personnel. Maureen Charron was instrumental in the creation of the cohort project dataand Colleen Wade provided invaluable data analysis support.

12 Karen A. Ryan

Methodology

Selection of Study Claims

The development of data that would allow for the longitudinal tracking of claims as they pro-gressed through the Worker’s Compensation system proved to be an enormous and complex task thatrequired months of co-operative effort on the parts of the royal commission and the WCB.

First, it was necessary to establish the rules for the selection of claimants and claims11 that wouldform the study group or cohort. The researcher in consultation with the royal commission decided thatthree cohorts would be comprised of claimants who registered a new claim in 1994, 1995, or 1996.These years were chosen as starting points for the three groups of claims because they were recentenough to reflect current practice and made data available from newer board information systems, andwere, it was expected, also old enough to have navigated many of the system’s decision points.

The method of claim selection allows for the possibility of individual claimants contributing multi-ple claims to a single cohort year. Claimants may also be represented in more than one cohort year.

The progress of claims that were registered in a cohort year was tracked to the end of 1997, mean-ing that the maximum age of a study claim is four years. The 1995 and 1996 cohorts have a maximumage of three years and two years, respectively. Care is needed when making direct comparisons betweenthe three cohorts because of the varying lengths of exposure to the phases of adjudication. The volumeof decisions made, including appeals filed and decided, and level of benefits received are all somewhatdependent on time.

Time is also a critical factor in the type of decisions that are made with respect to claims registeredwithin a cohort year. Decisions that can be made quickly will be over represented in comparison todecisions that take longer to make, such as those concerning complex or serious situations. With respectto permanent disability, for example, pension decisions that have been made within four, three or twoyears may not be representative of all pension decisions made by the board.12

An important first step in gathering information relating to new claims registered in a cohort yearwas to trace the consolidation history of those claims which were identified in the WCB annual reportsas “claims first reported” in those years. Claims consolidation refers to the merger of claim numbers thatmay occur for several reasons. The primary circumstance in which claim numbers are consolidated iswhen a new claim is opened for an injury for which there is already a claim number in the board’s sys-tems. A “duplicate” claim could arise when reports of an injury are received from the worker, theemployer and the worker’s doctor but, because of missing or inaccurate information (such as a mis-spelled name), the board does not immediately recognize that it is the same worker and injury. Similarlyan aggravation of a previously reported injury may be given a new claim number, rather than treated as areopening of an existing claim. When either of these errors are spotted claim numbers relating to thesame worker-injury are consolidated into one claim number.13

Some consolidation of claim numbers also occurs as a result of the board’s practice of retaining theyear of injury in the first two digits of the claim number. This type of consolidation is referred to as

11 It should be noted that the WCB makes no distinction between reports of injury and claims for compensation – both areregistered as claims.

12 According to information supplied by the WCB in response to the royal commission request dated February 9, 1998(response to questions 5(8) and 5(9)), and considering first payments made during the years 1991 to 1997, the averagelength of time from date of injury to first pension payment is approximately 3.5 years for permanent functional impair-ment awards and 4.5 years for loss of earnings pension awards. About 70-75% of permanent functional impairmentawards are first paid within three years. In the early 1990’s, about 50% of loss of earnings awards were first paidwithin three years, but by the later 1990’s this proportion fell to about 35%.

Karen A. Ryan 13

reassignment and it occurs when a claim number is assigned at claim registration but subsequent investi-gation or adjudication (including Review Board or Appeal Division adjudication) of the claim deter-mines that the injury took place in a different year.14 A new claim number that reflects the newlyunderstood year of injury would then be started and the original claim number would be “consolidatedinto” the new claim number.

The implication of reassignment for the cohort study was that the reassigned claim looks like a newinjury claim registered in a cohort year when in fact the reassignment of an existing injury claim numbertook place in the cohort year. The existence of a claim registration date in the cohort year was simply anartifact of the board’s information systems.

A specific type of reassignment consolidation arose when the board reinstated widow’s pensionsrelating to claims that had never before been registered in the board’s electronic registration system. Inthese cases a new claim number was registered and then consolidated into the original claim number.

Another source of error that was discovered in the course of creating consolidated information wasthe existence of pseudo-claims in the board’s information systems. In the absence of a testing environ-ment, the board’s production systems have been used on occasion for testing implemented changes toelectronic systems.

Approximately 2.5% of claims reported in a year are involved in consolidation.15 The board esti-mates that 1.5% of claim numbers registered in a year are “closed” and 1% are the target of claims con-solidation. Consolidation is an on-going process and it is likely that the picture presented in the dataprovided by the WCB to the end of 1997 has been modified somewhat since that time due to consolida-tion. Also, because more time has elapsed for claims registered in 1994, the 1994 cohort claims havebeen the subject of more consolidation than the 1995 or 1996 cohort claims.

The electronic record of all types of claims consolidation exists only in the board’s Claims Regis-tration System. The consolidation history of a claim can only be found here. None of the board’s otherinformation systems attempt to reflect the reality of “duplicate” claims within the electronic data and theboard’s annual statistics are not based on consolidated claims information.16

For the purposes of following a cohort of new claims, tracing the consolidation history is vitallyimportant because it allows for the identification and elimination of injury claims that are not actuallynew to the system. It also allows for the identification of all data that is related to the new injury claimregardless of which claim numbers (subsequently consolidated) the information was recorded against.Consolidated electronic data also more accurately reflects the number and content of paper claim filesthat are active, or potentially active, in the system.

Gathering information relating to claims involved in a consolidation with a claim first registered ina cohort year had two consequences for the composition of the cohort groups. One, in some cases oneor more of the claims involved in consolidation with a cohort claim was first registered prior to thecohort study period. This means in effect that the claim was not truly a new injury in the cohort year.

13 Duplication can also occur with respect to claimants who have been assigned more than one identifier. The royal com-mission Data Integration Project allowed for the identification of duplicate claimants in the board’s data, but unfortu-nately it was too late to implement the DIP findings in the cohort data. Approximately 1.3% of claimants in the threecohorts are identified by more than one “CPOID” (compensation person/organization identifier) (Colleen Wade, memodated 98-05-14).

14 In rare cases a reassignment may be necessary because the board officer electronically assigned the file does not havean arms length relationship with the injured worker (e.g., a relative). In such cases, a new claim number is generated inorder to direct the file to another board officer.

15 Maureen Charron, “Statistics on Claims Consolidation – as of Dec. 21, 1997”.16 Similarly, consolidation of “CPOID’s” is not generally reflected in the board’s data systems.

14 Karen A. Ryan

Two, any consolidated claim number that was linked to claim numbers generated in differentcohort years existed in more than one cohort. These claims were identified and the consolidated claimnumbers involved were assigned uniquely to the cohort year in which the new claim first arose.

The final results of the identification and elimination of claims that were not first registered in acohort year is summarized in Table 1.

17

Data Sources

Equally important as the identification of claimants and claims to include in the study was the loca-tion of data sources that would allow for the tracking of these claims through the entire life cycle. TheWCB maintains scores of databases, large and small, on a variety of platforms. Most informationsources are operational in nature and are managed by the Information Services Division (ISD). Otherelectronic data are collected by individual departments without the support or, perhaps, awareness ofISD. Summary databases have been developed for management information purposes. Ultimately, 15macro-sources of data were identified and the data relevant to cohort claims and claimants extracted.

Documentation of the cohort study data by the WCB was hampered by the lack of good existingdocumentation of the various data sources, particularly those not within the responsibility of ISD. Cru-cial knowledge about the meaning and limitations of certain data sources had not been documented.Efforts by ISD to compile written documentation in a relatively short period of time met with limitedsuccess. Some data sources were adequately documented but others were not and it was often at a criti-cal stage of the data analysis that the data’s shortcomings would become apparent.

Table 2 lists the high level data sources provided by the WCB along with a brief description of eachas supplied by the WCB.18 Table 2 also lists the databases and tables provided by the WCB to the royalcommission for this project.

Table 1New Injury Claims Reported

Year

Number of Claims “First

Reported” as per WCB

Annual Reports

Number of “Test” Claims

Removed

Number of Claims

Removed Due to Con-solidation (Not Re-Assigned)

Number of Claims

Removed Due to

Reassign-ment or

Reinstate-ment

Number of Claims

Removed Due to First

Registra-tion Prior to

Study Period

Number of Claims

Removed Due to Overlap

with Other Cohort

Groups17

Number of New Cohort

Claims Registered

1994 197,911 4 1,963 59 637 0 195,248

1995 194,280 3 1,910 15 348 339 191,665

1996 189,418 3 1,805 6 266 446 186,892

17 As any claim that overlapped with the 1994 cohort group was registered for the first time in 1994, no claims wereremoved from the 1994 cohort.

18 “Corporate Data Inventory – System Information”, prepared by Maureen Charron, Feb. 18, 1998 and “Cohort Tables(94, 95 and 96) Provided to the Royal Commission by Category and Data Base”, prepared by Maureen Charron,98/03/20.

Karen A. Ryan 15

Several data sources, such as pensions and Appeal Division appeals, involved multiple, relationaltables of data that were refined and simplified by the WCB prior to delivery.

Multiple sources of the same information were provided in several instances. In some cases thiswas due to the introduction of newer systems during the cohort study period. In other cases multiplesources were a result of different departments collecting the same piece of information.

Table 2WCB Data Sources and Data Bases/Tables Provided

Source Description Data Base Tables

Comp MIS Contains key events in the injured worker life cycle (e.g., injury, disable-ment, registration of claim, first wage loss payment, claim closure(s), claim reopening, end of disability) for all claims with activity since Jan. 1, 1994. Started Jan. 1994.

CMIS9xC

CMIS29xC

9xC MIS01 - Comp Claim History (MCCLH)9xC MIS01 - Short Comp Claim History (MCCLH)9xC MIS02 - Comp Claim Event History (MCCLE)9xC MIS03 - Comp Claim History Summary

(MCCLS)MIS04 - Event Types

CATS Contains information about all the events in the life cycle of the Appeal Division process, the participants and their roles(s), the matter under appeal, oral hearings and all decisions rendered. Started 1995.

CATS9xC AD - ACALE - Appeal Matter Event9xC AD - ADACT - Appeal Decision Activity9xC AD - AFOLD - Folder9xC AD - AMFAC - Appeal Matter Folder Activity9xC AD - AMORH - Appeal Matter Oral Hearing9xC AD - AMPRQ - Appeal Matter Participant

Request9xC AD - APDEC - Appeal Decision9xC AD - APMAT - Appeal Matter9xC AD - APMEM - Appeal Memo9xC AD - EOTRQ - Extension of Time Request9xC AD - MPARD - Matter Participant Disclosure9xC AD - MPREP - Matter Participant Representation9xC AD - MTPAR - Appeal Matter Participation9xC AD - APIRQ - Appeal Officer Panel Info Request

Disallows/Rejects

Contains disallow and reject information for all claims at all levels of adjudication and appeal. Source of official Board sta-tistics on disallows and rejects. Started Nov. 1992.

Disallows/Rejects

9xC Stats Disallows/Rejects

Disclosures Contains information that has been dis-closed via information requests that are allowed as a part of the regular claim process. Started approximately 1990.

Disclosures 9xC DS - DisclosuresDS - CT - DSCST - Disc Status

Medical ReviewPanel

Contains information about appeals of a medical nature that have been filed with the Medical Review Panel. Started 1987.

MRP 9xC MRP - MDBDP - Body Parts9xC MRP - MEDRV - Medical Review9xC MRP - MRPNL - Medical Review PanelMRP - CT - APPIT - Appeal IssueMRP - CT - BDPRT - Body PartMRP - CT - MDRSN - Medical Review Transfer Rea-

sonMRP - CT - MRPST - Status Code

16 Karen A. Ryan

ReviewBoard - Mainframe

Contains information about Review Board decisions until Dec. 31, 1996. Information was captured after the Review Board process is complete, the decision has been made and the claim file returned to Compensation Services Policy. Discontinued Dec. 1996.

ReviewBoard

9xC RB - Mainframe Review BoardRB - CT - APCAT - Adjudicator Disallow Reason

ReviewBoard- PC

Contains information about Review Board decisions after Jan. 1, 1997. Information was captured after the Review Board process is complete, the decision has been made and the claim file returned to Compensation Services Policy. Started Jan. 1997.

ReviewBoard

9xC RB - 1997 PC Review Board

DataBoutique Costs

Contains claims cost information from 1969 to present. Includes all directly allocated claim payments and some of the indirectly allocated claim costs - these balance to similar costs in Table A of the Annual Report. Does not include overhead costs that are included in Table A of the Annual Report as these costs are allocated in a more general sense from other data sources and they are not captured on the Compensation Detail tape. Costs are summarized by claim, employer, CLSBIN, fund, payment year and month.

DB Costs Data Boutique Detailed CostsCosts by Claim/Fund/Employer/Industry/Payment

DateCosts by Claim/Fund/Payment YearCOST - WSACT - Dummy Employers IDs/CLSBINS

for Relief of CostCOST - CLSBI-Valid CLSBINs

FatalsDesk 1994

Contains information about the claims referred to Disability Awards and Com-pensation Services Sensitive Claims Section (formerly Fatals Desk). Started 1994. Discontinued Apr. 1997.

FtlDesk 9xC Fatals_T1Reported Fatals

DASCOM Contains information about the claims referred to Disability Awards and Com-pensation Services Sensitive Claims Section (formerly Fatals Desk) for pen-sion consideration. The system tracks the activities internal and external to Disability Awards to assist Disability Awards management and staff in moni-toring the pension consideration pro-cess. Started Nov. 1996.

SQLFATAL 9xC DBO_CLAIM9xC DBO_CLAIM_INJURY9xC DBO_CLAIM_PENSION9xC DBO_CLAIM_REFERRAL9xC DBO_CLAIM_REVIEW9xC DBO_CLAIMANT9xC DBO_CLAIMANT_SURVIVOR9xC DBO_EMPLOYER9xC DBO_OFFICER9xC DBO_OFFICER_OFFICE9xC DBO_TEAM_OFFICE9xC DBO_TEAM_OFFICER+ 19 code tables

StatsFatal Contains information about fatal claims first reported and accepted as deter-mined by Statistical Services. This table is used to produce the official Board sta-tistics.

Stats Fatal 9xC Accepted Fatals9xC Reported Fatals

Karen A. Ryan 17

StatsMaster

Contains CSA coding for most STD, LTD, and Survivor's Benefits claims. Includes nature of injury, body part, occupation (Stats Canada and WCB), source of injury, accident type, gender, and other accident/work related infor-mation. Started 1971

Stats StatsStats-Injured Worker Claim ViewCT - ACCDT - Accident TypeCT - BDYPT - Body PartCT - DIAGN - Medical DiagnosisCT - GenderCT - Marital Status CodeCT - NTINJ - Nature of InjuryCT - SRINJ - Source of InjuryCT - STCOC - Stats Can Occupation CodeCT - WCBOC - WCB Occupation Code

Pensions Contains information about long-term disability pensions that are established as a result of work related injuries. Started Jan. 1986.

In addition to the cohort specific tables of data, the WCB provided data tables relating to all pensions recorded since 1986 (including all active pensions).

PNALC9xC

PNCST9xC

PNOTH9xC

PNWGE9xC

9xC - PENS - Claim#/Pension#9xC - PENS - Reserves EstablishedPENS - CT - PENCT - Award/Pension CategoryPENS - CT - PENRL - Pensioner RolePENS - CT - PENST - Pension Status TypePENS - CT - PPDPT-PPD - Pension TypePENS - CT - WSACT - Dummy Emplolyer IDs/CLS-

BINS for Relief of Cost9xC - PENS - Actual Pension Costs9xC - PENS - Claim#/Pension#9xC - PENS - Commuted and Paid Amount9xC - PENS - Fatal Wage Amount9xC - PENS - Monthly Benefit ValuePENS - CT - COMRN - Commutation ReasonPENS - CT - COMTP - Commutation TypePENS - CT - PENCT - Award/Pension CategoryPENS - CT - PENRL - Pensioner RolePENS - CT - PENST - Pension Status TypePENS - CT - PMTTY - Payment TypePENS - CT - PPDPT-PPD - Pension Type9xC - PENS - Claim#/Pension#9xC - PENS - % Disability9xC - PENS - Injury Codes9xC - PENS - PensionersPENS - CT - INJRY - Pension Injury TypePENS - CT - PENCT - Award/Pension CategoryPENS - CT - PENRL - Pensioner RolePENS - CT - PENST - Pension Status TypePENS - CT - PPDPT-PPD - Pension Type9xC PENS - Claim#/Pension#9xC PENS - Monthly Wage AmountPENS - CT - PENCT - Award/Penson CategoryPENS - CT - PENRL - Pensioner RolePENS - CT - PENST - Pension Status TypePENS - CT - PPDCT-PPD - Calculation TypePENS - CT - PPDPT-PPD - Pension Type

Collection of all employers who appear in the Cost database in that cohort year and the associated industry. Note some employers belong to several industry classifications.

Employer 9x Employers9x Employer Industry

All claim history for the set of worker injured in 199x. This is derived by fol-lowing the CPO alias chains and extract-ing any claim for the injured worker regardless of the CPOID identified on the claim.

HistoricalClaims

Historical ClaimsClaim Counts by IWIW Counts by # of Claims

The set of workers injured in 199x, exactly as exists on the production DB2 system with multiple copies of the same injured worker when there are aliases.

Base InjuredWorkers

Base Injured Workers

18 Karen A. Ryan

Two data sources, data boutique (costs) and the Case Management Information System (CMIS),were existing summary data developed by the board. The data boutique contained high-level aggregatedcost data based on monthly extracts from the Compensation Detail Tape and the Medical PaymentsTape. The availability of this summary data saved considerable, perhaps insurmountable, effort on thepart of the WCB to extract claim cost information from the various payment systems.

The Case Management Information System (CMIS) is a relatively recent summary data sourcebased on monthly extracts from the Automated Wage Loss and Claims Registration systems. The pur-pose of this database is to provide summary information about events in the life cycle of a claim frominjury to claim registration, first wage loss payment, final wage loss payment, reopening, wage loss pay-ment, final wage loss payment and so on.

The WCB provided data collected by the board relating to Review Board appeals, however, theresearcher deemed it preferable to rely on data provided by the Review Board itself for a number of rea-sons. First, the data was collected by the source according to its procedures and interpretation of issuesand events. Second, the Review Board data could provide up-to-date information on appeals inprogress, whereas the board’s data is collected following the conclusion of the appeal when the claimfile is returned to the WCB. Third, the review board appeals database developed by the board to replaceits mainframe system in January 1997 omitted crucial information about claims appeals, including theability to distinguish multiple appeals filed on a claim.

In addition to the above data, the board extracted information about all claims involving cohortclaimants that had ever been electronically registered in the Claims Registration System. This dataincluded a record for each claim registered and allowed for the calculation of the number of claims filedby cohort claimants prior to the cohort year.

The set of workers injured in 199x, with all duplicates removed. At the present time, this consists of removal of those identified by the system as aliases or duplicates, but does not take into account the cleansing that is being done by UBC Data Linkages.A subset of the above rows excluding injured workers whose only claims were not within the scope of the cohort project.

Unique InjuredWorkers

Unique Injured Workers

RC Injured Workers

Base claims involved in Cohort study, i.e. Claims first registered in 199x (exclusive of Criminal Injury claims).Claims added to Cohort study because they were consolidated with the base set of claims as of December 31, 1997

9xClaims 9x Claims

9x Claims - Consolidated Set

Consolidated view of all claims regis-tered in 199x. Date claim registered is derived from the earliest date claim reg-istered of all the claims involved in the consolidation. Same is true for date of injury. The official date of injury is taken from the current claim. All other pertinent information is taken from the current claim.Subset of above claims within the scope of the cohort study.

Consoli-datedClaims

Consolidated View of 199x Claims

RC View of 199x Claims

Karen A. Ryan 19

Unfortunately, adequate information on an important phase of the claim’s life cycle — the worker’s

return to work — could not be provided.19

Data Quality Issues

For the most part, the collection of data by the WCB is driven by the operational needs of the orga-nization. Systems are designed to pay bills and account for expenses. Information that is not necessary

to achieving these operational goals is given a lower priority.20

For example, very little descriptive information is collected about a claimant or the nature of aclaim unless there are short-term disability and/or long-term disability costs associated with the claim.Basic information about the claimant, such as gender, occupation and industry, or about the claim, suchas the nature and source of the injury, is not systematically21 collected when either health care only orno benefits have been paid. Unfortunately, the data recorded for STD and LTD claims is also not com-plete due to the board’s reliance on a manual procedure that requires the relevant claim file to be for-warded to Statistical Services for coding. This process has been known to break down and as a resultsome records are missing. The board estimates than an average of one percent of STD and LTD claimsare missing from the Stats Master file each year, but in 1996 this figure was approximately four per-

cent.22

Where different departments collected the same piece of information there was often little integritybetween the data sources; that is, multiple sources were not synchronized for content. For example, dur-ing the analysis of the cohort data it was discovered that some claimants were identified as males in onesource and females in another, or visa-versa. The quality of data generated by the various departmentsand sections of the board is sometimes driven by the importance of that data to the function of thedepartment that is generating it. The date of a claimant’s birth, for example, is not critically important tomost compensation payments. It is, however, important to the administration of permanent disabilityawards and survivor’s pensions. So while other arms of the Compensation Services Division collect thispiece of information, the Disability Awards section collects it again for themselves and their data is con-sidered to be the most accurate. Where less accurate sources were all that was available, care wasneeded to avoid nonsensical results based on erroneous data. The analysis of the cohort data was a con-tinuous struggle with choosing the best source, improving it where possible and understanding theimplications of its limitations.

Accounting for expenses on a claim is the primary goal of much of the board’s operational data.The methods used by the WCB to account for and allocate claim costs, and the justifications for thosemethods, go well beyond the scope of this research. However, as described in the following section, itbecame necessary to rely on cost data to make inferences about the benefits that were paid as the resultof an injury claim. The limitations of the cost information must, therefore, be clearly understood.

19 The best data identified by the board was collected as part of several customer satisfaction surveys of injured workerswho had participated in board supplied or funded work conditioning programs. Each survey included one or morequestions about the worker’s current work status. The researcher decided that this data was not good enough for use inthe cohort project for several reasons: 1) only injured workers who participated in a work conditioning program (andin the survey itself) are included; 2) several different survey instruments (with differing conceptualizations of “work-ing”) were used; 3) none of the data sets were continuous for a long enough period to permit tracking of cohort mem-bers; and 4) data was missing altogether for a six month period.

20 As part of its strategic plans, the WCB has undertaken a corporate-wide data warehouse project that has highlightedsome of the same data quality problems described here. The warehouse, developed and maintained by ISD, becameoperational in early July, 1998 but it remains to be seen how well the board responds to the identified data deficiencies.

21 While other systems do record the injury site, the data is stored in text fields that are not suitable for analysis withoutsignificant recoding, (e.g., back equals bck, bk, rback, lwrbck, etc.).

22 Personal communication, Colleen Wade, May 1998.

20 Karen A. Ryan

As mentioned above, the data boutique is a summary of extracts from the board’s payment systems.These systems are dynamic and a payment made today may well be recovered tomorrow. In part thismeans that the cost data does not accurately reflect compensation costs that the WCB is not ultimatelyresponsible for paying – these costs are not relevant from a financial or actuarial standpoint. Data isincomplete for claims where STD and/or LTD costs have been recovered from a third party, such asICBC or the employer. In these cases, payments made by the WCB are reversed out of the records.Some vocational rehabilitation payments may also be reversed if the money has been recovered from apension award. When payments are reversed, the total cost to that particular benefit type fund is

reduced, in some cases to zero.23 Reversal errors mean that for some claims total costs in a fund typesum to less than zero and care was needed to eliminate the impact of these negative amounts in the cal-culation of total costs attributable to cohort claims.

A more significant problem relates to full time employees of the federal government, for whom theWCB adjudicates the claim and pays health care benefits but is not responsible for any wage loss or pen-sion costs. The extraction rules used to create the data boutique specify that STD and LTD costs for fed-eral government (class 19) claims be ignored.

The allocation of claim costs by the board also impacts the accuracy of the cost information pro-vided by the data boutique. Costs incurred as a result of a claim are not necessarily attached to the spe-cific claim if the costs are to be allocated across employers or classes of industry. Some costs may beattributed to “dummy” claim numbers in order to save the administrative expense of recording individ-ual charges against specific claim numbers. Bulk purchases of medical supplies (e.g., hearing aids) andtransportation are examples of the type of costs that may not be included in the cost information relatingto a specific claim.

The use of “dummy” claim numbers took on added significance when during the analysis of thecohort data it was discovered that claim numbers that had been used to record general costs such astransportation could inadvertently be assigned to real compensation claims. These real claims appearedto have thousands of dollars in costs that in fact were not valid for those claims. Until recently, therewere no safeguards in place to prevent the Claims Registration System from assigning a “dummy” claimnumber to a new injury claim.

Some data sources were incomplete. The data set used to record decisions to reject or disallow aclaim is maintained by Statistical Services and its accuracy relies on the same manual flow of paper thatleads to missing information about STD and LTD claims. This process also means that informationrelating to the same decision may be recorded more than once if the file is mistakenly transferred to Sta-tistical Services more than once. The steps taken to improve the quality of the Disallows/Rejects file arediscussed below.

The Case Management Information System (CMIS), which was the only available source for claimreopening information, was found to be unreliable. Records, which logically should have been there

(e.g., a claim must be closed before it can be reopened), were missing.24 A great deal of time was spendduring the analysis of the cohort data to find a way to make this data useful, but ultimately those effortswere abandoned.

23 In some cases wage loss costs are reversed but the number of days of wage loss is retained.24 Problems with the closure information in CMIS were recognized and documented by the WCB. These problems could

not be overcome during the analysis despite attempts to supplement the information with data from other sources.

Karen A. Ryan 21

The accuracy of information about historical claims is limited by the availability of electronicinformation on claims registered with the board since 1917. The board estimates that approximately75% of claims registered between 1917 and 1997 have been registered electronically.25

The Computerized Appeal Tracking System (CATS) used by the Appeal Division of the boardrecords a great deal of information about the appeals it is responsible for and, as the name suggests, oneof its primary purposes is to ensure that work on the appeal proceeds in an orderly and timely manner.Unfortunately CATS does not allow for the recording of more than one appeal issue (e.g., wage rate andtermination of wage loss benefits) on an appeal and the issue is only recorded for appeals on which thepanel has rendered a decision. To make matters worse, Appeal Division staff record the first appealissue listed by the appellant, not necessarily the most important or primary issue under appeal. Thismakes it difficult to quantify the issues that are of most concern to workers and employers.

Data Integration Issues

Tracking the adjudicative process applied to claims through the use of existing electronic data pre-sented some unique challenges. Linking events in the claim’s life was often an exercise in logicgrounded in an understanding of relevant decision points and time limitations in the adjudication of aclaim by the WCB, the WCRB, the Appeal Division of the WCB, and Medical Review Panels.26 Thegreatest difficulty arose due to the lack of accurate and complete information relating to most adjudica-tion decisions made by the WCB. This shortcoming led to a reliance on cost information to infer, in theabsence of other evidence, positive decisions (e.g., the granting of wage loss benefits) made in relationto the claim. A decision to deny specific benefits on a compensable claim could only be identified if thatdecision was appealed and the issue recorded accurately.

