Canadian Safety Reporter

3 Canadian HR Reporter, a Thomson Reuters business 2015 News | November 2015 | CSR Doctor claims WSIB part of fraud in Ontario's workers' comp system BY LIZ FOSTER A LAWSUIT filed against On- tario's Workplace Safety and Insurance Board (WSIB) is al- leging the unlawful dismissal of Brenda Steinnagel, a doctor, is indicative of a broader pattern of fraud within the workers' compensation system. Before she was fired, Steinna- gel worked for Workplace Health & Cost Solutions (WHCS) in Vaughan, Ont. In her work, Ste- innagel provided external medi- cal consultations to assist WSIB case managers in adjudicating claims filed by workers. Steinna- gel consulted on claims to deter- mine whether workers' injuries were connected to a workplace accident and, therefore, eligible for benefits. In a statement of claim filed with the Ontario Superior Court of Justice in July, Steinnagel al- leged WSIB attempted to co- erce her to change her medical opinion about an injured work- er. When she refused to do so, WSIB pressured WHCS to fire her, she said. "In a desperate effort to re- duce claims paid out, WSIB and WHCS have been conspiring to deny legitimate claims in a shock- ing display of arrogance and corruption," read the statement of claim, referencing WSIB's un- funded liability. "They pressured Dr. Steinnagel over a period of months to reverse her medi- cal opinion on a high-cost case. When she refused, she was fired." Contractors — including WHCS — were given orders to reduce the number of claims paid out to workers, even if that meant benefits may be unfairly denied, according to the state- ment of claim. "Even more disturbing, this fraud upon the public has been repeated by WSIB and WHCS in other cases." At least one other "unco-op- erative" doctor was pressured to change the wording on an opin- ion she drafted, said the claim. That incident ultimately result- ed in the doctor quitting her job. Because WSIB oversees a ros- ter of doctors approved to carry out its assessments, Steinnagel alleged she is now effectively unemployable in her field. She is seeking more than $1.3 mil- lion in damages from the WSIB and more than $1.8 million from WHCS, as well as a declaration that she was wrongfully termi- nated. WSIB and WHCS vehemently denied the allegations. "There is no truth to Dr. Stein- nagel's allegations and we deny acting wrongfully in any way," said WSIB senior public affairs consultant Christine Arnott. "The WSIB will vigorously de- fend the lawsuit." The WSIB receives more than 200,000 new claims each year from injured and ill workers. It says upwards of $2.6 billion in benefits are paid out annually. Because the issue is still be- fore the courts, however, WSIB declined to provide any further comment. WHCS also declined to com- ment, with Gred McGinnis — a lawyer at Mathews, Dinsdale & Clark in Toronto representing WHCS — saying only "Steinna- gel is an apparently disgruntled former employee of WHCS, who has brought an action against WHCS and WSIB following the end of her employment. The claims she has made about improper conduct are without merit, and we have brought a motion to the court to strike out many parts of the claim." The motion to strike much of the claim was to be heard in court on Oct. 26, with the law- suit itself expected to follow in November. Preventing fraud Significant protections are in place to prevent fraud within the workers' compensation system, according to Joanne Woodward Fraser, senior communications advisor, media communications and marketing division at the Ministry of Health and Long- Term Care. Using the Ontario Health In- surance Plan (OHIP) as an ex- ample, Woodward Fraser said the ministry has applied a proac- tive approach to deter fraud and reduce any losses. "We maintain a valued part- nership with the Ontario Pro- vincial Police's Health Fraud In- vestigation Unit (OPP HFIU) for investigation of potential cases of fraudulent activity," she said. "We have also increased our invest- ment in staff engaged in activi- ties supporting risk management and fraud control initiatives." All suspected cases of fraud go through a triage process, Wood- ward Fraser said. These cases are reviewed and evaluated against ministry resources before being sent onward to the OPP HFIU. Part of that review and evalu- ation process includes verifica- tion letters randomly generated by a computer system. These letters are sent to recipients of health-care services to verify billing accuracy. Additionally, claim payments are analyzed to detect patterns of activity the ministry has iden- tified as problematic. The Fraud Awareness and Management (FAM) section is the central point of contact with- in the ministry to coordinate anti-health fraud activities. The FAM section operates within the Risk Management and Fraud Control Union of the ministry's Accounting Policy and Financial Reporting Branch. In an effort to make these re- sources even more available to the public, toll-free fraud hot- lines are available to report po- tential fraud, Woodward Fraser said. A similar line is available for health-care providers. The statement of claim filed by Steinnagel, however, calls for more stringent investigations into the possibility of a broader pattern of fraud within the work- ers' compensation system. "The misconduct against Dr. Steinnagel is part of a long pat- tern of such fraud and intimida- tion of those who get in the way of their fraud… the defendants' conduct was harsh, vindictive, reprehensible and malicious," the claim read. "The misconduct by WSIB and WHCS was planned and de- liberate and formed a protracted corporate conspiracy against Dr. Steinnagel." Credit: mangostock /Shutterstock

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