The Statistical Services of the WCB maintains a record of negative initial adjudication decisions –decisions to reject or disallow a claim for compensation. However, the Disallows/Rejects file was foundto be incomplete. The manual process used to collect this information is subject to error. These errorsand the logical inconsistencies that they introduced into the subsequent analysis led to the use of WCRBdata in conjunction with cost data and the Disallows/Rejects file to identify claims which had beendenied compensation. Reliance upon the WCRB appeal issues information was also not totally straight-forward due to confusion between an initial decision to deny the claim and a decision to deny reopeningof a claim which may be accompanied by a decision that there is no new compensable injury.27 Thelack of reliable reopening information made this confusion nearly impossible to clarify.

Ultimately, claims which were not in the Disallows/Rejects file, were identified as having been ini-tially disallowed or rejected based on the following rules: a) the claim had incurred zero days of wageloss and less than $1 in STD costs prior to the date of the WCB decision that was appealed to theWCRB, and b) one of the issues appealed to the WCRB was either “No Compensable Injury”, “NotWithin Scope of Part 1” or “Not Within Scope of Employment”.

In addition, where a reversal of the WCB decision to disallow or reject the claim was recorded inthe Disallows/Rejects file but the original decision to deny the claim was not, disallow or reject recordswere added to the data file.

The benefits received on a claim accepted for compensation were derived from the cost informationsupplied by the WCB. In order to classify claims by the benefits received a “claim benefit type” flagwas generated. The logic used was hierarchical. First, if a claim had incurred costs from fund type 4

25 “Corporate Data Inventory – System Information”, prepared by Maureen Charron, Feb. 18, 1998.26 For a complete description of the roles and responsibilities of the appeal bodies, see Samuels, S. (July 6, 1998)

“Appeals From WCB Claims Adjudication”.27 This confusion could be avoided if the decision regarding the possible new injury were recorded on a new claim num-

ber rather than the existing number.

22 Karen A. Ryan

(fatal) prior to the end of 1997, it was flagged “FTL”. Second, if a “FTL” claim had been reported as afatality after the end of the cohort year in which the claim was registered, the “FTL” flag was removed.Third, if no benefit type had been assigned and a claim had incurred costs from fund type 2 (LTD) priorto the end of 1997, it was flagged “LTD” (long-term disability). Fourth, if no benefit type had beenassigned and a claim had incurred costs from fund type 1 (STD) or fund type 5 (Voc. Rehab.) prior to theend of 1997, it was flagged “STD” (short-term disability).28 Fifth, if no benefit type had been assignedand a claim had incurred costs from fund type 3 (HCB) prior to the end of 1997, it was flagged “HCO”(health care only). Lastly, if no benefit type had been assigned by any of the previous steps, the claimwas flagged “NP” (not paid).

The method used to generate the claim benefit type flag has several implications. One, non-fatalclaims that were registered in a cohort year that became fatal claims in a subsequent cohort year areflagged with the claim benefit type that represents the benefits received on the non-fatal claim prior tothe death. Claims with a claim benefit type “FTL” were reported as fatalities during the current cohortyear and fatal benefits had been paid on the claim prior to the end of 1997. Two, claims that receivedlong-term disability payments may have also received STD and/or health care benefits. Similarly,claims that received short-term disability benefits may have also receive health care benefits. Claimsthat were flagged “HCO” only received health care benefits. It is important to note that health care onlyclaims are not necessarily claims accepted for compensation, as the WCB may pay health care costsincurred during the adjudication of the compensability of the claim. It must also be kept in mind that theaccuracy of the claim benefit type flag reflects the limitations of the cost information provided by theWCB.

Inconsistencies in the identifier information contained in source data led to data integration prob-lems when attempting to link historical claims information with pensions data. The source of this prob-lem is the failure to update the pensions systems when duplicate claimant identifiers are consolidated inthe Claims Registration system. If the current identifier is not added to the disability awards data files,pensions attached to the old or replaced identifier are dropped in the analysis of claimant pensions.

Difficulties were also encountered when integrating claims adjudication information due to differ-ences in the methods used by the WCRB and the Appeal Division of the WCB to record appeal issues.The lack of complete information regarding the issues appealed to the Appeal Division means that it isnot possible to recognize all of the WCRB findings that are appealed to that body or to calculate a pro-portion of Review Board findings that are appealed to the Appeal Division. It also leads to the unfortu-nately ambiguous Appeal Division finding “partial allow”.

28 The STD claim benefit type flag had the additional requirement that the sum of costs from either fund be greater than$1 or that the sum of days of wage loss be greater than 0.

Karen A. Ryan 23

Results

Fatal vs. Non-Fatal Cohort Claims

The 1994 cohort is comprised of 195,248 claims of which 195,060 (99.9%) were non-fatal claimsand 188 (0.1%) were fatal claims. Seventeen claimants who made at least one non-fatal claim in 1994also registered a separate fatal claim in 1994. In addition, eighteen non-fatal claims registered in 1994became fatal claims in 1995,1996 or 1997; that is, the subsequent death was attributed to the compens-able injury.29

The 1995 cohort is comprised of 191,665 claims of which 191,476 (99.9%) were non-fatal claimsand 189 (0.1%) were fatal claims. Thirteen claimants registered at least one non-fatal claim as well as afatal claim in 1995. Sixteen non-fatal 1995 claims became fatal claims in 1996 or 1997.30

Of the 186,892 claims in the 1996 cohort, 186,732 (99.9%) were non-fatal claims and 160 (0.1%)were fatal claims. Eleven claimants registered at least one non-fatal as well as a fatal claim in 1996. Sixnon-fatal 1996 claims became fatal claims in 1997.31

Only results relating to non-fatal claims will be presented in this paper. The small number of fatalclaims limited the potential of these claims to illuminate the operation of the adjudication and appealssystems. However, an understanding of decision-making surrounding fatal claims is non-trivial andwould benefit from a longitudinal research approach. In addition, although the relationship betweennon-fatal and fatal claims needs further exploration, the persistent pattern seen in the cohort data sug-gests the value of focused analysis of longitudinal, as opposed to cross-sectional, data for prevention/intervention purposes.

Characteristics of 1994 Non-Fatal Claims

Worker Characteristics

The 195,060 non-fatal cohort claims that were registered in 1994 were filed by 164,846 claimants.The average number of claims per claimant is 1.18 and the maximum number of claims filed by a singleclaimant during 1994 is 10.

Gender information was available for 86,788 (52.6%) claimants. Of these claimants, 75.9% aremale and 24.1% are female. The gender of the worker was known in relation to 56.1% of claims. Ofclaims, males filed 77.3% and females filed 22.7%, indicating that the male members of the cohortgroup contributed proportionally more claims to the sample than did the female members.

The age of the claimant at the time of the injury32 could be calculated for 194,177 claims. Theaverage age of claimants is 36.4 years and the median age is 35 years. The average age of claimants wassomewhat lower for males at 36.1 years and somewhat higher for females at 37.8 years. The distributionof claimant age at date of injury by gender is provided in Table 3.

29 Seventeen of these claims received fatal benefits (e.g., survivor’s pensions) prior to December 31, 1997.30 Each of these 16 claims received fatal benefits prior to December 31, 1997.31 Fatal benefits were paid on all six of these claims by the end of 1997.32 This is the official date of injury recognized by the WCB.

24 Karen A. Ryan

Marital status had been recorded for 61,147 claimants. Of these claimants, 51.3% were married,39.1% were single (never married), and 9.6% were divorced, separated or widowed.

Class of industry was available for approximately 40% of claims. The industry attached to a claimis based on the classification of the employer allocated the claim costs, not necessarily the reportingemployer. Also, a claim may be counted in more than one class of industry, or more than once in thesame class of industry, if claim costs have been allocated to multiple employers.33 Table 4 summarizesthe classes of industry responsible for costs arising from injuries to cohort claimants.

Table 3Age at Date of Injury by Gender and Age Group


Age GroupMale Female Unknown Gender

Count % Count % Count %

15 to 24 13,912 16.5% 3,593 14.5% 15,759 18.5%

25 to 34 28,284 33.5% 6,649 26.9% 25,844 30.4%

35 to 44 23,179 27.5% 7,127 28.8% 22,862 26.9%

45 to 54 12,422 14.7% 5,242 21.2% 13,658 16.0%

55 to 64 5,766 6.8% 2,028 8.2% 5,846 6.9%

65 to 74 620 0.7% 79 0.3% 849 1.0%

Over 74 146 0.2% 10 0.0% 302 0.4%

Total 84,329 100.0% 24,728 100.0% 85,120 100.0%

33 In Table 4, 340 claims are counted twice because costs had been allocated to two employers.

Table 4Claims by Class of Industry


Class of Industry Count Percentage

Light manufacturing, service and trade 35,843 44.7%

Heavy manufacturing and construction 17,038 21.2%

Forest-products industries 8,836 11.0%

Municipalities and school board 5,549 6.9%

Power and gas, communications, transportation 5,191 6.5%

Water transportation, wharf operations, fishing 2,294 2.9%

Government of the province of BC 2,157 2.7%

Canadian Pacific Ltd. and associated companies 970 1.2%

Mining; quarrying, and related 904 1.1%

Karen A. Ryan 25

34

Claimant occupation at the time of the injury was recorded for a total of 79,385 claims. The mostfrequent twenty occupations are listed in Table 5 along with the number of claims filed by claimantsworking in these occupations.

Dummy Industry34 502 0.6%

Financial institutions and business services 328 0.4%

Canadian National Railways, Air Canada, Via Rail 241 0.3%

Federal government 195 0.2%

Medical, dental offices 108 0.1%

Federal government job creation 29 0.0%

Unknown 7 0.0%

Burlington Northern Inc. 2 0.0%

Total 80,194 100.0%

34 Dummy codes are used when costs are not allocated to a specific employer or class.

Table 5Number of Claims by the Top 20 Occupations


Description of Occupation Count

Practical Nurse, Nurse's Aide, Ward Attendant 2,701

Truck Driver 2,424

Carpenter, Framer, Woodworker (Const.),Criber (Const.), Car Builder (Railroad Cars) 2,249

Dishwasher; Kitchen Worker; Busperson (Any Industry) 2,154

Retail Clerk; Sales Clerk; Deli Clerk (Retail Trade) 1,900

Chefs and Cooks 1,892

Warehouseman (Any Industry) 1,853

Labourer - Building Const., Construction Worker, Log Peeler - Const. 1,373

Custodian; Janitor; Caretaker (Church/School) 1,371

Welder (Any Industry - Includes Owner/Operators) 1,361

Registered Nurse 1,272

Heavy Duty Mechanic, Elevator Mech., Hydraulic Specialist, Motorboat/Small Motor Mech.

1,251

Mill Hand, Block Piler - Saw or Plan. Mills 1,250

Delivery Driver, Mover, Parts Delivery, Brewery Driver (From Brewery to LCB), Pilot Car Driver

1,115

26 Karen A. Ryan

Claim Characteristics

On average, 18.9 days elapsed from the “official”35 date of the injury to the date the claim was firstregistered. The median length of time to claim registration is 9 days.

The highest level or type of benefits paid on claims was derived from cost information and is basedon costs incurred on the claims to December 31, 1997. The frequency of claims according to claim ben-efit type is shown in Table 6.

The total and average health care and short-term disability (including both wage loss and voca-tional rehabilitation) benefits are shown for each benefit type in Table 7.36

Automobile Mechanic/Repairman, BCAA Mobile Repairman 999

Gardener, Greenskeeper, Landscaper, Nursery Worker, Labourer (Landscape Gardening) 890

Home Support Worker; House Maid; Home-maker (Any Industry) 764

Bucker, Faller, Limber - Logging 763

Waiter/Waitress, Server (Rest.) 727

Maintanance Man; Iceman/Zamboni Driver (Any Industry) 727

35 This is the date the WCB recognizes as the date of injury which means that, in some cases, the first claim registrationdate precedes the date of injury. When the “earliest” date of injury that is recorded on any claim subject to consolida-tion with a cohort claim is used in this calculation, the average length of time is 21.5 days. The median is 9 days.

Table 6Claims by Benefit Type1994 Non-Fatal Cohort

Description Count Percentage

Not Paid 24,788 12.7%

Health Care Only 88,615 45.4%

Short-Term Disability 78,361 40.2%

Long-Term Disability 3,296 1.7%

Total 195,060 100.0%

36 This analysis highlighted an error in the cost information when one disallowed claim showed $157,797.20 in healthcare costs. Further investigation by the WCB determined that this error arose due to the use of a “dummy” claim num-ber to record some transportation costs in 1990. In 1994, when the claim in question was registered (in relation to a1990 injury), there were no safeguards in place to prevent the Claims Registration System from assigning this“dummy” claim number to the new injury claim. All invalid costs attached to the claim (all but $49.40) were excludedfrom the analysis.

Karen A. Ryan 27

3738

Vocational rehabilitation benefits (included with STD benefits in the above table) were paid39 inrelation to 1,990 claims. The total VR costs showing on these claims is $33,100,837.19 or an average of$16,633.59 per claim. The median VR cost is $8,287.35. Approximately ten percent (218) of theseclaims received income continuity payments. The average number of days of income continuity is 151days, with a median of 140 days, and a total of 32,948 days.

The date wage loss was first paid was not known for all claims that had received wage loss. In rela-tion to 78,318 claims, an average of 40.5 days elapsed between the “official” date of injury and the dateof the first wage loss payment. The average length of time from date of registration to first wage losspayment is 27.6 days and the median is 13 days. The distribution of claims by the length of time fromclaim registration to first wage loss payment is shown in Figure 1.

Table 7Total and Average Health Care and STD Costs by Benefit Type


Benefit TypeHealth Care Benefits STD Benefits (Incl. VR)

Count Total $ Average $ Count Total $ Average $

Health Care Only 88,615 $12,116,466.07 $136.73

STD 76,708 $57,491,144.40 $749.4878,07937 $222,229,967.91 $2,846.22

LTD 3,283 $27,473,787.99 $8,368.502,52438 $64,038,377.03 $25,371.78

Total 168,606 $97,081,398.46 80,603 $286,268,344.94

37 The 282 STD claims that did not have STD costs had days of wage loss recorded for the claim indicating that wage losscosts had not bee recorded or had been reversed out of the cost data.

38 Most of the 772 claims that received LTD benefits but no STD benefits are hearing loss claims.39 Note that this count represents claims for which vocational rehabilitation benefits had been paid and not recovered

from a pension award prior to December 31, 1997. In particular, “Code R” income continuity payments were subjectto recovery.

28 Karen A. Ryan

In total, 3,047,760 days of wage loss were paid on STD and LTD claims, for an average of 37.7days of wage loss per claim. The median number of days of wage loss is much lower at 10. Figure 2shows the distribution of days of wage loss by time groups.

Injury

Nature of injury was recorded for 79,843 (40.9%) of the 195,060 claims. Over half (51.9%) ofclaims where this information was known involved a sprain or strain injury. The next most common, butfar less frequent (14.7%), type of injury involved contusions, crushing or bruises (soft tissue). Cuts, lac-erations and punctures accounted for 12.1% of claims and fractures accounted for 5%. All other typesof injuries were recorded for less than 5% of claims. Table 8 summarizes the frequency of injury types.

Figure 1Length of Time from Claim Registration to First Wage Loss Payment


0

5000

10000

15000

20000

25000

0 Days

1 Day2-3 Days

4-5 Days

6-7 Days

8-14 Days

15-21 Days

22-28 Days

29-60 Days

61-90 Days

3-4 Months

4-5 Months

5-6 Months

6-7 Months

7-8 Months

8-9 Months

9-10 Months

10-11 Months

11-12 Months

1-2 Years

2-3 Years

> 3 YearsLength of Time

Num

ber of Claim

s

Figure 2Days of Wage Loss by Time Groups


0

2000

4000

6000

8000

10000

12000

14000

1 Day 2-3 Days

4-5 Days

6-7 Days

8-14 Days

15-21 Days

22-28 Days

29-60 Days

61-90 Days

3-4 Months

4-5 Months

5-6 Months

6-7 Months

7-8 Months

8-9 Months

9-10 Months

10-11 Month

11-12 Month

1-2 Years

2-3 Years


Num

ber of Claim

s

Karen A. Ryan 29

Table 8

Claims by Nature of Injury1994 Non-Fatal Cohort

Nature of Injury Count Percentage

Sprains, Strains 41,456 51.9%Contusion, Crushing, Bruise (Soft Tissue) 11,734 14.7%Cut, Laceration, Puncture - Open Wound 9,636 12.1%Fracture 4,020 5.0%Tenosynovitis, Synovitis, Tendonitis 2,983 3.7%Scratches, Abrasions (Superficial Wound) 2,523 3.2%Burn or Scald (Heat) (Hot Substances) 1,543 1.9%Bursitis (Epicondylitis, Tennis Elbow) 1,333 1.7%Hearing Loss or Impairment 663 0.8%Carpal Tunnel Syndrome 527 0.7%Chemical Burn 484 0.6%Concussion - Brain, Cerebral 416 0.5%Hernia, Rupture (Inguinal & Noninguinal) 386 0.5%Dislocation 384 0.5%Stress 291 0.4%Radiation Effects Sunburn, Welding Flash 262 0.3%Lower Respiratory Inflammation 235 0.3%Dermatitis 220 0.3%Amputation or Enucleation 157 0.2%Poisoning, Systemic (Insect Stings) 108 0.1%Occupational Injury, NEC 83 0.1%Other Contagious/Infectious Disease, NEC 77 0.1%Electric Shock or Burns, Electrocution 74 0.1%Allergic Reaction 48 0.1%Freezing, Frostbite, Expos. to Low Temps. 44 0.1%Upper Respiratory Inflammation 39 0.0%Occupational Disease, NEC 34 0.0%Asbestosis 23 0.0%Heat Stroke, Sunstroke, Heat Exhaustion 21 0.0%Inflammation of Joints, Tendons, NEC 9 0.0%Conjunctivitis 9 0.0%Infected Blisters 6 0.0%Tuberculosis 3 0.0%Raynaud's Phenomenon 3 0.0%Heart Attack (Includes Stroke) 3 0.0%Non-Personal Damage (Artificial Limbs, etc.) 2 0.0%Silicosis (Mining) 1 0.0%Multiple Injuries 1 0.0%Silicosis (Not Mining) 1 0.0%Cancer 1 0.0%Total 79,843 100.0%

30 Karen A. Ryan

Most of the claims where injury type is known are claims that received STD benefits and the distri-bution of STD claims by injury type closely mirrors the results in Table 8. The injury type for claimsthat received LTD benefits is shown in Table 9. Notably, over one-fifth of the LTD claims received ben-efits for a hearing loss or impairment injury.

Table 9

LTD Claims by Nature of Injury1994 Non-Fatal Cohort


Sprains, Strains 671 22.7%Hearing Loss or Impairment 628 21.2%Fracture 609 20.6%Cut, Laceration, Puncture - Open Wound 427 14.4%Contusion, Crushing, Bruise (Soft Tissue) 257 8.7%Amputation or Enucleation 125 4.2%Tenosynovitis, Synovitis, Tendonitis 49 1.7%Dislocation 43 1.5%Burn or Scald (Heat) (Hot Substances) 36 1.2%Scratches, Abrasions (Superficial Wound) 23 0.8%Concussion - Brain, Cerebral 14 0.5%Occupational Injury, NEC 12 0.4%Asbestosis 12 0.4%Bursitis (Epicondylitis, Tennis Elbow) 10 0.3%Chemical Burn 6 0.2%Carpal Tunnel Syndrome 6 0.2%Electric Shock or Burns, Electrocution 5 0.2%Lower Respiratory Inflammation 4 0.1%Occupational Disease, NEC 3 0.1%Stress 3 0.1%Dermatitis 3 0.1%Freezing, Frostbite, Expos. to Low Temps 2 0.1%Multiple Injuries 1 0.0%Non-Personal Damage (Artiticial Limbs, etc.) 1 0.0%Hernia, Rupture (Inguinal & Noninjuinal) 1 0.0%Radiation Effects, Sunburn, Welding Flash 1 0.0%Silicosis (Mining) 1 0.0%Heart Attack (Includes Stroke) 1 0.0%Cancer 1 0.0%Raynaud's Phenomenon 1 0.0%Silicosis (Not Mining) 1 0.0%Upper Respiratory Inflammation 1 0.0%Total 2,958 100.0%

Karen A. Ryan 31

In nearly all cases in which hearing loss was recorded for a claim, the claim had received an LTDbenefit by the end of 1997. The number of claims receiving LTD benefits as a proportion of all injuriesreported in the top five categories is presented in Table 10.

Historical Claims

More than two-thirds (70.6%) of the claimants who registered a non-fatal claim in 1994 had previ-ously registered at least one claim with the WCB. In total these claimants had filed 670,529 claims priorto 1994, or an average of 5.8 claims per claimant. The median number of historical claims per claimantis 4 and the maximum number of claims filed by a single claimant is 77.

Pensions

Less than 2% of non-fatal claims registered in 1994 had received any type of long-term disabilitybenefit as a result of the claim by December 31, 1997. For the majority of these 3,296 claims a monthlypension award was established, but 36 claims received lump sum LTD payments classified as “cos-metic”, likely compensation for disfigurement under s 23(5) of the Workers Compensation Act.

LTD benefits were paid to 3,286 claimants. Most (89.4%) of these claimants are male. In eightcases, LTD benefits were paid on two claims registered by a claimant in 1994. One claimant hadreceived LTD benefits on three 1994 claims.

Approximately six percent of LTD benefit claimants had received LTD benefits in relation to aninjury claim made prior to 1994. The majority of these 204 claimants had received LTD benefits in rela-tion to one historical claim, but 13 had received LTD benefits in relation to two previous claims, twoclaimants were paid LTD benefits for three prior claims, and one claimant had received LTD benefits onfour historical claims.

By the close of 1997, monthly pensions had been awarded for 3,260 claims. A loss of earnings pen-sion40 was established for approximately 5% of these claims and for the remaining 3,093 claims, pen-sions based on permanent functional impairment41 were established. Pensions for permanent totaldisability were awarded in twenty-one cases.

Table 10

LTD Claims by Number of Claims in Top 5 Injury Types1994 Non-Fatal Cohort

Nature of Injury# of

Claims% of

Injuries# of LTDClaims

% ofClaims

Sprains, Strains 41,456 51.9% 671 1.6%

Contusion, Crushing, Bruise (Soft Tissue) 11,734 14.7% 257 2.2%

Cut, Laceration, Puncture - Open Wound 9,636 12.1% 427 4.4%

Fracture 4,020 5.0% 609 15.1%

Hearing Loss or Impairment 663 0.8% 628 94.7%

Total 67,509 84.5% 2,592 3.8%

40 Workers Compensation Act, s. 23(3).41 Workers Compensation Act, s. 23(1).

32 Karen A. Ryan

The length of time from the date the claim was registered to the date of the first pension awardestablished for the claim, by the type of pension awarded is shown in Figure 3. In general, loss of earn-ings (LOE) pensions took longer to establish than permanent functional impairment (PFI) awards, withan average number of months of 29.3 and 19.8, respectively.

Claimants who received a loss of earnings pension tended to be older at the time of the injury thanthose who received a permanent functional impairment pension. Sixty percent of the LOE pensionswere awarded to claimants between 55 and 64 years of age. The average age of claimants who receivedLOE awards is 55.6 years, while the average age of claimants who received PFI awards is 45.5 years.The distribution of the two types of awards by age groups is provided in Table 11.

The loss of earnings award is calculated based on the board’s assessment of the pre-injury wageless the assessed post-injury wage divided by the assessed pre-injury wage. The average percent loss of

Table 11

Comparison of Permanent Functional Impairment vs. Loss of EarningsPension Awards by Age at Date of Injury


Age Group PFI LOECount Percentage Count Percentage

15 to 24 201 6.5% 0 0.0%25 to 34 648 21.0% 5 3.0%35 to 44 759 24.5% 9 5.4%45 to 54 576 18.6% 44 26.3%55 to 64 504 16.3% 101 60.5%65 to 74 283 9.1% 7 4.2%Over 74 122 3.9% 1 0.6%Total 3093 100.0% 167 100.0%

Figure 3Number of Months from Date of Registration to Date of First Pension

Award by Type of Pension Award1994 Non-Fatal Cohort

0

200

400

600

800

1000

1200

1400

1600

<13 13-24 25-36 37-48

Number of Months

Num

ber of Claim

s

Functional

Loss of Earnings

Karen A. Ryan 33

earnings for the claimants42 who received a loss of earnings award is 43.6%. The minimum percentLOE is 5.5% and the maximum is 86.6%.

Where a loss of earnings pension is awarded, the board also maintains a record of the level, or per-centage, of permanent functional impairment suffered by the claimant. At 10.4% the average percentPFI is higher for claims that received a LOE pension than it is for claims that received a PFI awardwhere the average percent PFI is 5.2%.

Table 12 summarizes the average percent PFI for the two types of pension awards within the topfive injury categories. With the exception of hearing loss, the permanent functional impairment result-ing from these injuries is greater for recipients of LOE pensions than for recipients of PFI awards.

Because the board records both the percent PFI and the percent LOE for loss of earnings pensionawards, it is possible to compare these measures for claims that received LOE pensions. Figure 4 plotsthese figures and demonstrates that there is little relationship between these two measures of disability;that is, all levels of percent PFI are associated with all levels of percent LOE.

42 Percent loss of earnings could only be calculated for 114 of the 167 claims that received a loss of earnings award due tomissing data; that is, either the assessed pre-injury wage, the assessed post-injury wage, or both were missing.

Table 12

Permanent Functional Impairment vs. Loss of Earnings Pension Awardsby Nature of Injury for Top 5 Injury Types


Nature of Injury PFI LOE

Count Avg. % PFI Count Avg. % PFIHearing Loss or Impairment 628 1.6% 0 0.0%Sprains, Strains 594 4.5% 77 7.6%Fracture 569 7.0% 37 15.0%Cut, Laceration, Puncture - Open Wound 415 3.7% 3 23.9%Contusion, Crushing, Bruise (Soft Tissue) 241 7.0% 15 10.5%Total 1578 117

34 Karen A. Ryan

The costs associated with PFI and LOE pension awards differ markedly. On a per claim basis theaverage reserve amount put aside to cover an LOE pension is more than seven times larger than for a PFIpension. This information is summarized in Table 13.

Disclosure of Claim Files

Workers and employers are entitled to full disclosure of the claim file once either party has initiatedan appeal on the claim to one of the three appellate bodies. Full disclosure43 was requested by and pro-vided to workers 5,433 times in relation to 5,253 (2.7%) claims and employers 4,054 times in relation to3,927 (2.0%) claims. On average, full disclosure took 56.3 days. The median length of time fromrequest to full disclosure is 50 days and nearly ninety percent (87.2%) of full disclosures are completedwithin 90 days.

Update disclosures44 were provided to workers 2,376 times in relation to 1,703 files and to employ-ers 1,287 times in relation to 985 files. On average, the disclosure was updated 1.4 times for workersand 1.3 times for employers. The average length of time for an update disclosure is 26.2 days and themedian is 18 days.

Table 13

Pension Reserves for Permanent Functional Impairment vs. Loss of Earnings Pension Awards


Type of Award Total Awards Total Reserves Average Reserves

PFI 3,093 $80,363,287.08 $25,982.31

LOE 167 $32,876,346.39 $196,864.35

Total 3,260 $113,239,633.47 $34,736.08

43 A complete copy of the claim file.44 These are subsequent disclosures that supplement the original full disclosure.

Figure 4Percent LOE vs PFI for Claims with LOE Awards


0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

0 5 10 15 20 25 30

% Functional Impairment

% Loss of E

arnings

Karen A. Ryan 35

Workers’ Compensation Review Board Appeals

For most workers and employers, the Workers’ Compensation Review Board (the Review Board) isthe first level45 of appeal from claim decisions46 of the WCB.47 At least one appeal48 to the ReviewBoard was filed in relation to approximately three percent of the 195,060 non-fatal claims registered in1994. Workers initiated at least one Review Board appeal in relation to 5,535 (2.8%) claims andemployers filed at least one appeal in relation to 460 (0.2%) claims. In a handful of cases, both theworker and the employer filed at least one Review Board appeal on the claim.

Workers and employers initiated a total of 7,900 Review Board appeals prior to the end of 1997.49

These appeals involved a total of at least 9,099 disputed issues.50 Table 14 breaks down these figuresfor appeals initiated by workers and employers.

The issues under appeal were defined for 5,618 worker appeals and 258 employer appeals. Tables15 and 16 summarize the issues appealed by these two groups. For both types of appellant the most fre-quent issue appealed concerns the compensability of the claim; that is, entitlement to compensation ben-efits.

45 While workers and employers do have the option of appealing WCB claim decisions involving medical issues directlyto the Medical Review Panel, most do not because the MRP decision is final and binding.

46 That is, decisions made with respect to a worker that can be appealed to the Review Board under s. 90(1) of the Work-ers Compensation Act.

47 Dependents filed at least one Review Board appeal with respect to ten claims; however, dependent appeals are notincluded in the following discussion.

48 “Notice of Appeal - Part 1”.49 Issues were grouped into appeals according to the date the “Notice of Appeal - Part 1” was filed. This method differs

from that used by the Review Board to count appeals. The Review Board groups issues into appeals based on the deci-sions communicated by the WCB within the same decision letter. However, the Review Board often adjudicates issuesidentified in a single Notice of Appeal at the same time, regardless of the number of WCB decision letters that commu-nicated the decisions under appeal. For the purposes of the cohort analysis, the grouping of issues according to the Part1 date was preferable, as it more closely reflected the appellant’s experience of the process.

50 Because the Review Board does not normally electronically code the issue(s) under appeal until a “Notice of Appeal -Part 2” is filed, the specific issue appealed is missing in some cases. In these cases it was assumed that the appealinvolved at least one issue.

Table 14

Total and Average Number of Appeals Initiated atReview Board by Appellant


AppellantTotal # of Appeals

Average # of Appeals

Total # of Issues Appealed

Average # of Issues per Appeal

Worker 7,375 1.3 8,532 1.5

Employer 525 1.1 567 1.2

Total 7,900 9,099

36 Karen A. Ryan

51

Table 15

Worker Appeals to Review Board by Issue1994 Non-Fatal Cohort

Issue Description Count PercentageNo Compensable Injury 1,629 29.0%Wage Loss Benefits Terminated 888 15.8%Reopening Denied 784 14.0%Other 591 10.5%P.P.D. Award Insufficient 283 5.0%Rehab Benefits Insufficient 275 4.9%Rate of Compensation 273 4.9%Health Care Benefits 250 4.4%Wage Loss Benefits Denied 226 4.0%Limited Acceptance of Claim 137 2.4%P.P.D. Award Denied 124 2.2%Rehab Benefits Denied 92 1.6%No New Significant Info 30 0.5%Surgery Denied 13 0.2%Not Within Scope of Part 1 12 0.2%Not Within Scope of Employment 3 0.1%Commutation 3 0.1%Repair/Replacement Denied 3 0.1%Simple Appeal 2 0.0%Total 5,618 100.0%

51 The designation “EA” and “WA” provides perspective on the nature of the employer’s objection. For example, anemployer appeal of “rate of compensation” is ambiguous with respect to the desired outcome. An employer may objectthat the rate is too high (“EA”) or is too low (“WA”).

Table 16Employer Appeals to Review Board by Issue51


Issue Description Count PercentageEA: Compensable Injury 155 60.1%EA: Other 66 25.6%EA: Reopening 21 8.1%EA: Duration of Wage Loss Benefits 6 2.3%EA: P.P.D. Granted 4 1.6%WA: Wage Loss Benefits Terminated 2 0.8%EA: Cost Allocation (Claimant) 1 0.4%WA: No New Significant Info 1 0.4%WA: Rate of Compensation 1 0.4%WA: No Compensable Injury 1 0.4%Total 258 100.0%

Karen A. Ryan 37

An extension of time (EOT) problem was recorded for 824 (9.1%) appeal issues where the “Noticeof Appeal – Part 1” was filed more than 90 days after the decision that was being appealed was commu-nicated to the appellant.52 For workers, EOT problems were recorded for 769 (9.0%) appeal issues.EOT problems were recorded for 55 (9.7%) employer appeal issues.

The Review Board records both the date that the notice of appeal was “originally received”, forcases where the appellant sent the application to the WCB rather than the Review Board, and the datethat the notice of appeal was received by the Review Board.53 With reference to the “originallyreceived” date, the average number of days over the 90 day time limit is 161 (median is 90). Just under20% (18.3%) of cases with EOT problems were 28 days or less beyond the time limit. One-half (50.1%)of cases were 90 days or less beyond the time limit, over two-thirds (70.0%) were 6 months or lessbeyond, and 87.6% were 12 months or less beyond the 90 day time limit.

With reference to the date the notice of appeal was received by the Review Board, the average num-ber of days over the 90 day time limit is 172 (median is 99). Approximately one in six (16.3%) caseswith EOT problems were 28 days or less beyond the time limit. Less than one-half (46.8%) of caseswere 90 days or less beyond the time limit, two-thirds (67.8%) were 6 months or less beyond, and 85.7%were 12 months or less beyond the 90 day time limit.

EOT decisions were made in relation to 696 worker appeals and 44 employer appeals. EOT wasgranted in 555 (79.7%) worker appeals and 27 (61.4%) employer appeals.54

Summary decisions were made in relation to 2,996 (32.9%) appeal issues. As shown in Table 17,the most common summary decision involves the closing of an appeal because it has been abandoned orwithdrawn by the appellant. One-quarter (24.8%) of issues appealed by workers were abandoned orwithdrawn while nearly half (44.1%) of issues appealed by employers were dropped prior to a finding ofthe Review Board.

52 Section 90(1) of the Workers Compensation Act.53 Where the notice of appeal was sent to the Review Board these two dates are identical.54 EOT was denied in 141 worker appeals and 17 employer appeals. Each of these counts includes one case in which the

Review Board determined that the issue was not appealable.

Table 17

Summary Decisions on Review Board Appeal Issues by Appellant1994 Non-Fatal Cohort

Description TotalWorker Employer

Count Percent Count PercentAbandon/Withdraw 1006 846 31.6% 160 50.6%

Abandoned/Part 2 Not Received 1362 1272 47.5% 90 28.5%

Suspended 271 250 9.3% 21 6.6%

Extension Of Time Not Granted 156 140 5.2% 16 5.1%

Not Appealable 143 115 4.3% 28 8.9%

Resuspended 30 30 1.1% 0 0.0%

Suspended/Withdrawn 24 24 0.9% 0 0.0%

Initiated in Error 4 3 0.1% 1 0.3%

Total 2,996 2,680 100.0% 316 100.0%

38 Karen A. Ryan

Review Board decisions in relation to an additional 1,685 (19.7%) worker issues and 46 (8.1%)employer issues were in progress at the close of 1997.

The method of hearing the appeal – via oral hearing or read and review – was known for 5,802appeal issues. In three-quarters of these cases, an oral hearing had been held or had been scheduled. Anoral hearing was more likely for worker initiated appeals (76.5%) than employer appeals (41.9%).Three-person panels conduct over 90% of oral hearings held for either worker (94.9%) or employer(98.1%) initiated appeals. Nearly all read and review appeals were handled by three-member panels –98.5% of worker appeals and 100% of employer appeals.

Approximately half of the oral hearings of both worker (51.8%) and employer (52.8%) initiatedappeals were held “in town” at the Review Board offices.

Respondents were more likely to participate in an appeal when an oral hearing was held or sched-uled, and this was especially true for employer initiated appeals. Workers participated in over seventypercent of employer appeals that proceeded by way of oral hearing. These figures are provided in Table18.

Workers were represented at nearly three-quarters of oral hearings, usually by a union representa-tive. Employers were not represented at almost half of oral hearings. The most frequent employer repre-sentative is an officer of the company, followed by a consultant.

Table 18Participation of Respondent in Review Board Appeals

by Type of Appeal and Appellant1994 Non-Fatal Cohort

Appellant # of OH's Respondent Participating # of R&R's Respondent Participating

Count Percentage Count PercentageWorker 4245 2083 49.1% 1304 518 39.7%Employer 106 76 71.7% 147 69 46.9%

Table 19Representation at Review Board Oral Hearings

by Appellant and Representative Type1994 Non-Fatal Cohort

Description of RepresentativeAppellant

Worker EmployerCount Percent Count Percent

Adviser 682 16.1% 8 7.5%Consultant 142 3.3% 18 17.0%Employer Organization 0 0.0% 1 0.9%Friend/Relative 59 1.4% 0 0.0%Lawyer 398 9.4% 6 5.7%No Representative 1177 27.7% 50 47.2%Officer 0 0.0% 23 21.7%Politician 1 0.0% 0 0.0%Union 1786 42.1% 0 0.0%Total 4245 100.0% 106 100.0%

Karen A. Ryan 39

A Review Board panel had rendered findings in relation to 4,372 (48.0%) appeal issues by the closeof 1997.55 This percentage was somewhat lower for employer appeals where findings had been made inrelation to 36.2% of appeal issues. The proportion of appeal issues allowed or denied by the ReviewBoard is very similar for worker and employer initiated appeals. Allow findings were rendered for36.5% of worker appeal issues and 37.1% of employer issues. Over sixty percent of both worker andemployer appeal issues were denied by the Review Board.

Table 20 summarizes findings for appeals that were dealt with via oral hearing or read and review.For both workers and employers a greater proportion of appeal issues were allowed when the appealproceeded by way of oral hearing.

The following two tables show panel findings by the issue under appeal.56 The most successfulworker appeals involved WCB decisions to deny wage loss benefits on a claim. Other worker issues thatapproached an allow rate of 50%, were those that involved the sufficiency of vocational rehabilitationbenefits and the rate of compensation paid on a claim.

55 Decisions were either in progress or summary decisions had been made in relation to the remaining issues.

Table 20

Review Board Findings by Type of Appeal and Appellant1994 Non-Fatal Cohort

Appellant# of

OH'sAllowed Denied # of

R&R'sAllowed Denied

Count Percent Count Percent Count Percent Count PercentWorker 3,074 1,179 38.4% 1,895 61.6% 1,092 343 31.4% 749 68.6%Employer 76 34 44.7% 42 55.3% 129 42 32.6% 87 67.4%

56 The specific issue under appeal was not recorded in two cases.

Table 21

Worker Appeals to Review Board by Issue and Finding1994 Non-Fatal Cohort

Issue Description TotalAllowed Denied

Count Percent Count Percent

No Compensable Injury 1403 505 36.0% 898 64.0%

Wage Loss Benefits Terminated 641 208 32.4% 433 67.6%

Reopening Denied 549 199 36.2% 350 63.8%

Other 494 177 35.8% 317 64.2%

P.P.D. Award Insufficient 125 37 29.6% 88 70.4%

Rehab Benefits Insufficient 139 72 51.8% 67 48.2%

Rate of Compensation 222 108 48.6% 114 51.4%

Health Care Benefits 204 69 33.8% 135 66.2%

Wage Loss Benefits Denied 176 75 42.6% 101 57.4%

Limited Acceptance of Claim 44 14 31.8% 30 68.2%

40 Karen A. Ryan

On the whole, the proportion of specific employer appeal issues that were allowed and denied doesnot vary much from the overall allow rate of 37.1%. Notably, however, in three cases the employer hadobjected to decisions of the WCB from the perspective of the worker and in each of these cases theReview Board panel agreed.

The average number of days from the date of the WCB decision appealed to the date the “Notice ofAppeal – Part 1” was filed with the Review Board is 65 and the median length of time is 45 days. Onaverage a further 207 days elapse from the Part 1 date to the date the “Notice of Appeal - Part 2” wasfiled (median is 187). From the Part 2 date to the date the Review Board made its finding took an aver-age of 252 days (median is 224 days). Overall, the average number of days from the Part 1 date to thefinding date is 426 and the median is 395.

For appeals that were dealt with via oral hearing, the average number of days from the date the Part2 was filed to the hearing date is 175 days and the median is 157 days. From the oral hearing date to thefinding date is, on average, 102 days and the median is 78.

P.P.D. Award Denied 69 21 30.4% 48 69.6%

Rehab Benefits Denied 57 22 38.6% 35 61.4%

No New Significant Info 14 5 35.7% 9 64.3%

Surgery Denied 10 5 50.0% 5 50.0%

Not Within Scope of Part 1 10 4 40.0% 6 60.0%

Not Within Scope of Employment 3 0 0.0% 3 100.0%

Repair/Replacement Denied 3 0 0.0% 3 100.0%

Simple Appeal 2 1 50.0% 1 50.0%

Unknown 2 0 0.0% 2 100.0%

Total 4167 1522 36.5% 2645 63.5%

Table 22Employer Appeals to Review Board by Issue and Finding



Count Percent Count Percent

EA: Compensable Injury 130 48 36.9% 82 63.1%

EA: Other 53 18 34.0% 35 66.0%

EA: Reopening 14 5 35.7% 9 64.3%

EA: Duration of Wage Loss Benefits 4 2 50.0% 2 50.0%

EA: P.P.D. Granted 1 0 0.0% 1 100.0%

WA: Wage Loss Benefits Terminated 2 2 100.0% 0 0.0%

WA: Rate of Compensation 1 1 100.0% 0 0.0%

Total 205 76 37.1% 129 62.9%

Karen A. Ryan 41

Workers’ Compensation Board Appeal Division Appeals

The second level57 of appeal for most workers and employers who are dissatisfied with the findingsof the Review Board is the Workers’ Compensation Board Appeal Division (Appeal Division).58 Atleast one notice of intent to appeal a Review Board decision before the Appeal Division was filed inrelation to less than one percent of the 195,060 non-fatal claims registered in 1994. Workers initiated atleast one Appeal Division appeal in relation to 1,035 claims and employers filed at least one appeal inrelation to 130 claims.

A total of 1,170 notices of intent to appeal were filed with the Appeal Division prior to December31, 1997. Workers were responsible for 1,039 (88.8%) appeals and employers filed 131 (11.2%). Twoclaims each generated two worker appeals and one claim generated three worker appeals to the AppealDivision. One claim generated two employer appeals.

With respect to the 1,039 worker appeals, 112 (10.8%) were withdrawn or abandoned, 19 (1.8%)were denied an extension of time, four (0.4%) were rejected due to the absence of an appealable deci-sion, and 170 (16.4%) were in progress at the end of 1997. Appeal Division panels rendered final deci-sions on 734 (70.6%) worker appeals.

With respect to the 131 employer appeals, 25 (19.1%) were withdrawn or abandoned, one (0.8%)was rejected due to the absence of an appealable decision, and 10 (7.6%) were in progress. Final deci-sions were rendered for 95 (72.5%) employer appeals.

The appellant requested an extension of time (EOT) to appeal in relation to 60 (5.8%) workerappeals and 2 (1.5%) employer appeals. As a reason for the request 15 (25.0%) workers cited “unawareof time limit/procedure”, six (10.0%) reported “representative delayed submitting”, two (3.3%) claimed“out of town”, and in four cases (6.7%) the reason for the request was not recorded. The remaining 33(55.0%) worker requests and both employer requests cited “other” reasons.

The Appeal Division records the number of days the appeal application is beyond the time limit59

when the request for an extension of time is made. In relation to the 60 worker requests, the appealapplications are an average of 100 days beyond the time limit. The median is 46 days.60 The twoemployer requests were 30 days and 76 days beyond the time limit.

Decisions on the extension of time requests were made in relation to 48 worker requests and bothemployer requests. An Appeals Commissioner made the EOT decision for 25 worker requests and oneemployer request. The Appeals Manager made the decisions for 23 worker requests and one employerrequest. Of the 48 worker requests for EOT, 29 (60.4%) were allowed and, as noted above, 19 (39.6%)were denied. Both employer requests for EOT were allowed.

The Appeal Division electronically records a single issue for each appeal, and only where theappeal has reached a final conclusion.61 Table 23 shows the issues identified for worker and employerappeals. As was noted for Review Board appeals, the most frequent issue appealed to the Appeal Divi-sion involves the initial adjudication of the claim.

57 While workers and employers do have the option of appealing Review Board decisions involving medical issuesdirectly to the Medical Review Panel, most do not because the MRP decision is final and binding.

58 These appeals are filed under s. 91(1) of the Workers Compensation Act.59 Section 91(1) of the Workers Compensation Act allows for 30 days to appeal a finding of the Review Board.60 For 40% of worker requests for EOT the application is beyond the time limit by 28 days or less. For 70% of requests,

applications are beyond the time limit by 90 days or less, 83.3% are 6 months or less beyond the limit, and 95% are 12months or less beyond the time limit.

61 In a handful of cases, the issue was not recorded even when a final decision had been made.

42 Karen A. Ryan

Oral hearings by the Appeal Division were very rare. Only 38 (3.7%) worker appeals and three(2.3%) employer appeals had proceeded by way of oral hearing or were scheduled for oral hearing. Thereasons cited by workers who requested an oral hearing included: “present evidence orally”, 13(34.2%); “issue of credibility”, ten (26.3%); “other”, ten (26.3%); “English second language”, two(5.3%); “new evidence”, two (5.3%); and “error or confusion in decision”, one (2.6%). Two employerappeals cited “issue of credibility” and one cited “present evidence orally”.

Decisions had been rendered by the Appeal Division panels hearing the appeals orally for 33(86.9%) worker appeals and all three employer appeals. In eleven (33.3%) of these cases, workers werenot represented. Eight (24.2%) workers were represented by a worker advisor, six (18.2%) by a lawyer,four (12.1%) by a trade union representative, three (9.1%) by a consultant, and one (3.0%) by a law firm.An employer advisor represented one employer at an oral hearing.

Approximately one-half (51.5%) of the panels that heard worker initiated appeals were composedof three members and the remaining 16 appeals were heard by one-person panels. Two of the threeemployer initiated appeals were heard by three-person panels.

The majority of appeals proceeded by way of read and review. The number of cases in which theappellant was represented along with the type of representative is shown in Table 24.

Table 23

Appeal Division Appeals by Issue and Appellant1994 Non-Fatal Cohort

Issue

Appellant

Worker Employer

Count Percent Count PercentAdjudication of Reopening 106 10.2% 9 6.9%

Allow Care/Clothing/Subsist./Transp. 2 0.2% 0 0.0%

Assign/Withhold Benefits 4 0.4% 2 1.5%

Average Earnings 52 5.0% 3 2.3%

Coverage of Worker Under Act 7 0.7% 2 1.5%

Disfigurement Award 2 0.2% 0 0.0%

Initial Adj.- Industrial Disease 18 1.7% 1 0.8%

Initial Adj.- Personal Injury 332 32.0% 55 42.0%

Medical Aid 8 0.8% 0 0.0%

Misc - Overpayment, Ref. MRP, Late Filing 27 2.6% 0 0.0%

Permanent Disability Award 29 2.8% 0 0.0%

Rehabilitation 11 1.1% 3 2.3%

Review Board General 2 0.2% 0 0.0%

Temporary Disability Payment 132 12.7% 19 14.5%

Unknown 307 29.5% 37 28.2%

Total 1039 100.0% 131 100.0%

Karen A. Ryan 43

An Appeal Division panel had reached a final decision in relation to 714 worker and 94 employerread and review appeals. Just under one-half (48.9%) of these worker initiated appeals were dealt withby three-person panels and the remainder were handled by one-person panels. Two-thirds (67%) of theemployer initiated appeals were dealt with by three-member panels.

In total, final decisions were rendered for 734 worker appeals and 95 employer appeals. Workerappeals were allowed in 251 cases (34.2%), denied in 391 cases (53.3%), partially allowed in 90 cases(12.3%), and the appeal was referred to a Medical Review Panel62 in two cases (0.3%). In three casesthe original decision was reconsidered and overturned by the panel. One appeal that was originallyallowed was reconsidered and then denied, one appeal that was originally denied was subsequentlyallowed, and one appeal that was partially allowed was ultimately denied.

The allow rate for employer appeals was much lower than for worker appeals. Employer appealswere allowed in 11 cases (11.6%), denied in 80 cases (84.2%), and partially allowed in four cases(4.2%).


The following two tables summarize the outcomes of worker and employer appeals by the issueidentified in the appeal.63 The issues for which the allow rate for worker appeals approached orexceeded 50% were “coverage of worker under Act”, “initial adjudication of personal injury”, and“rehabilitation”.

Table 24

Appeal Division Read and Review Appeals by Appellant and Type of Representative


RepresentativeAppellant

Worker Employer

Count Percent Count PercentAgent 10 1.0% 0 0.0%Association 9 0.9% 2 1.6%Consultant 62 6.2% 43 33.6%Employer 0 0.0% 3 2.3%Employer Advisor 0 0.0% 10 7.8%Law Firm 44 4.4% 1 0.8%Lawyer 111 11.1% 7 5.5%No Representative 167 16.7% 62 48.4%Physician 1 0.1% 0 0.0%Trade Union 362 36.2% 0 0.0%Unknown 10 1.0% 0 0.0%Worker Advisor 220 22.0% 0 0.0%Worker Dependent 5 0.5% 0 0.0%Total 1001 100.0% 128 100.0%

62 Referral to the MRP is permitted under s. 58(5) of the Workers Compensation Act.63 The specific issue decided was not recorded for two worker appeals and one employer appeal.

44 Karen A. Ryan

64

The allow rate for employer appeals was consistently low across all appeal issues with the excep-tion of “coverage of worker under Act”. The Appeal Division panel allowed one of two appeals on thisissue.

Table 25

Worker Appeals to Appeal Division by Issue and Result1994 Non-Fatal Cohort

Issue Total Allow Deny Partial Allow

Count Percent Count Percent Count PercentAdjudication of Reopening 106 34 32.1% 61 57.5% 11 10.4%Allow Care/Clothing/Subsist./Transp. 2 0 0.0% 2 100.0% 0 0.0%Assign/Withhold Benefits 4 1 25.0% 3 75.0% 0 0.0%Average Earnings 52 19 36.5% 20 38.5% 13 25.0%Coverage of Worker Under Act 7 4 57.1% 3 42.9% 0 0.0%Disfigurement Award 2 0 0.0% 2 100.0% 0 0.0%Initial Adj.- Industrial Disease 17 6 35.3% 11 64.7% 0 0.0%Initial Adj.- Personal Injury 332 151 45.5% 162 48.8% 19 5.7%Medical Aid 8 1 12.5% 5 62.5% 2 25.0%Misc - Overpayment, Ref. MRP, Late Filing 27 2 7.4% 21 77.8% 4 14.8%Permanent Disability Award 29 4 13.8% 14 48.3% 11 37.9%Rehabilitation 11 6 54.5% 5 45.5% 0 0.0%Review Board General 2 0 0.0% 2 100.0% 0 0.0%Temporary Disability Payment 131 23 17.6% 79 60.3% 29 22.1%Unknown 2 0 0.0% 1 50.0% 1 50.0%

Total64 732 251 34.3% 391 53.4% 90 12.3%

64 Two worker appeals were referred to the Medical Review Panel.

Table 26

Employer Appeals to Appeal Division by Issue and Result1994 Non-Fatal Cohort


Count Percent Count Percent Count PercentAdjudication of Reopening 9 1 11.1% 8 88.9% 0 0.0%Assign/Withhold Benefits 2 0 0.0% 1 50.0% 1 50.0%Average Earnings 3 0 0.0% 2 66.7% 1 33.3%Coverage of Worker Under Act 2 1 50.0% 1 50.0% 0 0.0%Initial Adj.- Industrial Disease 1 0 0.0% 1 100.0% 0 0.0%Initial Adj.- Personal Injury 55 7 12.7% 47 85.5% 1 1.8%Rehabilitation 3 0 0.0% 3 100.0% 0 0.0%Temporary Disability Payment 19 2 10.5% 16 84.2% 1 5.3%Unknown 1 0 0.0% 1 100.0% 0 0.0%Total 95 11 11.6% 80 84.2% 4 4.2%

Karen A. Ryan 45

An average of 50 days (median is 38 days) elapsed from the date the notice of appeal was filed tothe date the appeal was commenced by the Appeal Division. From the commencement date to the dateof the Appeal Division final result took an average of 122 days (median is 91 days). Approximately48% of Appeal Division appeals were completed within 90 days of the commencement date. The aver-age number of days from the notification date to the date of the final result is 169 and the median is 150.

For appeals that were dealt with via oral hearing the average number of days from the date the oralhearing began to the date of the final appeal result is 44 days and the median is 28.

Medical Review Panels

At least one Medical Review Panel (MRP) appeal was filed in relation to 297 claims. In elevencases, workers filed two MRP appeals on the same claim, making a total of 308 appeals. The vastmajority (94.5%) of appeals were filed by workers. Employers filed fifteen appeals and the WCB itself,through the Appeal Division65, filed two appeals.

The number one source of decisions appealed to the MRP is the Appeal Division. This informationis summarized for each appellant type in the following table.

For both workers and employers the type of decision most frequently appealed to the MRPinvolved the initial adjudication of personal injury; that is, entitlement to compensation following a trau-matic injury. For workers, the second most common identified issue involved temporary disability pay-ments; that is, wage loss benefits. For employers, the next most common issue involved the initialadjudication of industrial disease. MRP appeals by issue and appellant are summarized in Table 28.

65 Permitted under s. 58(5) of the Workers Compensation Act.

Table 27

Appeals to Medical Review Panel by Source of DecisionAppealed and Appellant1994 Non-Fatal Cohort

Decision SourceAppellant

Worker Employer WCB

Count Percent Count Percent Count PercentAppeal Division 147 50.5% 12 80.0% 2 100.0%

Review Board 67 23.0% 2 13.3% 0 0.0%

Board Officer 77 26.5% 1 6.7% 0 0.0%

Total 291 100.0% 15 100.0% 2 100.0%

46 Karen A. Ryan

Strain/sprain (23.0%), degeneration (9.3%), and carpal tunnel syndrome (6.9%) were the mostcommon medical issues identified in worker appeals. Strain/sprain (20.0%) and tendinitis (20.0%) werethe most common medical issues identified in employers appeals. The two WCB appeals involved ten-dinitis and psychological problems.

Medical Review Panels are asked to make determinations of the extent and cause of the disablinginjury or disease.66 In relation to the majority of both worker (67.7%) and employer (80.0%) appeals adetermination of both extent and cause was requested from the panel. A determination of causation onlywas requested in relation to 23.0% of worker appeals and 13.3% of employer appeals. A determinationof extent only was requested in relation to 7.9% of workers appeals and 6.7% of employer appeals.67

One of the WCB appeals requested a determination of both extent and cause and the other a determina-tion of cause only.

The Medical Review Panel Department determined that twenty-five worker appeals (8.6%) and oneemployer appeal (6.7%) lacked a bona fide medical dispute and the appeals were rejected. Incompleteapplications led to the rejection of twelve worker appeals (4.1%) and two employer appeals (13.3%).Seventeen worker appeals (5.8%) were rejected because the time allowed to file the appeal had expired,and nineteen worker appeals (6.5%) were withdrawn. Eleven employer appeals (73.3%) and 145 workerappeals (49.8) were still in progress at the close of 1997.

The Medical Review Panel issued certificates in relation to 73 worker appeals (25.1%) prior to theend of 1997. Panel findings are recorded as “Does Not Confirm” (previous decision), “Confirm” (previ-ous decision), and “Partial Confirm” (previous decision). In effect a “Does Not Confirm” is an allow of

Table 28

Medical Review Panel Appeals by Issue and Appellant1994 Non-Fatal Cohort

IssueAppellant

Worker Employer WCB

Count Percent Count Percent Count PercentAdjudication of Re-opening 47 16.2% 0 0.0% 0 0.0%

Assign/Withhold Benefits 1 0.3% 0 0.0% 0 0.0%

Average Earnings 1 0.3% 0 0.0% 0 0.0%

Coverage of Worker Under Act 6 2.1% 0 0.0% 0 0.0%

Initial Adj. Industrial Disease 24 8.2% 2 13.3% 0 0.0%

Initial Adj. Personal Injury 82 28.2% 6 40.0% 1 50.0%

Medical Aid 2 0.7% 0 0.0% 0 0.0%

Permanent Disability Award 13 4.5% 0 0.0% 0 0.0%

Rehabilitation 1 0.3% 0 0.0% 0 0.0%

Temporary Disability Payment 55 18.9% 1 6.7% 1 50.0%

Unknown 59 20.3% 6 40.0% 0 0.0%

Total 291 100.0% 15 100.0% 2 100.0%

66 Section 61(1) of the Workers Compensation Act requires that the Medical Review Panel certify as to both the extent andcause of the disability, if any. However, the data collected by the MRP Department indicate that both determinationsare not requested in every case.

67 Whether the MRP was to determine extent or cause (or both) was missing in relation to four worker appeals.

Karen A. Ryan 47

the appeal, while “Confirm” is a denial. In half of the cases in which the panel issued a certificate theprevious decision was not confirmed. Panel decisions are summarized for worker appeals in Table 29.

An MRP had issued a certificate in relation to only one employer appeal. In this case the panelconfirmed the previous decision regarding the initial adjudication of personal injury.

For one WCB appeal, the MRP did not confirm the Appeal Division decision regarding the initialadjudication of personal injury. In the second WCB appeal, the MRP did confirm the Appeal Divisiondecision regarding temporary disability payment.

With regard to the most common medical issues cited in worker appeals, panels issued certificatesin relation to eighteen strain/sprain appeals. Panels did not confirm the previous decision in nine casesand confirmed the previous decision in nine cases. Certificates were issued in relation to thirteen degen-eration appeals. Panels did not confirm the previous decision in six cases and confirmed the previousdecision in seven cases. Certificates were issued for seven carpal tunnel syndrome appeals. Panels didnot confirm the previous decision in five cases and confirmed the previous decision in two cases.

The panel confirmed the previous decision in the single employer appeal, which involved a strain/sprain issue.

The average length of time from the application date to the date the enabling certificate wasreceived by the MRP is 39 days. The median length of time is zero days indicating that the enabling cer-tificate often accompanies the MRP application.

On average, 152 days (about five months) elapse from the date the enabling certificate is receivedto the date the MRP Department renders a decision regarding whether the appeal involves a bona fidemedical dispute. The median length of time is 150 days.

From the date the bona fide medical dispute determination is made to the date that the MedicalReview Panel issues a certificate, an average of 360 days pass. The median length of time is 357 days.

The average number of days from the date the enabling certificate is received to the date that theMedical Review Panel issues a certificate is 484 and the median is 498.

Table 29

Worker Appeals to Medical Review Panel by Issue and Panel Decision1994 Non-Fatal Cohort

Issue TotalDoes Not Confirm Confirm Partial Confirm

Count Percent Count Percent Count PercentAdjudication of Re-opening 14 10 71.4% 4 28.6% 0 0.0%

Assign/Withhold Benefits 1 0 0.0% 1 100.0% 0 0.0%

Initial Adj. Industrial Disease 10 4 40.0% 6 60.0% 0 0.0%

Initial Adj. Personal Injury 27 16 59.3% 10 37.0% 1 3.7%

Permanent Disability Award 1 0 0.0% 1 100.0% 0 0.0%

Temporary Disability Payment 20 7 35.0% 13 65.0% 0 0.0%

Total 73 37 50.7% 35 47.9% 1 1.4%

48 Karen A. Ryan

Adjudication of 1994 Non-Fatal Claims

Of particular interest to the commission was the experience of claimants as their claim is adjudi-cated by the WCB and up to three separate appeal bodies — the Workers’ Compensation Review Board,the WCB Appeal Division and the Medical Review Panel. The integration of data from these foursources provides a unique opportunity to answer questions about the overall system such as the volumeof claims that flow through the network of decision-makers, the outcomes achieved, and the length oftime it takes.

As reported above, a variety of decisions or issues may be appealed, however, because the WCBdoes not generally record many types adjudication decisions, it is impossible to know exactly how manydecisions have been made on a claim and therefore the proportion of board decisions that are appealed.One type of decision is made on the majority of claims68 and is usually recorded; that is the initial deci-sion to reject69 or disallow70 the claim. These decisions concerning entitlement to compensationaccount for the largest proportion of appeals filed with any of the appeal bodies. For these reasons, non-fatal claims were followed through the adjudicative phases as they relate to this single issue — the com-pensability of the claim. The initial adjudication of claims by the WCB and the flow of claims throughappeals initiated by both workers and employers are depicted in Figure 5 (Appendix 1).71

Initial Adjudication by WCB

The WCB initially rejected or disallowed 4.9% of the 195,060 non-fatal claims filed in 1994. Themajority of these 9,55772 claims (81.7%) were disallowed. The records indicate that the WCBreversed73 its decision in relation to 45 rejected claims and 276 disallowed claims, leaving a total of4.7% of non-fatal claims rejected or disallowed by the WCB. These 9,236 claims were subject to formalappeals by workers dissatisfied with the WCB decision.

The remaining 185,824 claims (95.3%) were not rejected or disallowed74 by the WCB and weresubject to appeals by employers dissatisfied with the WCB decision.

Workers’ Compensation Review Board Adjudication

Workers filed a Review Board appeal of the WCB decision to reject or disallow their claim in rela-tion to 1395 claims (15.1%). Approximately eight percent of these appeals were withdrawn, abandonedor suspended and just under three percent were in progress. Of the 1235 appeals with findings, 438(35.5%) were allowed and 797 (64.5) were denied. The Review Board decisions to allow the worker

68 In some cases, adjudication of a claim is suspended due to incomplete information from the claimant. The suspendedstatus of a claim is not recorded, however, and this status can only be inferred from the absence of a recorded decisionto reject or disallow the claim, coupled with a lack of benefits paid on the claim.

69 A claim is rejected when it is determined that either the worker or the employer is not covered under the Workers Com-pensation Act.

70 A claim is disallowed when it is determined that the injury is not covered under the Workers Compensation Act.71 The dotted lines in Figure 5 indicate the route of claims that do not proceed to the next step in the flow. In most cases

further appeals (either a re-filing of the original appeal or an appeal of a new issue) are possible. The dotted lines flowback into the total group of 1994 non-fatal claims that are then categorized according to the benefits received on theclaim prior to December 31, 1997.

72 This total includes claims recorded as rejected or disallowed in the WCB’s data plus 17 cases where a WCB reversal ofthe reject/disallow decision is recorded in the board’s data but not the original decision to reject/disallow the claim.Another 80 cases were added based on cost and appeals information, as described in the section “Data IntegrationIssues”. The totals also include one claim that was both rejected and disallowed by the WCB.

73 These reversals may be due to worker-requested manager reviews of the adjudicators’ decisions.74 Because some of the claims in this group were suspended prior to an initial adjudication decision, it is not possible to

talk about "accepted” claims.

Karen A. Ryan 49

appeals were subject to employer appeals to the Appeal Division or the MRP. Similarly, workers whoseReview Board appeal was denied can appeal the decision to the Appeal Division or the MRP.

Employers filed a Review Board appeal of the WCB decision to not reject or disallow the claim inrelation to 142 claims (.08%). Twenty-one appeals were withdrawn, abandoned or suspended and twowere in progress. Of the 119 appeals with findings, 45 (37.8%) were allowed and 74 (62.2%) weredenied. These decisions were subject to further appeals to the Appeal Division or the MRP by workersdissatisfied with the Review Board decision to allow the employer appeals75 and by employers dissatis-fied with the Review Board decision to deny their appeals.

For workers who appealed the WCB decision to reject or disallow their claims to the ReviewBoard76, the average length of time from the date of injury to the date of the WCB decision is 169 days.The median length of time is 98 days. In these same cases, the average length of time from the date ofclaim registration to the date of the WCB decision is 91 days and the median is 67 days. The averagenumber of days from the date of the WCB decision to the date the “Notice of Appeal — Part 1” wasfiled with the Review Board is 47 and the median length of time is 38 days. On average a further 208days elapse from the Part 1 date to the date the “Notice of Appeal — Part 2” was filed (median is 187).From the Part 2 date to the date the Review Board made its finding took an average of 228 days (medianis 200 days). Overall, the average number of days from the Part 1 date to the finding date is 425 and themedian is 385.

Workers’ Compensation Board Appeal Division Adjudication

Employers filed 44 (10.0%) Appeal Division appeals of the 438 Review Board decisions to allowthe workers’ appeals of the WCB decisions to reject or disallow the claims. Six of these appeals wereabandoned or withdrawn. Of the 38 appeals with final results, seven (18.4%) were allowed and 31(81.6%) were denied. Allow results were subject to worker appeals to the MRP and deny results weresubject to employer appeals to the MRP.

Workers filed 330 (41.4%) Appeal Division appeals of the 797 Review Board decisions to deny theworkers’ appeals of the WCB decisions to reject or disallow the claims. In four of these appeals anextension of time was denied, 23 appeals were withdrawn or abandoned and 21 were in progress. Of the282 appeals with final results, 122 (43.3%) were allowed, 18 (6.4%) were partially allowed, 141(50.0%) were denied, and one (0.4%) was referred to the MRP. Decisions to allow or partially allow theappeal were subject to employer appeals to the MRP. Decisions to deny or partially allow the appealwere subject to worker appeals to the MRP.

Moving to the lower half of Figure 5, workers filed 13 (17.6%) Appeal Division appeals of the 45Review Board decisions to allow the employers’ appeals of the WCB decisions to not reject or disallowthe claims. Three of these appeals were withdrawn or abandoned and one was in progress. Of the nineappeals with final results, six (66.7%) were allowed and three (33.3%) were denied. Allow decisionswere subject to employer appeals to the MRP and deny decisions were subject to worker appeals to theMRP.

Employers filed 15 (20.3%) Appeal Division appeals of the 74 Review Board decision to deny theemployers’ appeals of the WCB decision to not reject or disallow the claims. Two of these appeals werewithdrawn or abandoned. Of the 13 appeals with final results, one (7.7%) was allowed and 12 (92.3%)

75 In effect an allowed employer appeal of this issue means that the worker’s claim has been rejected or disallowed.76 The only source for the date of the WCB decision is the Review Board data, which records the date of the decision

under appeal. The Stats Disallows/Rejects database stores the date the reject/disallow record was added to the data-base, but due to problems with the process used to capture these decisions, the date added can be months or even yearsafter the decision was actually made.

50 Karen A. Ryan

were denied. Allow decisions were subject to worker appeals to the MRP and deny decisions were sub-ject to employer appeals to the MRP.

An average of 28 days (median is 27 days) elapsed from the date of the Review Board finding tothe date the appeal was filed with the Appeal Division. On average, 40 days (median is 33 days) passedfrom the filing date to the date the appeal was commenced by the Appeal Division. From the com-mencement date to the date of the Appeal Division final result took an average of 129 days (median is112 days). Approximately 40% of Appeal Division appeals were completed within 90 days of the com-mencement date. The average number of days from the filing date to the date of the final result is 168and the median is 151.

Medical Review Panel Adjudication

The initial decision of the WCB to reject or disallow the claim was appealed by workers directly tothe MRP in nineteen (0.2%) cases. Seven applications were not accepted for appeal and one was with-drawn. A panel certificate was issued in eleven cases (57.9%). The previous decision was not con-firmed in four (36.4%) cases, confirmed in six (54.5%), and partially confirmed in one (9.1%). Thesedecisions are final on this issue, meaning that in six cases the claims were effectively closed, while forfour claims the WCB would have to implement the MRP decision and the decisions the WCB makes indoing so are subject to appeal.

Employers appealed the WCB decision to not reject or disallow the claim directly to the MRP intwo cases. One of these appeals was in progress and the Medical Review Panel confirmed the WCBdecision in the other case.

Workers filed 19 MRP appeals (2.4%) of 797 Review Board decisions to deny the workers’ appealsof the WCB decisions to reject or disallow the claims. One of these appeals was withdrawn or resolvedand 10 were in progress. Of the eight appeals for which an MRP issued a certificate, the ReviewBoard’s decision were not confirmed in six (75.0%) and confirmed in two (25.0%).

Employers filed no appeals to the MRP of 438 Review Board decisions to allow the workers’appeals of the WCB decisions to reject or disallow the claims.

The lower half of Figure 5 shows that neither workers nor employers filed any MRP appeals ofReview Board decisions to allow or deny the employers’ appeals of WCB decisions not to reject or dis-allow the claims.

Continuing with the top portion of Figure 5, workers filed MRP appeals in relation to none of theseven Appeal Division decisions to allow the employers’ appeals of the Review Board decisions toallow the workers’ appeals of the WCB decision to reject or disallow the claims.

Employers filed one (3.2%) MRP appeal of the 31 Appeal Division decisions to deny the employ-ers’ appeals of the Review Board decisions to allow the workers’ appeals of the WCB decision to rejector disallow the claims. This appeal was still in progress at the close of 1997.

Employers filed no MRP appeals of Appeal Division decisions to allow or partially allow the work-ers’ appeals of the Review Board decisions to deny the workers’ appeals of the WCB decisions to rejector disallow the claims.

Workers filed MRP appeals in relation to two (11.1%) Appeal Division decisions to partially allowthe workers’ appeals of the Review Board decisions to deny the workers’ appeals of the WCB decisionsto reject or disallow the claims. One of these appeals was in progress and in the other the Appeal Divi-sion decision was confirmed by the MRP.

Karen A. Ryan 51

Workers filed 50 (35.5%) appeals to the MRP of 141 Appeal Division decisions to deny the work-ers’ appeals of Review Board decisions to deny the workers’ appeals of the WCB decision to reject ordisallow the claims. The Appeal Division referred another case to the MRP for a total of 51 (36.2%)worker MRP appeals arising from Appeal Division decisions relating to these Review Board decisions.Two of these appeals were withdrawn or resolved, ten were not accepted for appeal, two were being heldin abeyance and 23 were in progress. Panel certificates were issued in relation to 14 appeals. In half ofthese cases the previous decision was not confirmed and in half the decision was confirmed.

Returning to the lower portion of Figure 5, no employer MRP appeals were filed in relation toAppeal Division decisions to allow workers’ appeals of Review Board decisions to allow employers’appeals of WCB decisions to not reject or disallow the claims.

One (33.3%) worker appeal to the MRP was filed in relation to three Appeal Division decisions todeny the workers’ appeals of Review Board decisions to allow the employers’ appeals of the WCB deci-sions to not reject or disallow the claims. This single appeal was rejected due to a determination by theMRP Department that the appeal did not involve a bona fide medical dispute.

Neither workers nor employers filed any MRP appeals of Appeal Division decisions to allow ordeny the employers’ appeals of Review Board decisions to deny the employers’ appeals of the WCBdecisions to not reject or disallow the claims.

On average, 62 days passed from the date of the Appeal Division decision to the date the applica-tion to the MRP was filed. The median length of time is 65 days. The average length of time from theapplication date to the date the enabling certificate was received by the MRP is 61 days, however, themedian length of time is zero days indicating that the enabling certificate often accompanies the MRPapplication.

On average, 166 days (nearly six months) elapse from the date the enabling certificate is receivedto the date the MRP Department renders a decision regarding whether the appeal involves a bona fidemedical dispute. The median length of time is even longer at 178 days.

From the date the bona fide medical dispute determination is made to the date that the MedicalReview Panel issues a certificate, an average of 325 days pass. The median length of time is somewhatless at 288 days.


Summary

Workers appealed the WCB decision to reject or disallow their claims to either the Review Boardor the MRP (in the first instance) in 1,414 cases. Those workers who first appealed to the Review Boardmay have gone on to appeal the Review Board decision to the Appeal Division and/or the MRP. In total,after taking into account employer appeals of Review Board or Appeal Division decisions favoringworkers, 594 WCB decisions to reject or disallow the claims were overturned or partially overturned onappeal. Of the 1,414 workers who appealed to the Review Board or the MRP (in the first instance), 42%were successful in having their claims accepted or partially accepted for compensation by the end of1997. These 594 cases represent 6.4% of the 9,236 claims that were originally rejected or disallowed bythe WCB.

Employers appealed the WCB decision to not reject or disallow the workers’ claims to either theReview Board or the MRP (in the first instance) in 144 cases. Those employers who first appealed tothe Review Board may have gone on to appeal the Review Board decision to the Appeal Division and/orthe MRP. In total, after taking into account worker appeals of Review Board or Appeal Division deci-

52 Karen A. Ryan

sions favoring employers, 40 WCB decisions to not reject or disallow the workers’ claims were over-turned on appeal. Of the 144 employers who appealed to the Review Board or the MRP in the firstinstance, 27.8% were successful in having the claims rejected or disallowed for compensation. These 40cases represent .02%, or one in 5,000, of the 185,824 claims that were originally not rejected or disal-lowed by the WCB.

The original number of claims rejected or disallowed by the WCB (9,236) was reduced by 594 suc-cessful worker appeals, leaving 8,642 rejected or disallowed claims. Add to this figure the 40 employerappeals that were successful in having the claim rejected or disallowed and the final number of rejectedor disallowed claims is 8,682, or 4.5% of all non-fatal claims filed in 1994. The final number of claimsnot rejected or disallowed is 186,378, or 95.5% of all non-fatal claims filed in 1994.

For those claims that began with an appeal to the Review Board and concluded with an appeal tothe MRP, the average length of time from the date the Part 1 was filed with the Review Board to the datethe MRP issued its certificate is 1,020 days — nearly three years. The median number of days is higherat 1,040 days.

Karen A. Ryan 53



The 191,476 non-fatal cohort claims that were registered in 1995 were filed by 162,145 claimants.The average number of claims per claimant is 1.18 and the maximum number of claims filed by a singleclaimant during 1995 is 10.

Gender was recorded for 59,345 (36.6%) claimants. Of these claimants, 77.3% are male and22.7% are female. The gender of the worker was known in relation to 40.0% of claims. Males filed78.6% of claims and females filed 21.4%.

The age of the claimant at the time of the injury77 could be calculated for 190,515 claims. Theaverage age of claimants is 36.8 years and the median is 36 years. The average age of male claimants issomewhat lower at 37 years than for female claimants who had an average age of 38.6 years. Table 30summarizes claimant age at date of injury by gender.

Marital status was available for 21,657 claimants. Of these claimants, 51.4% were married, 39.0%were single (never married), and 9.6% were divorced, separated or widowed.

Class of industry was recorded for approximately 39% of claims. The industry attached to a claimis based on the classification of the employer allocated the claim costs, not necessarily the reportingemployer. Also, a claim may be counted in more than one class of industry, or more than once in thesame class of industry, if claim costs have been allocated to multiple employers.78 Table 31 summarizesthe classes of industry responsible for costs arising from injuries to cohort claimants.

77 This is the official date of injury recognized by the WCB.

Table 30

Age at Date of Injury by Gender and Age Group1995 Non-Fatal Cohort


Count % Count % Count %15 to 24 8,293 13.8% 1,971 12.1% 19,983 17.5%

25 to 34 19,650 32.7% 4,252 26.1% 34,442 30.2%

35 to 44 17,333 28.9% 4,907 30.2% 31,350 27.5%

45 to 54 9,563 15.9% 3,730 22.9% 19,233 16.8%

55 to 64 4,510 7.5% 1,345 8.3% 7,865 6.9%

65 to 74 544 0.9% 55 0.3% 1,016 0.9%

Over 74 157 0.3% 7 0.0% 309 0.3%

Total 60,050 100.0% 16,267 100.0% 114,198 100.0%

78 In Table 31, 417 claims are counted twice and 5 claims are counted three times because costs had been allocated tomore than one employer.

54 Karen A. Ryan

79












Canadian Pacific Ltd and associated companies 932 1.2%








Unknown 9 0.0%

Burlington Northern Inc. 1 0.0%

Total 74,576 100.0%

79 Dummy codes are used when costs are not allocated to a specific employer or class.

Table 32

Number of Claims by the Top 20 Occupations1995 Non-Fatal Cohort


Practical Nurse, Nurse's Aide, Ward Attendant 2,575Truck Driver 2,573Chefs and Cooks 1,921Dishwasher; Kitchen Worker; Busperson (Any Industry) 1,914Carpenter, Framer, Woodworker (Const.),Criber (Const.), Car Builder (Railroad Cars) 1,871Retail Clerk; Sales Clerk; Deli Clerk (Retail Trade) 1,748Warehouseman (Any Industry) 1,702Welder (Any Industry - Includes Owner/Operators) 1,479

Karen A. Ryan 55


On average, 20.6 days elapsed from the “official”80 date of the injury to the date the claim was firstregistered. The median length of time to claim registration is 8 days.

The highest level of benefits paid on 1995 cohort claims was derived from cost information and isbased on costs incurred on the claims to December 31, 1997. The type of benefits paid on the claims isshown in Table 33.

The total and average health care and short-term disability (including both wage loss and voca-tional rehabilitation) benefits are shown for each benefit type in Table 34.81

Custodian; Janitor; Caretaker (Church/School) 1,324Registered Nurse 1,231Heavy Duty Mechanic, Elevator Mech., Hydraulic Specialist, Motorboat/Small Motor Mech.

1,129

Mill Hand, Block Piler - Saw or Plan. Mills 1,087Automobile Mechanic/Repairman, BCAA Mobile Repairman 1,073Labourer - Building Const., Construction Worker, Log Peeler - Const. 1,070Gardener, Greenskeeper, Landscaper, Nursery Worker, Labourer (Landscape Gardening) 880Labourer - Road Gang, Highway Maintenance (Any Industry) 826Delivery Driver, Mover, Parts Delivery, Brewery Driver (From Brewery to LCB), Pilot Car Driver

776

Bucker, Faller, Limber - Logging 737Maintanance Man; Iceman/Zamboni Driver (Any Industry) 721Waiter/Waitress, Server (Rest.) 666

80 This is the date the WCB recognizes as the date of injury which means that, in some cases, the first claim registrationdate precedes the date of injury. When the “earliest” date of injury that is recorded on any claim subject to consolida-tion with a cohort claim is used in this calculation, the average length of time is 22.4 days. The median is 8 days.

Table 33

Claims by Benefit Type1995 Non-Fatal Cohort


Not Paid 23,976 12.5%




Total 191,476 100.0%

81 One claim showed $73,199.57 in health care only costs. Further investigation by the WCB determined that this errorarose due to the use of a “dummy” claim number to record “northern allowance adjustments” (paid to doctors) from1979 through 1994. When the cohort claim was registered it was assigned this previously used “dummy” claim num-ber. All invalid costs attached to the claim (all but $1,463.23) were excluded from the analysis.

56 Karen A. Ryan

Vocational rehabilitation benefits (included with STD benefits in Table 34) were paid82 in relationto 1,368 claims. The total VR costs showing on these claims is $17,953,125.01 or an average of$13,123.63 per claim. The median VR cost is $6,874.58. Income continuity payments were made on106 claims. The average number of days of income continuity is 106, with a median of 84 days, and atotal of 11,204 days.

83 84

The date wage loss was first paid was known in relation to 75,026 claims. For these claims an aver-age of 39.9 days elapsed between the official date of injury and the date of the first wage loss payment.The average length of time from the date of registration to the first wage loss payment is 27.4 days andthe median is 12 days. Figure 6 shows the distribution of claims by the length of time from claim regis-tration to first wage loss payment.

82 This count represents claims for which vocational rehabilitation benefits had been paid and not recovered from a pen-sion award prior to December 31, 1997. In particular, “Code R” income continuity payments were subject to recovery.

Table 34

Total and Average Health Care and STD Costs by Benefit Type1995 Non-Fatal Cohort


Count Total $ Average $ Count Total $ Average $Health Care Only 90,042 $11,549,754.46 $128.27STD 73,556 $61,560,229.16 $836.92 74,58683 $214,634,004.46 $2,877.67

LTD 2,389 $17,847,823.57 $7,470.83 1,74584 $32,465,504.96 $18,604.87

Total 165,987 $90,957,807.19 76,331 $247,099,509.42

83 The 474 STD claims that did not have STD costs had days of wage loss recorded for the claim indicating that wage losscosts had not been recorded or had been reversed out of the cost data.

84 Most of the 653 claims that received LTD benefits but no STD benefits are hearing loss claims.



0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

0 Days

1 Day 2-3 Days

4-5 Days

6-7 Days

8-14 Days

15-21 Days

22-28 Days

29-60 Days

61-90 Days

3-4 Months

4-5 Months

5-6 Months

6-7 Months

7-8 Months

8-9 Months

9-10 Months

10-11 Months

11-12 Months

1-2 Years

2-3 YearsLength of Time

Num

ber of Claim

s

Karen A. Ryan 57

In total, 2,684,172 days of wage loss were paid on STD and LTD claims, for an average of 35.1days of wage loss per claim. The median number of days of wage loss is much lower at 9. The distribu-tion of days of wage loss by time groups is shown in Figure 7.

Injury

Nature of injury was recorded for 74,173 (38.7%) of the 191,476 claims registered. Over half(51.2%) of claims where this information was known involved a sprain or strain injury. The next mostfrequent, but far less common (15.3%), type of injury involved contusions, crushing or bruises. Cuts,lacerations and punctures accounted for 12.2% of claims and fractures accounted for 5.3%. All othertypes of injury were recorded for less than 5% of claims. The frequency of injury types is summarizedin Table 35.

Table 35

Claims by Nature of Injury1995 Non-Fatal Cohort


Sprains, Strains 37,982 51.2%

Contusion, Crushing, Bruise (Soft Tissue) 11,337 15.3%

Cut, Laceration, Puncture - Open Wound 9,041 12.2%

Fracture 3,958 5.3%

Tenosynovitis, Synovitis, Tendonitis 2,634 3.6%

Scratches, Abrasions (Superficial Wound) 2,397 3.2%

Burn or Scald (Heat) (Hot Substances) 1,477 2.0%

Bursitis (Epicondylitis, Tennis Elbow) 1,211 1.6%

Hearing Loss or Impairment 575 0.8%

Chemical Burn 466 0.6%



0

2000

4000

6000

8000

10000

12000

14000

1 Day 2-3 Days

4-5 Days

6-7 Days

8-14 Days

15-21 Days

22-28 Days

29-60 Days

61-90 Days

3-4 Months

4-5 Months

5-6 Months

6-7 Months

7-8 Months

8-9 Months

9-10 Months

10-11 Month

11-12 Month

1-2 Years

2-3 Years


Num

ber of Claim

s

58 Karen A. Ryan

Most of the claims for which the nature of injury is recorded are claims that received STD benefitsand these claims are predominant in the above results. The nature of injury for claims that received LTDbenefits is presented in Table 36. One-quarter of LTD claims received benefits for a hearing loss orimpairment injury.

Concussion - Brain, Cerebral 400 0.5%

Dislocation 393 0.5%

Hernia, Rupture (Inguinal & Noninguinal) 366 0.5%

Carpal Tunnel Syndrome 349 0.5%

Radiation Effects Sunburn, Welding Flash 273 0.4%

Stress 248 0.3%

Lower Respiratory Inflammation 204 0.3%

Dermatitis 147 0.2%

Amputation or Enucleation 141 0.2%

Electric Shock or Burns, Electrocution 104 0.1%

Poisoning, Systemic (Insect Stings) 98 0.1%

Occupational Injury, NEC 66 0.1%

Freezing, Frostbite, Expos. to Low Temps. 54 0.1%

Allergic Reaction 49 0.1%

Occupational Disease, NEC 43 0.1%

Other Contagious/Infectious Disease, NEC 36 0.0%

Upper Respiratory Inflammation 27 0.0%

Asbestosis 27 0.0%

Inflammation of Joints, Tendons, NEC 16 0.0%

Conjunctivitis 14 0.0%

Heat Stroke, Sunstroke, Heat Exhaustion 12 0.0%

Infected Blisters 6 0.0%

Cancer 5 0.0%

Tuberculosis 3 0.0%

Raynaud's Phenomenon 3 0.0%

Heart Attack (Includes Stroke) 3 0.0%

Non-Personal Damage (Artificial Limbs, etc.) 2 0.0%

Silicosis (Mining) 2 0.0%

Sprains, Strains, Tears 2 0.0%

Injury or Illness, NEC 2 0.0%

Multiple Injuries 1 0.0%

Silicosis (Not Mining) 1 0.0%

Asphyxia, Strangulation, Drowning 1 0.0%

Total 74,173 100.0%

Karen A. Ryan 59

In nearly all cases in which hearing loss was recorded for a claim, the claim had received an LTDbenefit by the end of 1997. The number of claims receiving LTD benefits as a proportion of all injuriesreported in the top five categories is presented in Table 37.

Table 36

LTD Claims by Nature of Injury1995 Non-Fatal Cohort


Hearing Loss or Impairment 539 25.1%Fracture 409 19.1%Cut, Laceration, Puncture - Open Wound 379 17.7%Sprains, Strains 368 17.2%Contusion, Crushing, Bruise (Soft Tissue) 215 10.0%Amputation or Enucleation 107 5.0%Dislocation 24 1.1%Asbestosis 21 1.0%Tenosynovitis, Synovitis, Tendonitis 20 0.9%Burn or Scald (Heat) (Hot Substances) 15 0.7%Bursitis (Epicondylitis, Tennis Elbow) 14 0.7%Scratches, Abrasions (Superficial Wound) 13 0.6%Electric Shock or Burns, Electrocution 4 0.2%Occupational Injury, NEC 3 0.1%Concussion - Brain, Cerebral 3 0.1%Chemical Burn 2 0.1%Silicosis (Mining) 2 0.1%Carpal Tunnel Syndrome 1 0.0%Occupational Disease, NEC 1 0.0%Freezing, Frostbite, Expos. to Low Temps 1 0.0%Radiation Effects, Sunburn, Welding Flash 1 0.0%Raynaud's Phenomenon 1 0.0%Silicosis (Not Mining) 1 0.0%Inflammation of Joints, Tendons, NEC 1 0.0%Total 2,144 100.0%

Table 37LTD Claims by Number of Claims in Top 5 Injury Types


Nature of Injury # ofClaims

% ofInjuries

# of LTDClaims

% ofClaims

Sprains, Strains 37,982 51.2% 368 1.0%Contusion, Crushing, Bruise (Soft Tissue) 11,337 15.3% 215 1.9%Cut, Laceration, Puncture - Open Wound 9,041 12.2% 379 4.2%Fracture 3,958 5.3% 409 10.3%Hearing Loss or Impairment 575 0.8% 539 93.7%Total 62,893 84.8% 1,910 3.0%

60 Karen A. Ryan

Historical Claims

More than two-thirds (71.0%) of the claimants who registered a non-fatal claim in 1995 had previ-ously registered at least one claim with the WCB. In total these claimants had filed 676,366 claims priorto 1995, or an average of 5.9 claims per claimant. The median number of historical claims per claimantis 4 and the maximum number of claims filed by a single claimant is 78.

Pensions

Just over 1% of non-fatal claims registered in 1995 had received any type of long-term disabilitybenefit by December 31, 1997. For the majority of these 2,398 claims a monthly pension award wasestablished, but lump sum LTD payments labelled “cosmetic” were made in relation to 24 claims.85

LTD benefits were paid to 2,387 claimants. Most (91.7%) of these claimants are male. Elevenclaimants received LTD benefits on two claims registered in 1995.

Just over 6% of the claimants who received an LTD benefit in relation to a 1995 claim had receivedLTD benefits on claims filed prior to 1995. Most of these 151 claimants had one previous LTD benefitclaim, but 13 claimants had two prior LTD benefit claims and two claimants had three previous LTDbenefit claims.

Monthly pensions were established for 2,374 claims. In most cases (96.3%) the pension award wasbased on permanent functional impairment.86 Pensions for permanent total disability were establishedin seventeen cases. A loss of earnings87 pension was awarded in relation to 87 claims.

The length of time from the date the claim was registered to the date of the first pension awardestablished for the claim, by the type of pension awarded is shown in Figure 8. In general, loss of earn-ings (LOE) pensions took longer to establish than permanent functional impairment (PFI) awards, withan average number of months of 22.9 and 16, respectively.

85 These payments are likely compensation for disfigurement under s. 23(5) of the Workers Compensation Act. Two lumpsum payments were made on one claim.

86 Workers Compensation Act, s. 23(1).87 Workers Compensation Act, s. 23(3).

Figure 8Number of Months from Date of Registration to Date of First Pension

Award by Type of Pension Award1995 Non-Fatal Cohort

0

200

400

600

800

1000

1200

1400

<13 13-24 25-36

Number of Months

Num

ber of Claim

s

Functional

Loss of Earnings

Karen A. Ryan 61

Claimants who received a loss of earnings pension tended to be older at the time of the injury thanthose who received a permanent functional impairment pension. Nearly 70% of the LOE pensions wereawarded to claimants between 55 and 64 years of age. The average age of claimants who received LOEawards is 57.2 years, while the average age of claimants who received PFI awards is 47 years. The dis-tribution of the two types of awards by age groups is provided in Table 38.

A loss of earnings pension award is calculated based on the board’s assessment of the pre-injurywage less the assessed post-injury wage divided by the assessed pre-injury wage. The average percentloss of earnings for the claimants88 who received a loss of earnings pension is 44.5%. The minimumpercent LOE is 8% and the maximum is 88.1%.

Where a loss of earnings pension is awarded, the board also maintains a record of the level, or per-centage, of permanent functional impairment suffered by the claimant. The average percent PFI ishigher for claims that received a loss of earnings pension at 11.8% than for claims that received a PFIaward (5%).

The average percent PFI for the two types of pension awards within the top five injury categories issummarized in Table 39. With the exception of hearing loss or impairment claims, for which no LOEpensions were awarded, the permanent functional impairment resulting from these injuries is greater forrecipients of LOE awards than for recipients of PFI awards.

Table 38Comparison of Permanent Functional Impairment vs Loss of Earnings

Pension Awards by Age at Date of Injury1995 Non-Fatal Cohort



88 Percent LOE could only be calculated for 55 of the 87 claims that received a loss of earnings award due to missingdata; that is, either the assessed pre-injury wage, the assessed post-injury wage, or both were missing.

Table 39Permanent Functional Impairment vs Loss of Earnings Pension Awards

by Nature of Injury for Top 5 Injury Types1995 Non-Fatal Cohort

Nature of InjuryPFI LOE

Count Avg. % PFI Count Avg. % PFIHearing Loss or Impairment 539 1.6% 0 0.0%Fracture 394 7.6% 15 13.6%Cut, Laceration, Puncture - Open Wound 365 3.3% 5 33.0%Sprains, Strains 339 4.3% 29 8.1%Contusion, Crushing, Bruise (Soft Tissue) 200 7.6% 14 11.7%Total 1837 63

62 Karen A. Ryan

Figure 9 shows the relationship between the percent PFI and the percent LOE recorded for claimsthat were awarded LOE pensions. Relatively low levels of permanent functional impairment are associ-ated with all levels of percent loss of earnings.

There is a marked difference in the costs associated with PFI and LOE pensions. The averageamount reserved for an LOE pension is more than seven times greater than the average amount reservedto fund a PFI pension award. Table 40 summarizes this information.


Workers and employers are entitled to full disclosure of the claim file once either party has initiatedan appeal on the claim to one of the three appellate bodies. Full disclosure89 was requested by and pro-vided to workers 5,499 times in relation to 5,362 (2.8%) claims and employers 3,787 times in relation to3,720 (1.9%) claims. On average, full disclosure took 52.8 days. The median length of time fromrequest to full disclosure is 43 days and nearly ninety percent (87.4%) of full disclosures are completedwithin 90 days.

Update disclosures90 were provided to workers 1,672 times in relation to 1,346 files and to employ-ers 806 times in relation to 668 files. On average, the disclosure was updated 1.2 times for both workers

Table 40Pension Reserves for Permanent Functional Impairment

vs. Loss of Earnings Pension Awards1995 Non-Fatal Cohort

Type of Award Total Awards Total Reserves Average ReservesPFI 2287 $57,163,128.01 $24,994.81LOE 87 $15,789,837.41 $181,492.38Total 2374 $72,952,965.42 $30,729.98

89 A complete copy of the claim file.90 These are subsequent disclosures that supplement the original full disclosure.

Figure 9Percent LOE vs PFI for Claims with LOE Awards


0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

0 5 10 15 20 25 30 35 40 45 50

% Functional Impairment

% Loss of E

arnings

Karen A. Ryan 63

and employers. The average length of time for an update disclosure is 33.5 days and the median is 19days.


For most workers and employers, the Workers’ Compensation Review Board (the Review Board) isthe first level91 of appeal from claim decisions92 of the WCB.93 At least one appeal94 to the ReviewBoard was filed in relation to approximately three percent of the 191,476 non-fatal claims registered in1995. Workers initiated at least one Review Board appeal in relation to 5,222 (2.7%) claims andemployers filed at least one appeal in relation to 398 (0.2%) claims.



The issues under appeal were defined for 4,197 worker appeals and 180 employer appeals. Theissue most frequently appealed by both workers and employers concerns entitlement to compensationbenefits. More than one-third of worker issues and over one-half of employer issues involved WCBdecisions regarding the compensability of the claim. The issues appealed by the two appellant groupsare summarized in Tables 41 and 42.

91 While workers and employers do have the option of appealing WCB claim decisions involving medical issues directlyto the Medical Review Panel, most do not because the MRP decision is final and binding.

92 That is, decisions made with respect to a worker that can be appealed to the Review Board under s. 90(1) of the Work-ers Compensation Act.

93 Dependents filed at least one Review Board appeal with respect to six claims; however, dependent appeals are notincluded in the following discussion.

94 “Notice of Appeal - Part 1”.95 Issues were grouped into appeals according to the date the “Notice of Appeal - Part 1” was filed.96 Because the Review Board does not normally electronically code the issue(s) under appeal until a “Notice of Appeal -

Part 2” is filed, the specific issue appealed is missing in some cases. In these cases it was assumed that the appealinvolved at least one issue.

Table 41

Total and Average Number of Appeals Initiated at Worker's CompensationReview Board by Appellant


AppellantTotal # ofAppeals

Average # of Appeals


Average # ofIssues per Appeal

Worker 6,309 1.2 7,119 1.4

Employer 436 1.1 471 1.2

Total 6,745 7,590

64 Karen A. Ryan

97

Table 42Worker Appeals to Review Board by Issue


Issue Description Count Percentage

No Compensable Injury 1,583 37.7%Wage Loss Benefits Terminated 672 16.0%Reopening Denied 539 12.8%Other 283 6.7%Health Care Benefits 211 5.0%Rate of Compensation 206 4.9%Limited Acceptance of Claim 178 4.2%Wage Loss Benefits Denied 169 4.0%P.P.D. Award Insufficient 84 2.0%Rehab Benefits Insufficient 84 2.0%P.P.D. Award Denied 63 1.5%No New Significant Info 53 1.3%Rehab Benefits Denied 38 0.9%Surgery Denied 16 0.4%Not Within Scope of Employment 8 0.2%Not Within Scope of Part 1 6 0.1%Repair/Replacement Denied 3 0.1%Commutation 1 0.0%Total 4,197 100.0%

Table 43

Employer Appeals to Review Board by Issue97


Issue Description Count PercentageEA: Compensable Injury 99 55.0%EA: Other 38 21.1%EA: Duration of Wage Loss Benefits 19 10.6%EA: Reopening 13 7.2%EA: P.P.D. Granted 4 2.2%EA: Within Scope of Employment 3 1.7%EA: Cost Allocation (Claimant) 1 0.6%WA: Reopening Denied 1 0.6%WA: Not Within Scope of Part 1 1 0.6%WA: No Compensable Injury 1 0.6%Total 180 100.0%

97 The designation “EA” and “WA” provides perspective on thenature of the employer’s objection. For example, anemployer appeal of “rate of compensation” is ambiguous with respect to the desired outcome. An employer may objectthat the rate is too high (“EA”) or too low (“WA”).

Karen A. Ryan 65

An extension of time (EOT) problem was recorded for 609 (8.0%) appeal issues where the “Noticeof Appeal – Part 1” was filed more than 90 days after the decision that was being appealed was commu-

nicated to the appellant.98 For workers, EOT problems were recorded for 567 (8.0%) appeal issues.EOT problems were recorded for 42 (8.9%) employer appeal issues.

The Review Board records both the date that the notice of appeal was “originally received”, forcases where the appellant sent the application to the WCB rather than the Review Board, and the date

that the notice of appeal was received by the Review Board.99 With reference to the “originallyreceived” date, the average number of days over the 90 day time limit is 138 (median is 79). One in five(20.5%) cases with EOT problems were 28 days or less beyond the time limit. Over one-half (53.3%) ofcases were 90 days or less beyond the time limit, nearly three-quarters (72.0%) were 6 months or lessbeyond, and 90.3% were 12 months or less beyond the 90 day time limit.

With reference to the date the notice of appeal was received by the Review Board, the average num-ber of days over the 90 day time limit is 148 (median is 91). Approximately one in six (16.4%) caseswith EOT problems were 28 days or less beyond the time limit. One-half (50.0%) of cases were 90 daysor less beyond the time limit, over two-thirds (70.2%) were 6 months or less beyond, and 89.2% were 12months or less beyond the 90 day time limit.

EOT decisions were made in relation to 493 worker appeals and 32 employer appeals. EOT was

granted in 384 (77.9%) worker appeals and 25 (78.1%) employer appeals.100

Summary decisions were made in relation to 2,625 appeal issues. As shown in Table 44, the mostcommon summary decision involves the closing of an appeal because it has been abandoned or with-drawn by the appellant. More than one-quarter (27.9%) of issues appealed by workers were abandonedor withdrawn while nearly one-half (49.5%) issues appealed by employers were dropped.

98 Section 90(1) of the Workers Compensation Act.99 Where the notice of appeal was sent to the Review Board these two dates are identical.100EOT was denied in 109 worker appeals. This count includes one case in which the appeal was abandoned or with-

drawn by the appellant.

Table 44Summary Decisions on Review Board Appeals/Issues by Appellant



Count Percent Count PercentAbandoned/Part 2 Not Received 1,433 1,315 55.6% 118 45.4%

Abandon/Withdraw 789 674 28.5% 115 44.2%

Suspended 161 156 6.6% 5 1.9%


Not Appealable 91 78 3.3% 13 5.0%

Resuspended 26 26 1.1% 0 0.0%



Total 2,625 2,365 100.0% 260 100.0%

66 Karen A. Ryan

Review Board decisions in relation to an additional 2,190 (30.8%) worker issues and 93 (19.7%)employer issues were in progress at the end of 1997.

The method of hearing the appeal – via oral hearing or read and review – was known for 4,363appeal issues. In almost three-quarters of these cases, an oral hearing was held or had been scheduled.Oral hearings were more likely for worker initiated appeals (75.2%) than employer appeals (39.2%).Three-person panels conduct nearly 90% of oral hearings held for either worker (87.9%) or employer(87.3%) initiated appeals. Nearly all read and review appeals were handled by three-member panels –99.3% of worker appeals and 100% of employer appeals.

Approximately half of the oral hearings of both worker (55.6%) and employer (50.7%) initiatedappeals were held “in town” at the Review Board offices.

Respondents were more likely to participate in the appeal when an oral hearing was held or sched-uled. Workers were more likely than employers to participate in both types of hearing, but especiallyoral hearings where workers participated in nearly 65% of employer appeals.

Workers were represented at over three-quarters of the oral hearings, often by a union representa-tive. Employers were represented at approximately 60% of oral hearings, most often by a consultant oran officer of the company.



Appellant # of OH'sRespondent Participating

# of R&R'sRespondent Participating

Count Percentage Count PercentageWorker 3143 1544 49.1% 1039 418 40.2%

Employer 71 46 64.8% 110 50 45.5%



Description of RepresentativeAppellant

Worker Employer

Count Percent Count PercentAdviser 420 13.4% 5 7.0%Consultant 133 4.2% 17 23.9%Employer Organization 0 0.0% 1 1.4%Friend/Relative 62 2.0% 0 0.0%Lawyer 232 7.4% 5 7.0%No Representative 752 23.9% 28 39.4%Officer 1 0.0% 15 21.1%Union 1543 49.1% 0 0.0%Total 3143 100.0% 71 100.0%

Karen A. Ryan 67

A Review Board panel had rendered findings in relation to 2,682 (35.3%) appeal issues by the endof 1997.101 This percentage was somewhat lower for employer appeals where findings had been madein relation to 25.1% of appeal issues. More worker than employer initiated appeal issues were allowedby the Review Board. Allow findings were rendered for 41.8% of worker issues and 28.8% of employerissues.

Table 47 summarizes findings for appeals that were dealt with via oral hearing or read and review.For worker initiated appeals, more appeal issues were allowed when the appeal proceeded by way oforal hearing rather than by way of read and review. For employer initiated appeals the allow rate did notvary according to the type of appeal.

The following two tables show panel findings by the issue under appeal.102 The most successfulworker appeal issues involved WCB decisions to deny compensation on a claim because the injury wasnot within the scope of employment and the sufficiency of vocational rehabilitation benefits.

101Decisions were either in progress or summary decisions had been made in relation to the remaining issues.

Table 47Review Board Findings by Type of Appeal and Appellant


Appellant# of


R&R'sAllowed Denied

Count Percent Count Percent Count Percent Count PercentWorker 1,796 795 44.3% 1,001 55.7% 768 277 36.1% 491 63.9%Employer 36 10 27.8% 26 72.2% 82 24 29.3% 58 70.7%

102The specific issue under appeal was not recorded in four cases.

Table 48Worker Appeals to Review Board by Issue and Finding


Issue Description Total Allowed DeniedCount Percent Count Percent

No Compensable Injury 1140 467 41.0% 673 59.0%Wage Loss Benefits Terminated 366 144 39.3% 222 60.7%Reopening Denied 288 134 46.5% 154 53.5%Other 193 79 40.9% 114 59.1%Rate of Compensation 144 68 47.2% 76 52.8%Health Care Benefits 142 59 41.5% 83 58.5%Wage Loss Benefits Denied 102 46 45.1% 56 54.9%Limited Acceptance of Claim 45 21 46.7% 24 53.3%P.P.D. Award Denied 28 10 35.7% 18 64.3%No New Significant Info 24 9 37.5% 15 62.5%P.P.D. Award Insufficient 22 4 18.2% 18 81.8%Rehab Benefits Insufficient 21 11 52.4% 10 47.6%Rehab Benefits Denied 20 9 45.0% 11 55.0%Surgery Denied 8 3 37.5% 5 62.5%Not Within Scope of Employment 7 5 71.4% 2 28.6%Not Within Scope of Part 1 6 0 0.0% 6 100.0%No Issue Defined 4 2 50.0% 2 50.0%Repair/Replacement Denied 3 0 0.0% 3 100.0%Commutation 1 1 100.0% 0 0.0%Total 2564 1072 41.8% 1492 58.2%

68 Karen A. Ryan

The most successful employer appeal issue involved WCB decisions to reopen the claim for wageloss.


For appeals that were dealt with via oral hearing, the average number of days from the date the Part2 was filed to the hearing date is 199 days and the median is 189 days. From the oral hearing date to thefinding date is, on average, 111 days and the median is 89.


The second level103 of appeal for most workers and employers who are dissatisfied with the find-ings of the Review Board is the Workers’ Compensation Board Appeal Division (Appeal Division).104

At least one notice of intent to appeal a Review Board decision before the Appeal Division was filed inrelation to less than half of one percent of the 191,476 non-fatal claims registered in 1995. Workers ini-tiated at least one Appeal Division appeal in relation to 652 claims and employers filed at least oneappeal in relation to 102 claims.

A total of 755 notices of intent to appeal were filed at the Appeal Division prior to December 31,1997. Workers were responsible for 653 (86.5%) appeals and employers filed 102 (13.5%). One claimgenerated two worker appeals.

With respect to the 653 worker appeals, 54 (8.3%) were withdrawn or abandoned, 6 (0.9%) weredenied an extension of time, three (0.5%) were rejected due to the absence of an appealable decision,and 219 (33.5%) were in progress at the end of 1997. Appeal Division panels rendered final decisions on371 (56.8%) worker appeals.




Count Percent Count PercentEA: Compensable Injury 75 18 24.0% 57 76.0%

EA: Other 29 10 34.5% 19 65.5%


EA: Reopening 3 3 100.0% 0 0.0%

EA: Within Scope of Employment 2 1 50.0% 1 50.0%

WA: No Compensable Injury 1 0 0.0% 1 100.0%

Total 118 34 28.8% 84 71.2%

103While workers and employers do have the option of appealing Review Board decisions involving medical issuesdirectly to the Medical Review Panel, most do not because the MRP decision is final and binding.

104These appeals are filed under s. 91(1) of the Workers Compensation Act.

Karen A. Ryan 69

With respect to the 102 employer appeals, 21 (20.6%) were withdrawn or abandoned, one (1.0%)was denied an extension of time, one (1.0%) was rejected due to the absence of an appealable decision,and 26 (25.5%) were in progress. Final decisions were rendered for 53 (52.0%) employer appeals.

The appellant requested an extension of time (EOT) to appeal in relation to 50 (7.7%) workerappeals and 2 (2.0%) employer appeals. As a reason for the request 7 (14.0%) workers cited “unawareof time limit/procedure”, five (10.0%) reported “representative delayed submitting”, two (4.0%)claimed “out of town”, and in nine cases (18.0%) the reason for the request was not recorded. Theremaining 27 (54.0%) worker requests and both employer requests cited “other” reasons.


when the request for an extension of time is made. In relation to the 50 worker requests, the appealapplications are an average of 53.5 days beyond the time limit. The median is 28 days.106 The twoemployer requests were 1 day and 7 days beyond the time limit.

Decisions on the extension of time requests were made in relation to 30 worker requests and bothemployer requests. An Appeals Commissioner made the EOT decision for 24 worker requests and oneemployer request. The Appeals Manager made the decision for 6 worker requests and one employerrequest. Of the 30 worker requests for EOT, 24 (80.0%) were allowed and, as noted above, 6 (20.0%)were denied. One employer request for EOT was allowed and one was denied.

The Appeal Division electronically records a single issue for each appeal, and only where theappeal has reached a final conclusion.107 Table 50 shows the issues identified for worker and employerappeals. As was noted for Review Board appeals, the most frequent issue appealed to the Appeal Divi-sion involves the initial adjudication of the compensability of the claim.

105Section 91(1) of the Workers Compensation Act allows for 30 days to appeal a finding of the Review Board.106Nearly one-half (48.0%) of worker applications for EOT were 28 days or less beyond the time limit. Over two-thirds

(84.0%) were 90 days or less beyond the limit, 90% were 6 months or less beyond the limit, and the remaining caseswere 12 months or less beyond the 30 day time limit.

107In a handful of cases, the issue was not recorded even when a final decision had been rendered.

Table 50Appeal Division Appeals by Issue and Appellant


IssueAppellant


Adjudication of Reopening 31 4.7% 5 4.9%Allow Care/Clothing/Subsist./Transp. 1 0.2% 0 0.0%Assign/Withhold Benefits 2 0.3% 0 0.0%Average Earnings 27 4.1% 0 0.0%Coverage of Worker Under Act 1 0.2% 0 0.0%Initial Adj.- Industrial Disease 10 1.5% 1 1.0%Initial Adj.- Personal Injury 196 30.0% 35 34.3%Medical Aid 5 0.8% 0 0.0%Misc - Overpayment, Ref. MRP, Late Filing 17 2.6% 3 2.9%Permanent Disability Award 13 2.0% 0 0.0%Rehabilitation 4 0.6% 1 1.0%Review Board General 5 0.8% 0 0.0%Temporary Disability Payment 57 8.7% 8 7.8%Unknown 284 43.5% 49 48.0%Total 653 100.0% 102 100.0%

70 Karen A. Ryan

Oral hearings by the Appeal Division were very rare. Only 23 (3.5%) worker appeals and two(2.0%) employer appeals had proceeded by way of oral hearing or were scheduled for oral hearing. Thereasons cited by workers who requested an oral hearing included: “present evidence orally”, 15(65.2%); “issue of credibility”, four (17.4%); and “other”, four (17.4%). One employer appeal cited“present evidence orally” and one cited “other”.

Decisions had been rendered by the Appeal Division panels hearing the appeals orally for 21(91.3%) worker appeals and both employer appeals. In nine (42.9%) of these cases, workers were notrepresented. Seven (33.3%) workers were represented by a worker advisor, three (14.3%) by a consult-ant, one (4.8%) by a lawyer, and one (4.8%) by a trade union representative. An employer advisor rep-resented one employer at an oral hearing.

The majority (61.9%) of the panels that heard worker initiated appeals were composed of onemember and the remaining eight appeals were heard by three-person panels. Both of the employer initi-ated appeals were heard by three-person panels.


An Appeal Division panel had reached a final decision in relation to 353 worker and 51 employerread and review appeals. Just over one-half (51.6%) of these worker initiated appeals were dealt with bythree-person panels and the remainder were handled by one-person panels. Most (80.4%) of theemployer initiated appeals were dealt with by three-member panels.

In total, final decisions were rendered for 371 worker appeals and 53 employer appeals. Workerappeals were allowed in 136 cases (36.7%), denied in 200 cases (53.9%), partially allowed in 34 cases

Table 51Appeal Division Read and Review Appeals by Appellant and Type of Representative



Worker Employer

Count Percent Count PercentAgent 12 1.9% 0 0.0%

Association 7 1.1% 0 0.0%

Consultant 54 8.6% 26 26.0%

Employer 0 0.0% 3 3.0%

Employer Advisor 0 0.0% 14 14.0%

Law Firm 30 4.8% 0 0.0%

Lawyer 40 6.3% 6 6.0%

No Representative 128 20.3% 51 51.0%

Worker 3 0.5% 0 0.0%

Trade Union 233 37.0% 0 0.0%

Unknown 9 1.4% 0 0.0%

Worker Advisor 111 17.6% 0 0.0%

Worker Dependent 3 0.5% 0 0.0%

Total 630 100.0% 100 100.0%

Karen A. Ryan 71

(9.2%), and the appeal was referred to a Medical Review Panel in one case (0.3%). In one case the orig-inal decision to allow the appeal was reconsidered and confirmed by the panel.

The allow rate for employer appeals was much lower than for worker appeals. Employer appealswere allowed in four cases (7.5%), denied in 45 cases (84.9%), and partially allowed in four cases(7.5%).


The following two tables summarize the outcomes of worker and employer appeals by the issueidentified in the appeal.108 The issue appealed by a sizeable number of workers and for which the allowrate approached 50% was “initial adjudication of personal injury”.

109

The allow rate for employer appeals was consistently low across all appeal issues with the excep-tion of “initial adjudication of industrial disease” where the Appeal Division allowed the single appealon this issue.

108The specific issue decided was not recorded for two worker appeals.

Table 52Worker Appeals to Appeal Division by Issue and Result


Issue TotalAllow Deny Partial Allow

Count Percent Count Percent Count PercentAdjudication of Reopening 31 8 25.8% 21 67.7% 2 6.5%

Allow Care/Clothing/Subsist./Transp. 1 1 100.0% 0 0.0% 0 0.0%

Assign/Withhold Benefits 2 1 50.0% 1 50.0% 0 0.0%

Average Earnings 27 8 29.6% 15 55.6% 4 14.8%

Coverage of Worker Under Act 1 0 0.0% 1 100.0% 0 0.0%

Initial Adj.— Industrial Disease 10 2 20.0% 8 80.0% 0 0.0%

Initial Adj.— Personal Injury 195 92 47.2% 88 45.1% 15 7.7%

Medical Aid 5 1 20.0% 4 80.0% 0 0.0%

Misc — Overpayment, Ref. MRP, Late Filing

17 1 5.9% 15 88.2% 1 5.9%

Permanent Disability Award 13 3 23.1% 8 61.5% 2 15.4%

Rehabilitation 4 1 25.0% 2 50.0% 1 25.0%

Review Board General 5 1 20.0% 4 80.0% 0 0.0%

Temporary Disability Payment 57 16 28.1% 32 56.1% 9 15.8%

Unknown 2 1 50.0% 1 50.0% 0 0.0%

Total109 370 136 36.8% 200 54.1% 34 9.2%

109One worker appeal was referred to the Medical Review Panel.

72 Karen A. Ryan

An average of 50 days (median is 41 days) elapsed from the date the notice of appeal was filed tothe date the appeal was commenced by the Appeal Division. From the commencement date to the dateof the Appeal Division final result took an average of 115 days (median is 90 days). Approximately53.2% of Appeal Division appeals were completed within 90 days of the commencement date. Theaverage number of days from the notification date to the date of the final result is 164 and the median is147.

For appeals that were dealt with via oral hearing the average number of days from the date the oralhearing began to the date of the final appeal result is 29 days and the median is 13.

Medical Review Panel Appeals

At least one Medical Review Panel (MRP) appeal was filed in relation to 149 claims. In two cases,workers filed two MRP appeals on the same claim, making a total of 151 appeals. The vast majority(96.0%) of appeals were filed by workers. Employers filed five appeals and the WCB itself, through theAppeal Division110, filed one appeal.

The largest source of decisions appealed by workers to the MRP is WCB officers. The source ofthe decisions appealed to the MRP is summarized for each appellant type in Table 54.

Table 53Employer Appeals to Appeal Division by Issue and Result


Issue Total Allow Deny Partial AllowCount Percent Count Percent Count Percent

Adjudication of Reopening 5 0 0.0% 5 100.0% 0 0.0%Initial Adj.— Industrial Disease 1 1 100.0% 0 0.0% 0 0.0%Initial Adj.— Personal Injury 35 3 8.6% 30 85.7% 2 5.7%Misc — Overpayment, Ref. MRP, Late Filing

3 0 0.0% 3 100.0% 0 0.0%

Rehabilitation 1 0 0.0% 1 100.0% 0 0.0%Temporary Disability Payment 8 0 0.0% 6 75.0% 2 25.0%Total 53 4 7.5% 45 84.9% 4 7.5%

110Permitted under s. 58(5) of the Workers Compensation Act.

Table 54 Appeals to Medical Review Panel by Source of Decision

Appealed and Appellant1995 Non-Fatal Cohort

Decision SourceAppellant

Worker Employer WCBCount Percent Count Percent Count Percent

Appeal Division 43 29.7% 4 83.3% 1 100.0%Review Board 25 17.2% 1 16.7% 0 0.0%Board Officer 77 53.1% 0 0.0% 0 0.0%Total 145 100.0% 5 100.0% 1 100.0%

Karen A. Ryan 73

For both workers and employers the type of decision most frequently appealed to the MRPinvolved the initial adjudication of personal injury; that is, entitlement to compensation following a trau-matic injury. For workers, the second most common identified issue involved adjudication of reopening.MRP appeals by issue and appellant are summarized in Table 55.

Strain/sprain (11.7%), degeneration (7.6%), and carpal tunnel syndrome (7.6%) were the mostcommon medical issues identified in worker appeals. The medical issue was identified in two employerappeals, namely hepatitis and plantar fasciitis. The single WCB appeal involved osteoarthritis.

Medical Review Panels are asked to make determinations of the extent and cause of the disablinginjury or disease.111 In relation to most worker (71.7%) and all employer appeals a determination ofboth extent and cause was requested from the panels. A determination of causation only was requestedin relation to 24.8% of worker appeals. A determination of extent only was requested in relation to 2.8%of workers appeals.112 The WCB appeal required a determination of both extent and cause.

The Medical Review Panel Department determined that fourteen worker appeals (9.7%) lacked abona fide medical dispute and the appeals were rejected. Incomplete applications led to the rejection ofseven worker appeals (4.8%) and nine worker appeals (6.2%) were rejected because the time allowed tofile the appeal had expired. Fifteen worker appeals (10.3%) were withdrawn. The five employerappeals, 85 worker appeals (58.6%), and the WCB appeal were still in progress at the close of 1997.

The Medical Review Panel issued certificates in relation to 15 worker appeals (10.3%) prior to theend of 1997. Panel findings are recorded as “Does Not Confirm” (previous decision) and “Confirm”(previous decision). In effect a “Does Not Confirm” is an allow of the appeal, while “Confirm” is adenial. In two-thirds of the cases in which the panel issued a certificate the previous decision was notconfirmed. Panel decisions are summarized for worker appeals in Table 56.

Table 55Medical Review Panel Appeals by Issue and Appellant


IssueAppellant

Worker Employer WCB

Count Percent Count Percent Count PercentAdjudication of Re-opening 19 13.1% 0 0.0% 0 0.0%Coverage of Worker Under Act 1 0.7% 0 0.0% 0 0.0%Initial Adj. Industrial Disease 13 9.0% 0 0.0% 0 0.0%Initial Adj. Personal Injury 48 33.1% 2 33.3% 1 100.0%Medical Aid 1 0.7% 0 0.0% 0 0.0%Permanent Disability Award 2 1.4% 0 0.0% 0 0.0%Temporary Disability Payment 17 11.7% 0 0.0% 0 0.0%Unknown 44 30.3% 3 50.0% 0 0.0%Total 145 100.0% 5 100.0% 1 100.0%

111Section 61(1) of the Workers Compensation Act requires that the Medical Review Panel certify as to both the extent andcause of the disability, if any. However, the data collected by the MRP Department indicate that both determinationsare not requested in every case.

112Whether the MRP was to determine extent or cause (or both) was missing in relation to one worker appeal and oneemployer appeal.

74 Karen A. Ryan

With respect to the most common medical issues cited in worker appeals, panels issued certificatesin relation to four strain/sprain appeals. Panel did not confirm the previous decision in two cases andconfirmed the previous decision in two cases. One certificate concerning the medical issue degenerationwas issued and the panel did not confirm the previous decision. Two certificates concerning carpal tun-nel syndrome were issued and in both cases the panels did not confirm the previous decision.


On average, 161 days elapse from the date the enabling certificate is received to the date the MRPDepartment renders a decision regarding whether the appeal involves a bona fide medical dispute. Themedian length of time is 193 days.




For the reasons described in the section on the adjudication of 1994 non-fatal claims, 1995 claimswere followed through the adjudicative phases as they related to decisions concerning the compensabil-ity of the claims. The initial adjudication of claims by the WCB and the flow of claims through appealsinitiated by both workers and employers are depicted in Figure 10 (Appendix 2).113

Table 56 Worker Appeals to Medical Review Panel by Issue and Panel Decision


Issue TotalDoes Not Confirm Confirm

Count Percent Count PercentAdjudication of Re-opening 1 1 100.0% 0 0.0%

Initial Adj. Industrial Disease 2 2 100.0% 0 0.0%

Initial Adj. Personal Injury 8 5 62.5% 3 37.5%

Temporary Disability Payment 4 2 50.0% 2 50.0%

Total 15 10 66.7% 5 33.3%

113The dotted lines in Figure 10 indicate the route of claims that do not proceed to the next step in the flow. In most casesfurther appeals (either a re-filing of the original appeal or an appeal of a new issue) are possible. The dotted lines flowback into the total group of 1995 non-fatal claims that are then categorized according to the benefits received on theclaim prior to December 31, 1997.

Karen A. Ryan 75


The WCB initially rejected or disallowed 5.7% of the 191,476 non-fatal claims filed in 1995. Themajority of these 10,845114 claims (85.3%) were disallowed. The WCB reversed115 its decision in rela-tion to 24 rejected claims and 142 disallowed claims, leaving a total of 5.6% of non-fatal claims rejectedor disallowed by the WCB. These 10,679 claims were subject to formal appeals by workers dissatisfiedwith the WCB decision.

The remaining 180,807 claims were not rejected or disallowed116 by the WCB and were subject toappeals by employers dissatisfied with the WCB decision.


Workers filed a Review Board appeal of the WCB decision to reject or disallow their claim in rela-tion to 1,438 claims (13.5%). Approximately eight percent of these appeals were withdrawn, aban-doned, rejected or suspended and seventeen percent were in progress. Of the 1,070 appeals withfindings, 434 (40.6%) were allowed and 636 (59.4%) were denied. The Review Board decisions toallow the worker appeals were subject to employer appeals to the Appeal Division or the MRP. Simi-larly, workers who were denied at the Review Board can appeal the decision to the Appeal Division orthe MRP.

Employers filed a Review Board appeal of the WCB decision to not reject or disallow the claim inrelation to 91 claims (.05%). Twelve appeals were withdrawn, abandoned or suspended and nine werein progress. Of 70 appeals with findings, 17 (24.3%) were allowed and 53 (75.7%) were denied. Thesedecisions were subject to further appeals to the Appeal Division or the MRP by workers dissatisfied withthe Review Board decision to allow the employer appeals117 and by employers dissatisfied with theReview Board decision to deny their appeals.

For workers who appealed the WCB decision to reject or disallow their claims to the ReviewBoard, the average length of time from the date of injury to the date of the WCB decision is 148 days.The median length of time is 93 days. In these same cases, the average length of time from the date ofclaim registration to the date of the WCB decision is 90 days and the median is 66 days. The averagenumber of days from the date of the WCB decision to the date the “Notice of Appeal – Part 1” was filedwith the Review Board is 45 and the median length of time is 36 days. On average a further 209 dayselapse from the Part 1 date to the date the “Notice of Appeal - Part 2” was filed (median is 189). Fromthe Part 2 date to the date the Review Board made its finding took an average of 280 days (median is 266days). Overall, the average number of days from the Part 1 date to the finding date is 460 and themedian is 453.


Employers filed 41 (9.4%) Appeal Division appeals of the 434 Review Board decisions to allow theworkers’ appeals of the WCB decisions to reject or disallow the claims. Twelve of these appeals wereabandoned or withdrawn, one was denied an extension of time, and ten were in progress. Of the 18

114This total includes claims recorded as rejected or disallowed in the WCB’s data plus 8 cases where a WCB reversal ofthe reject/disallow decision is recorded in the board’s data but not the original decision to reject/disallow the claim.Another 99 cases were added based on cost and appeals information, as described in the section “Data IntegrationIssues”. The totals also include 10 claims that were both rejected and disallowed by the WCB. One of these 10 casesinvolved a consolidation of two claims, one of which was rejected and one of which was disallowed.

115These reversals may be due to worker-requested manager reviews of the adjudicators’ decisions.116Because some claims in this group were suspended prior to an initial adjudication decision, it is not possible to call

these claims “accepted”.117In effect an allowed employer appeal of this issue means that the worker’s claim has been rejected or disallowed.

76 Karen A. Ryan

appeals with final results, one (5.6%) was allowed, one (5.6%) was partially allowed, and 16 (88.9%)were denied. Allow and partial allow results were subject to worker appeals to the MRP. Deny and par-tial allow results were subject to employer appeals to the MRP.

Workers filed 255 (40.1%) Appeal Division appeals of the 636 Review Board decisions to deny theworkers’ appeals of the WCB decisions to reject or disallow the claims. In two of these appeals anextension of time was denied, 15 appeals were withdrawn or abandoned and 78 were in progress. Of the160 appeals with final results, 64 (40.0%) were allowed, 10 (6.3%) were partially allowed, 85 (53.1%)were denied, and one (0.6%) was referred to the MRP. Decisions to allow or partially allow the appealwere subject to employer appeals to the MRP. Decisions to deny or partially allow the appeal were sub-ject to worker appeals to the MRP.

Following the lower half of Figure 10, workers filed four (23.5%) Appeal Division appeals of the17 Review Board decisions to allow the employers’ appeals of the WCB decisions to not reject or disal-low the claims. Two of these appeals were in progress. The two appeals with final results were bothallowed. Allow decisions were subject to employer appeals to the MRP.

Employers filed six (11.3%) Appeal Division appeals of the 53 Review Board decisions to deny theemployers’ appeals of the WCB decision to not reject or disallow the claims. One appeal was partiallyallowed and the remaining five were denied. Partial allow decisions were subject to worker appeals tothe MRP. Deny and partial allow decisions were subject to employer appeals to the MRP.

An average of 26 days (median is 23 days) elapsed from the date of the Review Board finding tothe date the appeal was filed with the Appeal Division. On average, 47 days (median is 37 days) passedfrom the filing date to the date the appeal was commenced by the Appeal Division. From the com-mencement date to the date of the Appeal Division final result took an average of 116 days (median is90 days). Approximately 53.4% of Appeal Division appeals were completed within 90 days of the com-mencement date. The average number of days from the filing date to the date of the final result is 163and the median is 142.


The initial decision of the WCB to reject or disallow the claim was appealed by workers directly tothe MRP in 35 (0.3%) cases. Thirteen applications were not accepted for appeal, two were withdrawn,and 2 were held in abeyance. Ten appeals were in progress. A panel certificate was issued in ten cases(28.6%). The previous decision was not confirmed in seven (70.0%) cases and confirmed in three cases(30.0%). These decisions are final on this issue, meaning that in three cases the claims were effectivelyclosed, while for seven claims the WCB would have to implement the MRP decision and the decisionsthe WCB makes in doing so are subject to appeal.

Employers appealed the WCB decision to not reject or disallow the claim directly to the MRP inone case. This appeal was in progress.

Workers filed six MRP appeals (0.9%) of 636 Review Board decisions to deny the workers’appeals of the WCB decisions to reject or disallow the claims. One of these appeals was rejected andthe remaining five were in progress.

By the close of 1997, employers had filed no appeals to the MRP of 434 Review Board decisions toallow the workers’ appeals of the WCB decisions to reject or disallow the claims.

The lower half of Figure 10 shows that neither workers nor employers had filed MRP appeals ofReview Board decisions to allow or deny the employers’ appeals of WCB decisions not to reject or dis-allow the claims.

Karen A. Ryan 77

Continuing with the top portion of Figure 10, no MRP appeal was filed in relation to the twoAppeal Divisions decision to allow or partially allow the employers’ appeals of the Review Board deci-sions to allow the workers’ appeals of the WCB decision to reject or disallow the claims.

No employer initiate MRP appeals had been filed in relation to the 17 Appeal Division decisions todeny or partially allow the employers’ appeals of the Review Board decisions to allow the workers’appeals of the WCB decision to reject or disallow the claims.

Employers also filed no MRP appeals of Appeal Division decisions to allow or partially allow theworkers’ appeals of the Review Board decisions to deny the workers’ appeals of the WCB decisions toreject or disallow the claims.

One worker filed an MRP appeal in relation to one (10.0%) Appeal Division decision to partiallyallow the worker’s appeal of the Review Board decision to deny the worker’s appeal of the WCB deci-sion to reject or disallow the claim. This appeal was in progress.

Workers filed six (7.1%) appeals to the MRP of 85 Appeal Division decisions to deny the workers’appeals of Review Board decisions to deny the workers’ appeals of the WCB decision to reject or disal-low the claims. The Appeal Division referred another case to the MRP for a total of seven (8.1%)worker MRP appeals arising from Appeal Division decisions relating to these Review Board decisions.One of these appeals was withdrawn or resolved, one was not accepted for appeal, and five were inprogress.

Returning to the lower portion of Figure 10, no employer MRP appeals were filed in relation toAppeal Division decisions to allow workers’ appeals of Review Board decisions to allow employers’appeals of WCB decisions to not reject or disallow the claims.

Neither workers nor employers filed MRP appeals of Appeal Division decisions to partially allowor deny the employers’ appeals of Review Board decisions to deny the employers’ appeals of the WCBdecisions to not reject or disallow the claims.

On average, 55 days passed from the date of the Appeal Division decision to the date the applica-tion to the MRP was filed. The median length of time is 30 days. The average length of time from theapplication date to the date the enabling certificate was received by the MRP is 13 days, however, themedian length of time is zero days indicating that the enabling certificate often accompanies the MRPapplication.

On average, 159 days (five months) elapse from the date the enabling certificate is received to thedate the MRP Department renders a decision regarding whether the appeal involves a bona fide medicaldispute. The median length of time is even longer at 214 days.

From the date the bona fide medical dispute determination is made to the date that the MedicalReview Panel issues a certificate, an average of 270 days pass. The median length of time is also 270days.

The average number of days from the date the enabling certificate is received to the date that theMedical Review Panel issues a certificate is 386 and the median is also 386.

Summary

Workers appealed the WCB decision to reject or disallow their claims to either the Review Boardor the MRP (in the first instance) in 1,473 cases. Those workers who first appealed to the Review Boardmay have gone on to appeal the Review Board decision to the Appeal Division and/or the MRP. In total,after taking into account employer appeals of Review Board or Appeal Division decisions favoring

78 Karen A. Ryan

workers, 514 WCB decisions to reject or disallow the claims were overturned or partially overturned onappeal. Of the 1,473 workers who appealed to the Review Board or the MRP (in the first instance),34.9% were successful in having their claims accepted or partially accepted for compensation by the endof 1997. These 514 cases represent 4.8% of the 10,679 claims that were originally rejected or disallowedby the WCB.

Employers appealed the WCB decision to not reject or disallow the workers’ claims to either theReview Board or the MRP (in the first instance) in 92 cases. Those employers who first appealed to theReview Board may have gone on to appeal the Review Board decision to the Appeal Division and/or theMRP. In total, after taking into account worker appeals of Review Board or Appeal Division decisionsfavoring employers, 15 WCB decisions to not reject or disallow the workers’ claims were overturned onappeal. Of the 92 employers who appealed to the Review Board or the MRP in the first instance, 16.3%were successful in having the claims rejected or disallowed for compensation. These 15 cases represent.01%, or one in 10,000, of the 180,807 claims that were originally not rejected or disallowed by theWCB.

The original number of claims rejected or disallowed by the WCB (10,679118) was reduced by 514successful worker appeals, leaving 10,165 rejected or disallowed claims. Add to this figure the 15employer appeals that were successful in having the claim rejected or disallowed and the final numberof rejected or disallowed claims is 10,180, or 5.3% of all non-fatal claims filed in 1995. The final num-ber of claims not rejected or disallowed is 181,306, or 94.7% of all non-fatal claims filed in 1995.

For those claims that began with an appeal to the Review Board and concluded with an appeal tothe MRP, the average length of time from the date the Part 1 was filed with the Review Board to the datethe MRP issued its certificate is 757 days – just over two years.

118Note that this count is inflated by the ten claims that were both rejected and disallowed.

Karen A. Ryan 79



The 186,732 non-fatal cohort claims that were registered in 1996 were filed by 158,604 claimants.The average number of claims per claimant is 1.18 and the maximum number of claims filed by a singleclaimant during 1996 is nine.

Gender information was available for 70,176 (44.2%) claimants. Of these claimants, 74.9% aremale and 25.1% are female. The gender of the worker was known in relation to 47.7% of claims. Ofclaims, males filed 76.2% and females filed 23.8%, indicating that the male members of the cohortgroup contributed proportionally more claims to the sample than did the female members.

The age of the claimant at the time of the injury119 could be calculated for 185,652 claims. Theaverage age of claimants is 37.1 years and the median age is 36 years. The average age of claimants issomewhat lower for males at 36.9 years than for females at 38.6 years. The distribution of claimant ageat date of injury by gender is provided in Table 57.

The marital status of claimants was not recorded for any of the claims registered in 1996.

Class of industry was recorded for approximately 37% of claims. The industry attached to a claimis based on the classification of the employer allocated the costs associated with the claim, not necessar-ily the reporting employer. Also, a claim may be counted in more than one class of industry or morethan once in the same class of industry, if claim costs have been allocated to multiple employers.120

Table 58 summarizes the classes of industry responsible for costs arising from injuries to cohort claim-ants.

119This is the official date of injury recognized by the WCB.

Table 57Age at Date of Injury by Gender and Age Group



Count % Count % Count %15 to 24 9,691 14.3% 2,751 13.1% 15,702 16.2%

25 to 34 21,451 31.7% 5,330 25.3% 28,827 29.8%

35 to 44 19,926 29.4% 6,209 29.5% 27,466 28.4%

45 to 54 11,057 16.3% 4,818 22.9% 17,189 17.7%

55 to 64 4,923 7.3% 1,868 8.9% 6,591 6.8%

65 to 74 564 0.8% 86 0.4% 824 0.9%

Over 74 118 0.2% 2 0.0% 259 0.3%

Total 67,730 100.0% 21,064 100.0% 96,858 100.0%

120In Table 58, 442 claims are counted twice and one claim is counted three times because costs had been allocated tomore than one employer.

80 Karen A. Ryan

121













Canadian Pacific Ltd and associated companies 846 1.2%







Unknown 4 0.0%

Total 70,165 100.0%

121Dummy codes are used when costs are not allocated to a specific employer or class.

Table 59Number of Claims by the Top 20 Occupations



Truck Driver 2,625

Practical Nurse, Nurse's Aide, Ward Attendant 2,380

Chefs and Cooks 1,849

Dishwasher; Kitchen Worker; Busperson (Any Industry) 1,706

Carpenter, Framer, Woodworker (Const.),Criber (Const.), Car Builder (Railroad Cars) 1,656

Retail Clerk; Sales Clerk; Deli Clerk (Retail Trade) 1,571

Warehouseman (Any Industry) 1,543

Welder (Any Industry - Includes Owner/Operators) 1,312

Karen A. Ryan 81


The average length of time from the “official”122 date of the injury to the date the claim was firstregistered is 17.2 days and the median is 7 days.

The highest level of benefits paid on 1996 cohort claims was derived from cost information and isbased on costs incurred on the claims to December 31, 1997. The type of benefits paid on the claims isshown in Table 60.

The total and average health care and short-term disability (including both wage loss and voca-tional rehabilitation) benefits are shown for each benefit type in Table 61.

Registered Nurse 1,252

Custodian; Janitor; Caretaker (Church/School) 1,207

Heavy Duty Mechanic, Elevator Mech., Hydraulic Specialist, Motorboat/Small Motor Mech.

1,042

Labourer - Building Const., Construction Worker, Log Peeler - Const. 1,031

Automobile Mechanic/Repairman, BCAA Mobile Repairman 946

Mill Hand, Block Piler - Saw or Plan. Mills 930

Gardener, Greenskeeper, Landscaper, Nursery Worker, Labourer (Landscape Gardening) 772

Labourer - Road Gang, Highway Maintenance (Any Industry) 759

Home Support Worker, House Maid 755

Maintanance Man; Iceman/Zamboni Driver (Any Industry) 751

Bucker, Faller, Limber - Logging 649

Waiter/Waitress, Server (Rest.) 625

122This is the date the WCB recognizes as the date of injury which means that, in some cases, the first claim registrationdate precedes the date of injury. When the “earliest” date of injury that is recorded on any claim subject to consolida-tion with a cohort claim is used in this calculation, the average length of time is 18.5 days. The median is 7 days.

Table 60Claims by Benefit Type1996 Non-Fatal Cohort


Not Paid 23,427 12.5%




Total 186,732 100.0%

82 Karen A. Ryan

123 124

Vocational rehabilitation benefits (included with STD benefits in Table 61) were paid125 in relationto 896 claims. The total VR costs showing on these claims is $7,993,286.71 or an average of $8,921.08per claim. The median VR cost is $5,549.72. Income continuity payments were made on 21 claims.The average number of days of income continuity is 71.9, with a median of 48 days, and a total of 1510days.

The date wage loss was first paid was known in relation to 71,879 claims. For these claims an aver-age of 32.1 days elapsed between the official date of injury and the date of the first wage loss payment.The average length of time from the date of registration to the first wage loss payment is 21.7 days andthe median is 11 days. Figure 11 shows the distribution of claims by the length of time from claim reg-istration to first wage loss payment.

Table 61Total and Average Health Care and STD Costs by Benefit Type



Count Total $ Average $ Count Total $ Average $Health Care Only 90,038 $11,367,590.99 $126.25

STD 70,417 $61,397,190.83 $871.9171,548123 $198,921,646.99 $2,780.25

LTD 1,344 $5,921,895.10 $4,406.17 810124 $8,335,392.56 $10,290.61

Total 161,799 $78,686,676.92 72,358 $207,257,039.55

123The 366 STD claims that did not have STD costs had days of wage loss recorded for the claim indicating that wage losscosts had not been recorded or had been reversed out of the cost data.

124Most of the 543 claims that received LTD benefits but no STD benefits are hearing loss claims.125This count represents claims for which vocational rehabilitation benefits had been paid and not recovered from a pen-

sion award prior to December 31, 1997. In particular, “Code R” income continuity payments were subject to recovery.



0

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4-5 Days

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22-28 Days

29-60 Days

61-90 Days

3-4 Months

4-5 Months

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6-7 Months

7-8 Months

8-9 Months

9-10 Months

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Num

ber of Claim

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Karen A. Ryan 83

In total, 2,287,209 days of wage loss were paid on STD and LTD claims, for an average of 31.6days of wage loss per claim. The median number of days of wage loss is much lower at 9. The distribu-tion of days of wage loss by time groups is shown in Figure 12.

Injury

Nature of injury was recorded for 69,739 (37.3%) of the 186,732 claims registered. Over half(51.8%) of claims where this information was known involved a sprain or strain injury. The next mostfrequent, but far less common (15.1%), type of injury involved contusions, crushing or bruises. Cuts,lacerations and punctures accounted for 12.2% of claims and fractures accounted for 5.3%. All othertypes of injury were recorded for less than 5% of claims. The frequency of injury types is summarizedin Table 62.

Table 62Claims by Nature of Injury



Sprains, Strains 36,148 51.8%

Contusion, Crushing, Bruise (Soft Tissue) 10,534 15.1%

Cut, Laceration, Puncture — Open Wound 8,495 12.2%

Fracture 3,729 5.3%

Tenosynovitis, Synovitis, Tendonitis 2,335 3.3%

Scratches, Abrasions (Superficial Wound) 2,205 3.2%

Burn or Scald (Heat) (Hot Substances) 1,340 1.9%

Bursitis (Epicondylitis, Tennis Elbow) 1,052 1.5%


Chemical Burn 426 0.6%

Concussion — Brain, Cerebral 423 0.6%



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84 Karen A. Ryan

Most of the claims for which the nature of injury is recorded are claims that received STD benefitsand these claims dominate the above counts. The nature of injury for claims that received LTD benefitsis presented in Table 63. More than one-third of LTD claims received benefits for a hearing loss orimpairment injury.

Hernia, Rupture (Inguinal & Noninguinal) 370 0.5%

Dislocation 339 0.5%

Stress 277 0.4%

Carpal Tunnel Syndrome 256 0.4%

Radiation Effects Sunburn, Welding Flash 245 0.4%

Lower Respiratory Inflammation 236 0.3%

Dermatitis 174 0.2%


Poisoning, Systemic (Insect Stings) 113 0.2%



Freezing, Frostbite, Expos. to Low Temps. 54 0.1%

Other Contagious/Infectious Disease, NEC 52 0.1%

Allergic Reaction 37 0.1%


Asbestosis 27 0.0%

Upper Respiratory Inflammation 19 0.0%

Conjunctivitis 16 0.0%

Inflammation of Joints, Tendons, NEC 8 0.0%

Infected Blisters 7 0.0%

Heat Stroke, Sunstroke, Heat Exhaustion 5 0.0%

Injury or Illness, NEC 5 0.0%

Non-Personal Damage (Artificial Limbs, etc.) 3 0.0%

Tuberculosis 2 0.0%


Multiple Injuries 2 0.0%

Sprains, Strains, Tears 2 0.0%

Heart Attack (Includes Stroke) 1 0.0%


Bruises, Contusions 1 0.0%

Traumatic Bursitis 1 0.0%

Total 69,739 100.0%

Karen A. Ryan 85

In nearly all cases in which hearing loss was recorded for a claim, the claim had received an LTDbenefit by the end of 1997. Table 64 shows the number of claims receiving LTD benefits as a proportionof all injuries reported in the top five categories.

Table 63LTD Claims by Nature of Injury




Fracture 214 17.5%

Cut, Laceration, Puncture — Open Wound 193 15.8%

Contusion, Crushing, Bruise (Soft Tissue) 106 8.7%


Sprains, Strains 100 8.2%

Asbestosis 20 1.6%

Scratches, Abrasions (Superficial Wound) 9 0.7%

Burn or Scald (Heat) (Hot Substances) 8 0.7%

Dislocation 4 0.3%


Concussion — Brain, Cerebral 2 0.2%

Freezing, Frostbite, Expos. to Low Temps 2 0.2%

Bursitis (Epicondylitis, Tennis Elbow) 2 0.2%

Tenosynovitis, Synovitis, Tendonitis 1 0.1%




Dermatitis 1 0.1%


Non-Personal Damage (Artificial Limbs) 1 0.1%

Total 1223 100.0%

Table 64LTD Claims by Number of Claims in Top 5 Injury Types


Nature of Injury # ofClaims

% ofInjuries

# of LTDClaims

% ofClaims

Sprains, Strains 36,148 51.8% 100 0.3%Contusion, Crushing, Bruise (Soft Tissue) 10,534 15.1% 106 1.0%Cut, Laceration, Puncture — Open Wound 8,495 12.2% 193 2.3%Fracture 3,729 5.3% 214 5.7%Hearing Loss or Impairment 474 0.7% 450 94.9%Total 59,380 85.1% 1,063 1.8%

86 Karen A. Ryan

Historical Claims

More than two-thirds (71.3%) of the claimants who registered a non-fatal claim in 1996 had previ-ously registered at least one claim with the WCB. In total these claimants had filed 674,751 claims priorto 1996, or an average of 6 claims per claimant. The median number of historical claims per claimant is4 and the maximum number of claims filed by a single claimant is 81.

Pensions

Less than 1% of non-fatal claims registered in 1996 had received any type of long-term disabilitybenefit by December 31, 1997. For the majority of these 1,353 claims a monthly pension award wasestablished, but lump sum LTD payments labelled “cosmetic” were made in relation to 18 claims.126

LTD benefits were paid to 1,350 claimants. Most (92.2%) of these claimants are male. Threeclaimants received LTD benefits on two claims registered in 1996.

Approximately 6% of the claimants who received an LTD benefit in relation to a 1996 claim hadreceived LTD benefits on claims filed prior to 1996. Most of these 75 claimants had one previous LTDbenefit claim, but eight claimants had two prior LTD benefit claims.

Monthly pensions were established for 1,335 claims. In almost all cases (99.5%) the pensionaward was based on permanent functional impairment.127 Pensions for permanent total disability wereestablished in ten cases. A loss of earnings128 pension was awarded in relation to 7 claims.

Almost two-thirds (64.2%) of the permanent functional impairment (PFI) awards were first estab-lished within one year of the date the claim was registered. Two of the seven (28.6%) loss of earnings(LOE) pensions were first established within one year of claim registration.

Claimants who received a loss of earnings pension tended to be older at the time of the injury thanthose who received a permanent functional impairment pension. Five of the seven (71.4%) LOE pen-sions were awarded to claimants between 55 and 64 years of age. The average age of claimants whoreceived LOE awards is 53.6 years, while the average age of claimants who received PFI awards is 49.5years. The distribution of the two types of awards by age groups is provided in Table 65.

126These payments are likely compensation for disfigurement under s. 23(5) of the Workers Compensation Act. 127Workers Compensation Act, s. 23(1).128Workers Compensation Act, s. 23(3).

Table 65Comparison of Permanent Functional Impairment vs Loss of Earnings Pension Awards

by Age at Date of Injury1996 Non-Fatal Cohort



Karen A. Ryan 87

A loss of earnings pension award is calculated based on the board’s assessment of the pre-injurywage less the assessed post-injury wage divided by the assessed pre-injury wage. The average percent

loss of earnings for the claimants129 who received a loss of earnings pension is 38.9%. The minimumpercent LOE is 10.4% and the maximum is 63.1%.

Where a loss of earnings pension is awarded, the board also maintains a record of the level, or per-centage, of permanent functional impairment suffered by the claimant. The average percent PFI ishigher for claims that received a loss of earnings pension at 9.2% than for claims that received a PFIaward (4.4%).

The average percent PFI for the two types of pension awards within the top five injury categories issummarized in Table 66. Within injury types where LOE pensions were awarded, permanent functionalimpairment resulting from these injuries is greater for recipients of LOE awards than for recipients ofPFI awards.

There is a marked difference in the costs associated with PFI and LOE pensions. The averageamount reserved for an LOE pension is almost eight times greater than the average amount reserved tofund a PFI pension award. Table 67 summarizes this information.

129Percent LOE could only be calculated for 6 of the 7 claims that received a loss of earnings award due to missing data;that is, either the assessed pre-injury wage, the assessed post-injury wage, or both were missing.

Table 66Permanent Functional Impairment vs Loss of Earnings Pension Awards

by Nature of Injury for Top 5 Injury Types1996 Non-Fatal Cohort

Nature of InjuryPFI LOE

Count Avg. % PFI Count Avg. % PFI

Hearing Loss or Impairment 450 1.5% 0 0.0%

Fracture 212 8.0% 1 15.0%

Cut, Laceration, Puncture — Open Wound 189 3.0% 0 0.0%

Sprains, Strains 97 4.4% 3 8.0%

Contusion, Crushing, Bruise (Soft Tissue) 103 7.5% 2 7.8%

Total 1051 6

Table 67Pension Reserves for Permanent Functional Impairment

vs. Loss of Earnings Pension Awards1996 Non-Fatal Cohort

Type of Award Total Awards Total Reserves Average Reserves

PFI 1328 $27,482,806.32 $20,694.88

LOE 7 $1,146,078.90 $163,725.56

Total 1335 $28,628,885.22 $21,444.86

88 Karen A. Ryan


Workers and employers are entitled to full disclosure of the claim file once either party has initiated

an appeal on the claim to one of the three appellate bodies. Full disclosure130 was requested by and pro-vided to workers 4,782 times in relation to 4,685 (2.5%) claims and employers 3,014 times in relation to2,975 (1.6%) claims. On average, full disclosure took 48.9 days. The median length of time fromrequest to full disclosure is 41 days and nearly ninety percent (86.2%) of full disclosures are completedwithin 90 days.

Update disclosures131 were provided to workers 683 times in relation to 618 files and to employers384 times in relation to 341 files. On average, the disclosure was updated 1.1 times for both workersand employers. The average length of time for an update disclosure is 34.3 days and the median is 21days.


For most workers and employers, the Workers’ Compensation Review Board (the Review Board) is

the first level132 of appeal from claim decisions133 of the WCB.134 At least one appeal135 to the ReviewBoard was filed in relation to approximately three percent of the 186,732 non-fatal claims registered in1996. Workers initiated at least one Review Board appeal in relation to 4,496 (2.4%) claims andemployers filed at least one appeal in relation to 520 (0.3%) claims.



130A complete copy of the claim file.131These are subsequent disclosures that supplement the original full disclosure.132While workers and employers do have the option of appealing WCB claim decisions involving medical issues directly

to the Medical Review Panel, most do not because the MRP decision is final and binding.133That is, decisions made with respect to a worker that can be appealed to the Review Board under s. 90(1) of the Work-

ers Compensation Act.134Dependents filed at least one Review Board appeal with respect to eight claims; however, dependent appeals are not

included in the following discussion.135“Notice of Appeal - Part 1”.136Issues were grouped into appeals according to the date the “Notice of Appeal - Part 1” was filed.137Because the Review Board does not normally electronically code the issue(s) under appeal until a “Notice of Appeal -

Part 2” is filed, the specific issue appealed is missing in some cases. In these cases it was assumed that the appealinvolved at least one issue.

Table 68Total and Average Number of Appeals Initiated at Worker's Compensation Review

Board by Appellant1996 Non-Fatal Cohort

Appellant Total # of Appeals Average # of Appeals


Average # of Issues per Appeal

Worker 4,984 1.1 5,452 1.2

Employer 561 1.1 589 1.1

Total 5,545 6,041

Karen A. Ryan 89

The issues under appeal were defined for 2,719 worker appeals and 196 employer appeals. Theissue most frequently appealed by both workers and employers concerns entitlement to compensationbenefits. One-half of worker issues and over one-half of employer issues involved WCB decisionsregarding the compensability of the claim. The issues appealed by the two appellant groups are summa-rized in Tables 69 and 70.

138

Table 69Worker Appeals to Review Board by Issue

1996 Non-Fatal CohortIssue Description Count Percentage

No Compensable Injury 1,370 50.4%Wage Loss Benefits Terminated 381 14.0%Reopening Denied 284 10.4%Limited Acceptance of Claim 136 5.0%Rate of Compensation 130 4.8%Wage Loss Benefits Denied 123 4.5%Health Care Benefits 91 3.3%Other 74 2.7%Rehab Benefits Insufficient 30 1.1%P.P.D. Award Denied 25 0.9%No New Significant Info 25 0.9%P.P.D. Award Insufficient 14 0.5%Rehab Benefits Denied 13 0.5%Not Within Scope of Part 1 10 0.4%Surgery Denied 7 0.3%Not Within Scope of Employment 6 0.2%Total 2,719 100.0%

Table 70Employer Appeals to Review Board by Issue138

1996 Non-Fatal CohortIssue Description Count Percentage

EA: Compensable Injury 117 59.7%EA: Duration of Wage Loss Benefits 39 19.9%EA: Other 21 10.7%EA: Reopening 8 4.1%WA: No Compensable Injury 3 1.5%WA: Other 3 1.5%EA: P.P.D. Granted 1 0.5%EA: Within Scope of Employment 1 0.5%EA: Cost Allocation (Claimant) 1 0.5%WA: Reopening Denied 1 0.5%WA: Wage Loss Benefits Terminated 1 0.5%Total 196 100.0%

138The designation “EA” and “WA” provides perspective on the nature of the employer’s objection. For example, anemployer appeal of “rate of compensation” is ambiguous with respect to the desired outcome. An employer mayobject that the rate is too high (“EA”) or is too low (“WA”).

90 Karen A. Ryan

An extension of time (EOT) problem was recorded for 326 (5.4%) appeal issues where the “Noticeof Appeal – Part 1” was filed more than 90 days after the decision that was being appealed was commu-nicated to the appellant.139 For workers, EOT problems were recorded for 295 (5.4%) appeal issues.EOT problems were recorded for 31 (5.3%) employer appeal issues.

The Review Board records both the date that the notice of appeal was “originally received”, forcases where the appellant sent the application to the WCB rather than the Review Board, and the datethat the notice of appeal was received by the Review Board.140 With reference to the “originallyreceived” date, the average number of days over the 90 day time limit is 85 (median is 50). Nearly one-third (31.3%) of cases with EOT problems were 28 days or less beyond the time limit. Two-thirds(67.5%) were 90 days or less beyond the time limit, and 88.3% were 6 months or less beyond the 90 daytime limit.

With reference to the date the notice of appeal was received by the Review Board, the average num-ber of days over the 90 day time limit is 95 (median is 57). One in five (21.8%) cases with EOT prob-lems were 28 days or less beyond the time limit. Nearly two-thirds (64.1%) of cases were 90 days or lessbeyond the limit and 85% were six months or less beyond the 90 day time limit.

EOT decisions were made in relation to 250 worker appeals and 28 employer appeals. EOT wasgranted in 202 (80.8%) worker appeals and 23 (82.1%) employer appeals.141

Summary decisions were made in relation to 1,722 appeal issues. As shown in Table 71, the mostcommon summary decision involves the closing of an appeal because it has been abandoned or with-drawn by the appellant. Nearly one-quarter (22.9%) of issues appealed by workers were abandoned orwithdrawn while nearly one-half (48.7%) issues appealed by employers were dropped.

Review Board decisions in relation to an additional 3,266 (59.9%) worker issues and 237 (40.2%)employer issues were in progress at the end of 1997.

139Section 90(1) of the Workers Compensation Act.140Where the notice of appeal was sent to the Review Board these two dates are identical.141EOT was denied in 48 worker appeals. This count includes one case in which the appeal was abandoned or withdrawn

by the appellant.

Table 71Summary Decisions on Review Board Appeals/Issues by Appellant



Count Percent Count PercentAbandoned/Part 2 Not Received 914 840 59.1% 74 24.6%

Abandon/Withdraw 623 410 28.9% 213 70.8%

Suspended 77 75 5.3% 2 0.7%


Not Appealable 49 42 3.0% 7 2.3%

Resuspended 4 4 0.3% 0 0.0%



Total 1,722 1,421 100.0% 301 100.0%

Karen A. Ryan 91

The method of hearing the appeal – via oral hearing or read and review – was known for 2,908appeal issues. In almost three-quarters of these cases, an oral hearing was held or had been scheduled.Oral hearings were more likely for worker initiated appeals (75.6%) than employer appeals (41.3%).Three-person panels conduct over 70% of oral hearings held for either worker (72.9%) or employer(72.8%) initiated appeals. Nearly all read and review appeals were dealt with by three-member panels –98.9% or worker appeals and 98.3% of employer appeals.

The majority of the oral hearings of both worker (56.9%) and employer (67.9%) initiated appealswere held “in town” at the Review Board offices.

Respondents were more likely to participate in the appeal when an oral hearing was held or sched-uled. Workers and employers as respondents participated in over half of oral hearings held or scheduledto hear employer and worker appeals.

Workers were represented at nearly two-thirds of the oral hearings, often by a union representative.Employers were represented at approximately 80% of oral hearings, usually by a consultant or an officerof the company.



Appellant # of OH'sRespondent Participating

# of R&R'sRespondent Participating

Count Percentage Count Percentage

Worker 2051 1143 55.7% 661 241 36.5%

Employer 81 47 58.0% 115 44 38.3%



Description of Representative

Appellant

Worker Employer

Count Percent Count PercentAdviser 194 9.5% 4 5.2%

Consultant 65 3.2% 24 31.2%

Employer Organization 0 0.0% 6 7.8%

Friend/Relative 28 1.4% 0 0.0%

Lawyer 100 4.9% 4 5.2%


Officer 0 0.0% 22 28.6%

Union 960 46.9% 0 0.0%

Politician 1 0.0% 0 0.0%

Total 2049 100.0% 77 100.0%

92 Karen A. Ryan

A Review Board panel had rendered findings in relation to 816 (13.5%) appeal issues by the end of1997.142 This percentage was somewhat lower for employer appeals where findings had been made inrelation to 8.7% of appeal issues. More worker than employer initiated appeal issues were allowed bythe Review Board. Allow findings were rendered for 45% of worker issues and 25.5% of employerissues.

Table 74 summarizes findings for appeals that were dealt with via oral hearing or read and review.For worker initiated appeals, more appeal issues were allowed when the appeal proceeded by way oforal hearing rather than by way of read and review. For employer initiated appeals the allow rate did notvary according to the type of appeal.

The following two tables show panel findings by the issue under appeal. The most successfulworker appeal issues involved WCB decisions to deny reopening of the claim and to deny wage lossbenefits.

142Decisions were either in progress or summary decisions had been made in relation to the remaining issues.

Table 74Review Board Findings by Type of Appeal and Appellant


Appellant# of


R&R'sAllowed Denied

Count Percent Count Percent Count Percent Count PercentWorker 453 226 49.9% 227 50.1% 312 118 37.8% 194 62.2%Employer 11 3 27.3% 8 72.7% 40 10 25.0% 30 75.0%

Table 75Worker Appeals to Review Board by Issue and Finding


Issue Description Total Allowed DeniedCount Percent Count Percent

No Compensable Injury 430 195 45.3% 235 54.7%Wage Loss Benefits Terminated 82 36 43.9% 46 56.1%Reopening Denied 52 28 53.8% 24 46.2%Other 28 13 46.4% 15 53.6%Rate of Compensation 46 21 45.7% 25 54.3%Health Care Benefits 36 14 38.9% 22 61.1%Wage Loss Benefits Denied 43 21 48.8% 22 51.2%Limited Acceptance of Claim 23 7 30.4% 16 69.6%P.P.D. Award Denied 3 0 0.0% 3 100.0%No New Significant Info 5 3 60.0% 2 40.0%P.P.D. Award Insufficient 1 0 0.0% 1 100.0%Rehab Benefits Insufficient 4 1 25.0% 3 75.0%Rehab Benefits Denied 2 0 0.0% 2 100.0%Surgery Denied 4 2 50.0% 2 50.0%Not Within Scope of Employment 2 1 50.0% 1 50.0%Not Within Scope of Part 1 4 2 50.0% 2 50.0%Total 765 344 45.0% 421 55.0%

Karen A. Ryan 93

The most successful employer appeal issue involved WCB decisions concerning the duration ofwage loss benefits.


For appeals that were dealt with via oral hearing, the average number of days from the date the Part2 was filed to the hearing date is 218 days and the median is 207 days. From the oral hearing date to thefinding date is, on average, 83 days (median is 79).


The second level143 of appeal for most workers and employers who are dissatisfied with the find-

ings of the Review Board is the Workers’ Compensation Board Appeal Division (Appeal Division).144

By the end of 1997, notices of appeal were filed with the Appeal Division in relation to less than half ofone percent of the 186,732 non-fatal claims registered in 1996. Workers initiated 188 (83.9%) AppealDivision appeals and employers filed 36 (16.1%) appeals. No appellants filed more than one notice ofappeal with the Appeal Division.

With respect to the 188 worker appeals, 15 (8.0%) were withdrawn or abandoned, one (0.5%) wasdenied an extension of time, one (0.5%) was rejected due to the absence of an appealable decision, and112 (59.6%) were in progress at the end of 1997. Appeal Division panels rendered final decisions on 59(31.4%) worker appeals.

With respect to the 36 employer appeals, four (11.1%) were withdrawn or abandoned, one (2.8%)was rejected due to the absence of an appealable decision, and 22 (61.1%) were in progress. Final deci-sions were rendered for nine (25.0%) employer appeals.




Count Percent Count PercentEA: Compensable Injury 30 5 16.7% 25 83.3%

EA: Other 4 0 0.0% 4 100.0%


EA: Reopening 1 1 100.0% 0 0.0%

WA: Other 2 1 50.0% 1 50.0%

Total 51 13 25.5% 38 74.5%

143While workers and employers do have the option of appealing Review Board decisions involving medical issuesdirectly to the Medical Review Panel, most do not because the MRP decision is final and binding.

144These appeals are filed under s. 91(1) of the Workers Compensation Act.

94 Karen A. Ryan

The appellant requested an extension of time (EOT) to appeal in relation to 14 (7.4%) workerappeals and 3 (8.3%) employer appeals. As a reason for the request one (7.1%) worker cited “unawareof time limit/procedure, one (7.1%) claimed “out of town”, and in three cases (21.4%) the reason for therequest was not recorded. The remaining nine (64.3%) worker requests cited “other” reasons. Of thethree employer requests for EOT, two (66.7%) cited “other” reasons, and in one case (33.3%) the reasonfor the request was not recorded.


when the request for an extension of time is made. In relation to the 14 worker requests, the appeal

applications are an average of 23.9 days beyond the time limit. The median is 15 days.146 The threeemployer requests were 21 days, 25 days, and 49 days beyond the time limit.

Decisions on the extension of time requests were made in relation to five worker requests. AnAppeals Commissioner made the EOT decision for three worker requests and the Appeals Managermade the decision for two worker requests. Four (80.0%) worker requests for EOT were allowed and, asnoted above, one (20.0%) was denied.

The Appeal Division electronically records a single issue for each appeal, and only where theappeal has reached a final conclusion. Table 77 shows the issues identified for worker and employerappeals. As was noted for Review Board appeals, the most frequent issue appealed to the Appeal Divi-sion involves the initial adjudication of the compensability of the claim.

Oral hearings by the Appeal Division were very rare. Only three (1.6%) worker appeals had pro-ceeded by way of oral hearing or were scheduled for oral hearing. The reason cited by workers whorequested an oral hearing was “present evidence orally”.

145Section 91(1) of the Workers Compensation Act allows for 30 days to appeal a finding of the Review Board.146Nearly two-thirds (64.3%) of worker applications for EOT were 28 days or less beyond the time limit. The remaining

five cases (35.7%) were 90 days or less beyond the 30 day limit.

Table 77Appeal Division Appeals by Issue and Appellant


IssueAppellant


Adjudication of Reopening 4 2.1% 1 2.8%Assign/Withhold Benefits 1 0.5% 0 0.0%Average Earnings 3 1.6% 0 0.0%Initial Adj.- Industrial Disease 1 0.5% 0 0.0%Initial Adj.- Personal Injury 34 18.1% 4 11.1%Medical Aid 0 0.0% 1 2.8%Misc - Overpayment, Ref. MRP, Late Filing 3 1.6% 0 0.0%Permanent Disability Award 1 0.5% 0 0.0%Review Board General 2 1.1% 0 0.0%Temporary Disability Payment 10 5.3% 3 8.3%Unknown 129 68.6% 27 75.0%Total 188 100.0% 36 100.0%

Karen A. Ryan 95

A decision had been rendered by an Appeal Division panel hearing the appeal orally for one(33.3%) worker appeal. A worker advisor represented this worker at the hearing. The three-memberpanel allowed the appeal.


An Appeal Division panel had reached a final decision in relation to 58 worker and nine employerread and review appeals. Just under one-half (48.3%) of these worker initiated appeals were dealt withby three-person panels and the remainder were handled by one-person panels. Most (77.8%) of theemployer initiated appeals were dealt with by three-member panels.

In total, final decisions were rendered for 59 worker appeals and nine employer appeals. Workerappeals were allowed in 29 cases (49.2%), denied in 28 cases (47.5%), and partially allowed in twocases (3.4%). In one case the original decision to deny the appeal was reconsidered and confirmed bythe panel.

The allow rate for employer appeals was much lower than for worker appeals. Employer appealswere allowed in two cases (22.2%) and denied in seven cases (77.8%).

The following two tables summarize the outcomes of worker and employer appeals by the issueidentified in the appeal. The issues appealed by a sizeable number of workers and for which the allowrate met or exceeded 50% were “temporary disability payment” and “initial adjudication of personalinjury”.

Table 78Appeal Division Read and Review Appeals by Appellant and Type of Representative



Worker Employer

Count Percent Count PercentAgent 2 1.1% 1 2.8%

Association 0 0.0% 2 5.6%

Consultant 11 5.9% 8 22.2%

Employer Advisor 0 0.0% 4 11.1%

Law Firm 6 3.2% 1 2.8%

Lawyer 4 2.2% 0 0.0%


Trade Union 64 34.6% 0 0.0%

Unknown 4 2.2% 0 0.0%

Worker Advisor 22 11.9% 0 0.0%

Physician 1 0.5% 0 0.0%

Total 185 100.0% 36 100.0%

96 Karen A. Ryan

Employer appeals were allowed on a single issue, “initial adjudication of personal injury”. TheAppeal Division allowed two of the four appeals on this issue.

An average of 42 days (median is 37 days) elapsed from the date the notice of appeal was filed tothe date the appeal was commenced by the Appeal Division. From the commencement date to the dateof the Appeal Division final result took an average of 99 days (median is 90 days). Approximately60.9% of Appeal Division appeals were completed within 90 days of the commencement date. Theaverage number of days from the notification date to the date of the final result is 140 and the median is126.

The single appeal that was dealt with via oral hearing took ten days from the date the oral hearingbegan to the date of the final appeal result.

Medical Review Panels

Workers filed at least one Medical Review Panel (MRP) appeal was filed in relation to 53 claims.In two cases, workers filed three MRP appeals on the same claim, for a total of 56 appeals. Neitheremployers nor the WCB filed any MRP appeals.

Table 79Worker Appeals to Appeal Division by Issue and Result



Count Percent Count Percent Count PercentAdjudication of Reopening 4 0 0.0% 4 100.0% 0 0.0%Assign/Withhold Benefits 1 0 0.0% 1 100.0% 0 0.0%Average Earnings 3 2 66.7% 1 33.3% 0 0.0%Initial Adj.- Industrial Disease 1 1 100.0% 0 0.0% 0 0.0%Initial Adj.- Personal Injury 34 17 50.0% 16 47.1% 1 2.9%Misc - Overpayment, Ref. MRP, Late Filing 3 2 66.7% 1 33.3% 0 0.0%Permanent Disability Award 1 0 0.0% 0 0.0% 1 100.0%Review Board General 2 1 50.0% 1 50.0% 0 0.0%Temporary Disability Payment 10 6 60.0% 4 40.0% 0 0.0%Total 59 29 49.2% 28 47.5% 2 3.4%

Table 80Employer Appeals to Appeal Division by Issue and Result



Count Percent Count Percent Count PercentAdjudication of Reopening 1 0 0.0% 1 100.0% 0 0.0%Initial Adj.- Personal Injury 4 2 50.0% 2 50.0% 0 0.0%Medical Aid 1 0 0.0% 1 100.0% 0 0.0%Temporary Disability Payment 3 0 0.0% 3 100.0% 0 0.0%Total 9 2 22.2% 7 77.8% 0 0.0%

Karen A. Ryan 97

The largest source of decisions appealed by workers to the MRP is WCB officers (94.6%). Twoworkers (3.6%) appealed Review Board findings and one worker (1.8%) appealed a decision of theAppeal Division.

The type of decision most frequently appealed to the MRP involved the initial adjudication of per-sonal injury; that is, entitlement to compensation following a traumatic injury. The second most com-mon identified issue involved adjudication of reopening. Worker MRP appeals by issue are summarizedin Table 81.

Strain/sprain (19.6%) and tendinitis (7.1%) were the most common medical issues identified inworker appeals.

Medical Review Panels are asked to make determinations of the extent and cause of the disablinginjury or disease.147 In relation to most worker appeals (76.8%) a determination of both extent andcause was requested. A determination of causation only was requested in relation to 16.1% of appealsand a determination of extent only was requested in relation to 7.1%.

The Medical Review Panel Department determined that six worker appeals (10.7%) lacked a bonafide medical dispute and the appeals were rejected. An incomplete application led to the rejection of oneappeal (1.8%) and another (1.8%) was rejected because the time allowed to file the appeal had expired.Nine appeals (16.1%) were withdrawn. Thirty-five worker appeals (62.5%) were in progress at the closeof 1997.

The Medical Review Panel issued certificates in relation to four worker appeals (7.1%) prior to theend of 1997. Panel findings are recorded as “Does Not Confirm” (previous decision), “Confirm” (previ-ous decision). In effect a “Does Not Confirm” is an allow of the appeal, while “Confirm” is a denial. Inthree of the four cases in which the panel issued a certificate the previous decision was confirmed. Paneldecisions are summarized for worker appeals in Table 82.

Table 81Worker Medical Review Panel Appeals by Issue


Issue Count Percent

Adjudication of Re-opening 10 17.9%

Initial Adj. Industrial Disease 4 7.1%

Initial Adj. Personal Injury 15 26.8%

Temporary Disability Payment 7 12.5%

Unknown 20 35.7%

Total 56 100.0%

147Section 61(1) of the Workers Compensation Act requires that the Medical Review Panel certify as to both the extentand cause of the disability, if any. However, the data collected by the MRP Department indicate that both determina-tions are not requested in every case.

98 Karen A. Ryan


On average, 270 days elapse from the date the enabling certificate is received to the date the MRPDepartment renders a decision regarding whether the appeal involves a bona fide medical dispute. Themedian length of time is 311 days.




For the reasons described in the section on the adjudication of 1994 non-fatal claims, 1996 claimswere followed through the adjudicative phases as they related to decisions concerning the compensabil-ity of the claims. The initial adjudication of claims by the WCB and the flow of claims through appealsinitiated by both workers and employers are depicted in Figure 13 (Appendix 3).148


The WCB initially rejected or disallowed 5.9% of the 186,732 non-fatal claims filed in 1996. Themajority of these 11,055149 claims (86.1%) were disallowed. The WCB reversed150 its decision in rela-tion to 25 rejected claims and 88 disallowed claims, leaving a total of 5.9% of non-fatal claims rejectedor disallowed by the WCB. These 10,942 claims were subject to formal appeals by workers dissatisfiedwith the WCB decision.

Table 82 Worker Appeals to Medical Review Panel by Issue

and Panel Decision1996 Non-Fatal Cohort

Issue TotalDoes Not Confirm Confirm

Count Percent Count PercentAdjudication of Re-opening 1 1 100.0% 0 0.0%

Initial Adj. Personal Injury 2 0 0.0% 2 100.0%

Temporary Disability Payment 1 0 0.0% 1 100.0%

Total 4 1 25.0% 3 75.0%

148The dotted lines in Figure 13 indicate the route of claims that do not proceed to the next step in the flow. In most casesfurther appeals (either a re-filing of the original appeal or an appeal of a new issue) are possible. The dotted lines flowback into the total group of 1995 non-fatal claims that are then categorized according to the benefits received on theclaim prior to December 31, 1997.

149This total includes claims recorded as rejected or disallowed in the WCB’s data plus 7 cases where a WCB reversal ofthe reject/disallow decision is recorded in the board’s data but not the original decision to reject/disallow the claim.Another 85 cases were added based on cost and appeals information, as described in the section “Data IntegrationIssues”. The totals also include 3 claims that were both rejected and disallowed by the WCB. One of these 3 casesinvolved a consolidation of two claims, one of which was rejected and one of which was disallowed.

150These reversals may be due to worker-requested manager reviews of the adjudicators’ decisions.

Karen A. Ryan 99

The remaining 175,793 claims were not rejected or disallowed151 by the WCB and were subject toappeals by employers dissatisfied with the WCB decision.


Workers filed a Review Board appeal of the WCB decision to reject or disallow their claim in rela-tion to 1310 claims (12.0%). Approximately six percent of these appeals were withdrawn, abandoned orsuspended and 62% were in progress. Of the 427 appeals with findings, 193 (45.2%) were allowed and234 (54.8%) were denied. The Review Board decisions to allow the worker appeals were subject toemployer appeals to the Appeal Division or the MRP. Similarly, workers who were denied at theReview Board can appeal the decision to the Appeal Division or the MRP.

Employers filed a Review Board appeal of the WCB decision to not reject or disallow the claim inrelation to 109 claims (.06%). Five appeals were withdrawn or abandoned and 74 were in progress. Of30 appeals with findings, five (16.7%) were allowed and 25 (83.3%) were denied. These decisions weresubject to further appeals to the Appeal Division or the MRP by workers dissatisfied with the ReviewBoard decision to allow the employer appeals152 and by employers dissatisfied with the Review Boarddecision to deny their appeals.

For workers who appealed the WCB decision to reject or disallow their claims to the ReviewBoard, the average length of time from the date of injury to the date of the WCB decision is 100 days.The median length of time is 76 days. In these same cases, the average length of time from the date ofclaim registration to the date of the WCB decision is 66 days and the median is 55 days. The averagenumber of days from the date of the WCB decision to the date the “Notice of Appeal – Part 1” was filedwith the Review Board is 39 and the median length of time is 30 days. On average a further 168 dayselapse from the Part 1 date to the date the “Notice of Appeal - Part 2” was filed (median is 178). Fromthe Part 2 date to the date the Review Board made its finding took an average of 261 days (median is 257days). Overall, the average number of days from the Part 1 date to the finding date is 376 and themedian is 375.


Employers filed 15 (7.8%) Appeal Division appeals of the 193 Review Board decisions to allow theworkers’ appeals of the WCB decisions to reject or disallow the claims. Ten of these appeals were inprogress at the end of 1997. Of the five appeals with final results, one (20.0%) was allowed and four(80.0%) were denied. Allow results were subject to worker appeals to the MRP. Deny results were sub-ject to employer appeals to the MRP.

Workers filed 85 (36.3%) Appeal Division appeals of the 234 Review Board decisions to deny theworkers’ appeals of the WCB decisions to reject or disallow the claims. Three of these appeals werewithdrawn or abandoned and 59 were in progress. Of the 23 appeals with final results, 14 (60.9%) wereallowed and nine (39.1%) were denied. Decisions to allow the appeal were subject to employer appealsto the MRP. Decisions to deny the appeal were subject to worker appeals to the MRP.

Following the lower half of Figure 13, workers filed two (40.0%) Appeal Division appeals of thefive Review Board decisions to allow the employers’ appeals of the WCB decisions to not reject or dis-allow the claims. One of these appeals was in progress and the other was allowed. The allow decisionwas subject to an employer appeal to the MRP.

151Because some claims in this group were suspended prior to an initial adjudication decision, it is not possible to callthese claims “accepted”.

152In effect an allowed employer appeal of this issue means that the worker’s claim has been rejected or disallowed.

100 Karen A. Ryan

Employers filed three (12.0%) Appeal Division appeals of the 25 Review Board decisions to denythe employers’ appeals of the WCB decision to not reject or disallow the claims. Two of these appealswere in progress and one was withdrawn or abandoned.

An average of 24 days (median is 22 days) elapsed from the date of the Review Board finding tothe date the appeal was filed with the Appeal Division. On average, 40 days (median is 35 days) passedfrom the filing date to the date the appeal was commenced by the Appeal Division. From the com-mencement date to the date of the final result took an average of 91 days (median is 90 days). Approxi-mately 70% of Appeal Division appeals were completed within 90 days of the commencement date.The average number of days from the filing date to the date of the final result is 128 and the median is120.


The initial decision of the WCB to reject or disallow the claim was appealed by workers directly tothe MRP in 16 (0.1%) cases. One application was not accepted for appeal and one was withdrawn.Twelve appeals were in progress. A panel certificate was issued in two cases (12.5%). The previousdecision was confirmed in both of these cases. These decisions are final on this issue, meaning that inthese cases the claims were effectively closed.

By the close of 1997, no other MRP appeals had been filed by either workers or employers.

Summary

Workers appealed the WCB decision to reject or disallow their claims to either the Review Boardor the MRP (in the first instance) in 1,326 cases. Those workers who first appealed to the Review Boardmay have gone on to appeal the Review Board decision to the Appeal Division and/or the MRP. In total,after taking into account employer appeals of Review Board or Appeal Division decisions favoringworkers, 192 WCB decisions to reject or disallow the claims were overturned or partially overturned onappeal. Of the 1,326 workers who appealed to the Review Board or the MRP (in the first instance),14.5% were successful in having their claims accepted for compensation by the end of 1997. These 192cases represent 1.8% of the 10,942 claims that were originally rejected or disallowed by the WCB.

Employers appealed the WCB decision to not reject or disallow the workers’ claims to either theReview Board or the MRP (in the first instance) in 109 cases. Those employers who first appealed tothe Review Board may have gone on to appeal the Review Board decision to the Appeal Division and/orthe MRP. In total, after taking into account worker appeals of Review Board or Appeal Division deci-sions favoring employers, 4 WCB decisions to not reject or disallow the workers’ claims were over-turned on appeal. Of the 109 employers who appealed to the Review Board or the MRP in the firstinstance, 3.7% were successful in having the claims rejected or disallowed for compensation by the endof 1997. These 4 cases represent .002%, or one in 50,000, of the 175,793 claims that were originally notrejected or disallowed by the WCB.

The original number of claims rejected or disallowed by the WCB (10,942153) was reduced by 192successful worker appeals, leaving 10,750 rejected or disallowed claims. Add to this figure the 4employer appeals that were successful in having the claim rejected or disallowed and the final numberof rejected or disallowed claims is 10,754, or 5.8% of all non-fatal claims filed in 1996. The final num-ber of claims not rejected or disallowed is 175,981, or 94.2% of all non-fatal claims filed in 1996.

153Note that this count is inflated by the three claims that were both rejected and disallowed.

Karen A. Ryan 101

Summary and Conclusions

With few exceptions, the three cohorts of claims present a very consistent picture of the character-istics of claims registered in a given year and the appeals generated by decisions made on those claims.

Less than one-tenth of a percent of new claims filed in a year are claims relating to the death of aworker. However, ten to twenty of these workers have filed compensation claims for non-fatal injurieswithin the same year. A similar number of workers will succumb to initially non-fatal (but perhaps ter-minal) injuries within the next three years.

Registration of multiple injury claims within a year was not uncommon. Up to ten claims wereregistered by a single claimant within a one-year period.

In addition, many (70%) claimants have filed previous workers’ compensation claims. Where thestudy claim was not the worker’s first claim, the median number of previous claims is four.

Worker characteristics are largely unknown for the approximately 60% of claims that receive onlymedical benefits or are not paid benefits. Where the information is recorded (short-term or long-termbenefit claims), claimants are mostly (75%) male with an average age in the mid-30’s. The femaleclaimants tended to be slightly older than male claimants. Occupationally, the largest groups of claim-ants are health care workers and truck drivers. Almost half of claims arise within light manufacturing,service and trade industries.

There is little change in the type of benefits received for claims that are two, three or four years old.Approximately half of claims receive only health care benefits. Two in five claims receive short-termdisability benefits (wage loss and/or vocational rehabilitation). Less than 2% of claims receive long-term disability benefits. One in eight claims registered in a given year are not paid any benefits.

For claims that receive only health care benefits, the average value of the benefits received to theend of the study period is approximately $130. Health care benefits paid on claims that also receivedshort-term disability benefits averaged about $820. Health care benefits paid on claims that alsoreceived long-term disability benefits varied according to the age of the claim and ranged from an aver-age of $8,300 for the 1994 cohort to $4,400 for the 1996 cohort.

For claims that receive wage loss benefits, an average of 3-4 weeks pass from the date the claim isregistered until the first wage loss payment is made, however 50% of first payments are made within 12days. Wage loss recipients receive an average of 32-37 days of wage loss payments, but again themedian number of days of wage loss is much lower at nine days. The average value of short-term dis-ability benefits received (including vocational rehabilitation benefits) by claimants who received thesebenefits but not long-term disability benefits is $2,840.

Approximately 50% of claims involve sprain and strain type injuries. However, these injuriesrarely lead to long-term disability benefits. Conversely, nearly all hearing loss or impairment claims(less than 1% of claims) receive long-term disability benefits.

Few pensions (less than 2% of claims) are awarded within two, three or four years of the registra-tion of the claim. Most pensions (95-99%) that have been established in these time periods are based onan assessment of permanent functional impairment. This type of pension award is, in general, estab-lished more quickly and is awarded to younger claimants than loss of earnings pension awards. For1994 cohort claims, permanent functional impairment awards were established an average of ten monthsearlier than loss of earnings pension awards and were established for claimants an average of ten yearsyounger.

102 Karen A. Ryan

The average value of the short-term disability benefits received by claimants who also receivedlong-term disability benefits varies according to the age of the claim and ranges from $25,400 for the1994 cohort to $10,300 for the 1996 cohort. The average reserve amount set aside to pay disabilityawards for permanent functional impairment ranges from $20,700 for the 1996 cohort to $26,000 for the1994 cohort. For loss of earnings pensions, the average reserve amount ranges from $163,700 for the1996 cohort to $196,900 for the 1994 cohort.

During the period of tracking, approximately 3% of a cohort’s claim files are fully disclosed toworkers or employers. Almost 90% of full disclosures are completed within 90 days of when they arerequested.

By the end of 1997, Review Board appeals had been filed in relation to less than 3% of claims reg-istered in a given cohort year. Workers initiate many of these appeals. At most, employers initiate onein ten appeals. The most common appeal issue for both worker and employer initiated appeals concernsentitlement to compensation. Other common issues concern the duration of wage loss benefits and deci-sions on claim reopening.

Less than 10% of Review Board appeals have an extension of time problem. These appeals areoften two to three months beyond the 90-day time limit. Most extension of time requests are granted.

One-quarter of issues appealed by workers and nearly one-half of issues appealed by employers inrelation to cohort claims are withdrawn or abandoned.

Most (75%) worker initiated Review Board appeals are dealt with by way of oral hearing. Oralhearings are held for approximately 40% of employer initiated appeals. Three-person panels conductmost oral hearings, although the proportion of three-member panels fell from over 90% for the 1994cohort to just over 70% for the 1996 cohort. Workers are represented at oral hearings 65% (1996) to75% (1994 and 1995) of the time while employers are represented at oral hearings 50% (1994) to 75%(1996) of the time.

The Review Board allows from 37% (1994) to 45% (1996) of worker initiated appeals. Employerappeals are allowed in 26% (1996) to 37% (1994) of cases. The allow rate is somewhat higher forworker appeals that proceed by way of oral hearing (38-49%) rather than read and review. For employerappeals, the allow rate for oral hearing appeals is also somewhat higher than for read and review appealsbut only in relation to the 1994 cohort (48%). The 1995 and 1996 results did not vary according to thetype of appeal.

It generally takes at least one year from the date the Review Board appeal is filed until a finding isrendered.

By the end of 1997, Appeal Division appeals had been filed in relation to less than 1% of claimsregistered in a given cohort year. Over 80% of these appeals are worker initiated.

About 10% of worker appeals are withdrawn or abandoned. One in five employer appeals gener-ated by the 1994 or 1995 cohorts were withdrawn or abandoned but this proportion drops to 11% for the1996 cohort.

Less than 10% of Appeal Division appeals have an extension of time problem and over 60% ofthose that do are granted the extension of time to appeal.

The most common appeal issue involves the initial adjudication of personal injury. The next morefrequent issue involves temporary disability payments.

Less than 5% of Appeal Division appeals proceed by way of oral hearing. Approximately half ofthe panels hearing worker initiated appeals arising from 1994 cohort claims were composed of three

Karen A. Ryan 103

members, but this percentage fell to less than 40% for the 1995 cohort. In relation to the 1994 cohort,two-thirds of the panels hearing employer initiated appeals were composed of three members.

Most workers (83% in 1994) are represented for the Appeal Division appeal; especially thoseappeals that proceed by way of read and review. The most frequent representative type is a trade unionrepresentative. One-half of employers (52% in 1994) are represented. The most common representativetype for employers is a consultant.

Three-person panels dealt with approximately one-half of worker initiated read and review appealsand 70-80% employer initiated read and review appeals.

Approximately one in three worker appeals to the Appeal Division are allowed, although this num-ber rose to 49% for the 1996 cohort. An additional 5-10% of worker appeals are partially allowed.Roughly one in eight employer appeals arising from the 1994 cohort are allowed, however in relation tothe 1995 cohort this percentage fell to 8% and then rose to 22% for the 1996 cohort. Another 5% ofemployer appeals are partially allowed.


About 50% of Appeal Division appeals are completed within 90 days of the date the appeal wascommenced. The overall time from the date the appeal is filed until a decision is rendered is roughlyfive months.

Workers initiate the vast majority (95-100%) of Medical Review Panel appeals in each of the threecohorts.

The largest source of the decisions appealed to an MRP depends on the age of the claim. For theoldest cohort (1994), the largest source of appealable decisions is the Appeal Division. In each of theother two cohort years the largest source of appealable decisions is the WCB.

Initial adjudication of personal injury is the decision type that is most frequently appealed to anMRP. The most common type of injury referred to a Medical Review Panel is strains and sprains.

Approximately 10% of worker applications for an MRP are rejected due to a determination by theMedical Review Panel Department that the appeal lacks a bona fide medical dispute. Another 10% arewithdrawn.

In relation to worker initiated MRP appeals, 25% (1996) to 67% (1995) of Medical Review panelcertificates do not confirm the decision under appeal.

In total, one to one and a half years pass from the date the appellant provided an enabling certificateto the date the panel issued its certificate. Approximately five months pass from the date the enablingcertificate is provided until the Medical Review Panel Department determines whether the appealinvolves a bona fide medical dispute. From the date this decision is made to the date the panel issues itscertificate another year elapses.

The flow and interaction of worker and employer appeals to the Review Board, Appeal Division,and MRP were traced for appeals arising from WCB decisions concerning entitlement to compensation.Approximately 5% to 6% of claims registered in a given year are rejected or disallowed by the WCB.Workers appeal about 15% of these decisions to the Review Board. The Review Board allows 35% to45% of these worker appeals. Employers appeal roughly 10% of these Review Board decisions to theAppeal Division which allows less than 20% of the employer appeals.

104 Karen A. Ryan

The Review Board denies 55% to 65% of worker appeals involving entitlement to compensation.Approximately 40% of these decisions are appealed by workers to the Appeal Division, which allowsabout 40% of the appeals.

With reference to the 1994 cohort, where workers are denied at both the Review Board and theAppeal Division, approximately one in three appeal the Appeal Division decision to the MRP.

Roughly 95% to 96% of claims are not rejected or disallowed by the WCB. Employers rarelyappeal these decisions (less than 0.1%). At the Review Board, one in three employer appeals areallowed. Workers appeal about 20% of these Review Board findings to the Appeal Division, whichallows at least 60% of the appeals. Employers appeal from 10% to 20% of the Review Board decisionsto deny their appeals to the Appeal Division, which allows less than 10% of these appeals.

With reference to the 1994 cohort, 42% of workers who appealed a WCB decision to reject or dis-allow their claim to one or more appellate body were successful in getting their claim accepted for com-pensation by the end of 1997. These 594 cases represent 6.4% of the 9,236 claims that were originallyrejected or disallowed by the WCB. Approximately 28% of employers who appealed a WCB decisionto not reject or disallow a claim to one or more appellate bodies were successful in having the claimrejected or disallowed for compensation. These 40 cases represent .02%, or one in 5,000, of the 185,824claims that were originally not rejected or disallowed by the WCB.

All of this decision-making activity and the processes that support it consume considerable time.Figure 14 below shows the average and median length of time for each stage of the process for workerswho pursued one or more appeals of the WCB decision to reject or disallow their 1994 cohort claims.For those workers who had this issue adjudicated by all three appellate bodies, the average length oftime from the Review Board notice of appeal to the MRP certificate is nearly three years. This totalincludes roughly one year for the Review Board to make its decision, about 4 months for the AppealDivision to make its decision and about eighteen months for the MRP to make its decision. In addition,several dozen appeals arising from cohort claims were still in progress at the end of 1997. It should bekept in mind that this analysis followed a single, routine type of adjudication decision that is made onnearly every claim filed with the WCB and which involves presumptions favouring the acceptance of theclaim. Yet, as demonstrated by the adjudication and appeals flow charts, the decision-making process isneither straightforward nor efficient.

Tracking the flow of claims through the appeals process was a difficult and time-consuming task.Nearly every step in the linkage and analysis presented a new challenge. Time constraints precluded amore in-depth follow up of appeals resulting from claims adjudication decisions, however, the adjudica-tion of entitlement to compensation is only the first decision type that may potentially be adjudicated fora claim. Successful worker appeals (to one or more appeal bodies) of a WCB decision to reject or disal-low a claim may be followed by further appeals, by both workers and employers, of claims decisionsinvolving medical, wage loss, vocational rehabilitation, and long-term disability benefits. Of course,decisions in these areas for claims that are “accepted” are also subject to multiple levels and iterations of

Avg=47 Avg=208 Avg=228 Avg=28 Avg=40 Avg=129 Avg=62 Avg=61 Avg=166 Avg=325Med=38 Med=187 Med=200 Med=27 Med=33 Med=112 Med=65 Med=0 Med=178 Med=288

Avg # of days from RB Pt 1 to MRP Certificate=1020; Median # of days=1040

Lengthof Timein Days

Figure 14Time Elapsed Between Appeal Stages for Worker Appeals of Decisions to Reject/Disallow Claims


WCBDecisionDate

RB Part 1Date

RB Part 2Date

AD ReceivedDate

BFMDDecisionDate

MRPCertificateDate

RB FindingDate

AD FinalResult Date

AD Com-mencem'tDate

MRPApplicat'nDate

EnablingCert. Rec'dDate

Karen A. Ryan 105

appeals. Additionally, some appeals may result from dissatisfaction with the implementation of anappellate body’s decision as suggested by submissions to the royal commission.

Instead of doing their (WCB) job properly and making me, the injured worker feel as ifthe WCB is doing something for me they: turn down my request for help and make meappeal (usually up to a year); turn down my appeal and make me appeal again (usuallyanother year); turn me down and make me appeal to the MRP (about 6-8 months); com-pletely screw up the MRP findings and start the sloooooooow process of doing something(usually a year and a half); give me some money and cut me off; start at appeal overagain (about a year); turn down my appeal etc. etc. etc.154

Worker and employer submissions to the royal commission are in agreement that the current appealsystem is too slow and the delays cause claimants emotional and financial hardship. In addition, “theadversarial nature of the WCB, the lack of information provided to employees and employers, the com-plexity of the process, administrative inefficiency, and inconsistency and delay in decision-making con-tribute to backlogs and delays in the process.”155 The evidence provided by the cohort data analysissupports these concerns.

The results presented in this paper will undoubtedly be the subject of interpretation and debate.The data is weak in some areas and allowances had to be made. The development of quality, integrateddata that captures worker and injury characteristics as well as positive and negative adjudication deci-sions would certainly enhance understanding. However, debate may also arise because the perspectiveon claims, claimants and process presented here is unique in that it is not muddied by business activityconducted on any claim ever registered. By following a specific group of claims over a several yearperiod it is possible to calculate accurate percentages, whether they be the allow rate of an appeal bodyor the disallow rate of the WCB. This makes it possible to discern and follow trends that are notobscured by other business.

The preceding report only scratches the surface of the analyses that are possible with cohort-styledata, particularly if such data spans a longer history of adjudication than any of these cohorts do. Thedifferences between the three cohorts (e.g., number of appeals generated) highlight the impact of timeon the system’s ability to produce decisions. An important element of the cohort concept is the trackingof a progression of events to the end product or outcome. With respect to claims adjudication andappeals it is not known when the process will end (even death does not necessarily end the compensa-tion decisions required for an injury) or how long the “tail” is, but it is certainly longer than four years.

In addition, longitudinal data from several cohorts could be compared to assess the impact on legis-lative, policy and practice changes within the system. Ideally such analyses would compare severalcohorts of claims that have aged to the same point in time (i.e, five years or ten years from claim regis-tration).

These and other avenues to a better understanding of the operation and performance of the claimsadjudication and appeals system should be pursued. Longitudinal data has much to offer in the contextof informing managers, executives and legislators by providing meaningful measures of effectivenessand efficiency.

References

Hunt HA, Barth PS, Leahy, MJ. The workers’ compensation system of British Columbia: Still intransition. Richmond (BC): WCB of British Columbia; 1996.

154Injured worker’s submission, INJ-030.155PRAXIS Background Paper, 6.0 Appeals, September 16, 1998 Draft One, pp. 1-2.

106 Karen A. Ryan

Documents

Cohort Project Report - British Columbia · The Cohort Project Report A Longitudinal Analysis of New Claims Registered with the WCB of BC, 1994 - 1996 Prepared for the Royal Commission