On a Thursday in early February Sharon Cager was assaulted while doing her job in downtown Vancouver.
Along with a difficult physical recovery, the assault led to what she says has been a stressful interaction with the Workers Compensation Board, or WorkSafeBC, an agency that says it has been taking steps to become more centred on the needs of injured workers.
An overdose outreach worker employed by Vancouver Coastal Health for the last 12 years, Cager was walking down Cordova Street in the city’s Downtown Eastside when the assault happened.
“Some guy came up behind me, tried to grab my backpack off my back, and I had it strapped across my chest,” Cager said. “He couldn’t get it off me and he reefed my arm around, then I spun around to get him off of me because people are getting stabbed downtown right now.”
A longtime hockey player who also practised taekwondo, she hit the assailant with her forearm and got away from him. Such assaults being common in the area where she works, she didn’t bother filing a police report.
“I thought nothing of it,” said Cager, who is 53. She went home and took a couple of ibuprofen anti-inflammatory pills.
But when she went to work the next day she realized the injury was worse than she’d thought. “It just was on fire,” she said. “I had no feeling in my hand and it was just this shooting pain.”
She went to an urgent primary care centre and was sent to a hospital emergency room, but the professionals who saw her had little they could do for her.
“A week later I was still basically writhing in pain,” Cager said. “I went to emerge again, the doctor there did a CT and he said there’s definitely something going on. He thought there was a break in my shoulder, a fracture.”
She saw a surgeon who said there was a slight fracture in the shoulder socket, but not to worry about it unless it was still bothering her in a couple weeks, in which case she should get more imaging done.
An MRI was finally done March 29 at her doctor’s urging. As of this writing, she’s waiting for the results.
While seeking help and taking medication for pain control, Cager also saw an acupuncturist. “It was really helping minimize the pain. I wasn’t taking as many opioids, which I didn’t want to take but kind of needed.”
She said the acupuncture treatment would have been covered under her extended medical benefits when she was working. In some circumstances the treatment may also be paid for through the province’s Medical Services Plan that covers medically necessary services.
Because the injury happened on the job, WorkSafeBC has been involved. Cager said the case manager who did the intake told her it was OK to continue with the acupuncture, but when she submitted her claims for repayment she heard nothing back.
Through WorkSafeBC’s website she pulled up her file. “I looked at my documentation, and some doctor, never seen [by me] before, a WorkSafeBC doctor, put in a communication that I did not need an MRI, that it was soft tissue damage and that WorkSafeBC does not pay for acupuncture.”
The response made little sense to Cager. “My thought was ‘why are you taking away something that is working for me?’” A spokesperson for WorkSafeBC said the agency can pay for acupuncture.
Between her regular doctor, her physiotherapist and the acupuncturist, there was a plan to help her manage the pain and recover and it seemed to be working. She was becoming much less reliant on pain killers and she was optimistic about getting better.
But the doctor working for WorkSafeBC, who had never seen her in person, recommended she go to the Back in Motion clinic for a more active rehabilitation program, a plan that she worried she wasn’t ready for and that would in fact set her back.
(Cager understood she was expected to start at the clinic within a week, though she would later learn there were no appointments available until late in May anyway.)
“They’re not taking my doctor, my physiotherapist, anyone’s advice, and the case manager never calls me back,” Cager said. According to WorkSafeBC, a case manager should respond to email or telephone messages by the next business day.
“I’m worried that these people are going to injure me more,” Cager said, adding that even lifting a cup of coffee still causes her sharp pain. “I can’t lift weights.”
WorkSafeBC is mandated to promote safe and healthy workplaces, support rehabilitation of people injured at work and provide compensation to replace lost wages.
“Each working day, WorkSafeBC makes thousands of decisions about compensation, prevention, assessment and rehabilitation,” a spokesperson for the agency said.
“Our goal is to arrive at the correct decision in a timely manner by weighing evidence consistently, while complying with law and policy. In the absence of a law or policy to cover every conceivable situation, each issue is decided on its own merits, within the parameters of law and policy.”
The system is rooted in a historic compromise in which both employees and employers give up the right to sue in exchange for a predictable no-fault method of determining how much support an injured worker is entitled to. It’s funded by premiums paid by employers and investment income.
But for workers like Cager, WorkSafeBC’s involvement can feel counterproductive. Both her employer and her union have been understanding and helpful, she said, but WorkSafeBC has introduced uncertainty into the healing process and she doesn’t know what happens if she refuses to go to the clinic the agency has chosen.
“It’s just the stress of it all,” she said. “I’d rather just go back to work and take a whole shit ton of pills to get through work just so I can get acupuncture paid for. That way I can do the treatments that my people are telling me to do.”
But returning to work too soon can also be risky.
A September 2021 report from B.C. ombudsperson Jay Chalke told the story of a cabinet maker who lost the tips of four fingers in a workplace accident, then suffered a worse injury after WorkSafeBC stopped benefits too soon, forcing him to return to work before he was ready.
The B.C. government commissioned its own report on the system from retired labour lawyer Janet Patterson, which it released in August 2020.
The 517-page "New Directions: Report of the WCB Review 2019" followed a public engagement process that included hearings in 14 communities and more than 70 written submissions from unions, employers, business associations and other stakeholders.
Many workers said the WorkSafeBC process was often adversarial and that they didn’t feel heard throughout it, Patterson found.
“Many reported being spoken to by case managers in hostile or dismissive ways and that they considered themselves abandoned or further injured by the compensation process.”
The report included 102 recommendations, many of which require changes to provincial laws and WorkSafeBC policy. Overall, they speak to a need for a change of culture that returns the agency to a focus on helping injured workers and treating them with respect and dignity.
Despite promising signs from the government, the needed changes are yet to be made, according to the BC Federation of Labour.
In December the BC Fed launched a campaign highlighting the stories of injured workers and calling on the province to act.
Around the same time there was a statement from Labour Minister Harry Bains saying the changes were coming soon. “In 2022, our government will explore a series of reforms to improve programs and services for workers injured in the workplace, as well as ensure workers are treated fairly while navigating the system,” he said.
The government had already made significant changes to WorkSafeBC and would continue working on it based on what it heard from Patterson and other reviewers of the system, he said, adding the work would include consultations with employers, workers and other stakeholders.
“We are committed to a sustainable workers’ compensation system with affordable and stable premium rates paid by employers that places injured workers at the centre,” he said.
“My ministry and WorkSafeBC are committed to supporting all those who rely on the workers’ compensation system during extremely difficult times in their lives,” he said. “We are encouraged by the progress we have made so far, and we know we have much more to do.”
Bains was unavailable for an interview last week.
Nor was anyone from WorkSafeBC available for an interview, but a spokesperson responded to questions by email.
The next steps on implementing the Patterson report are up to the government, they said, pointing out that the agency has already implemented 34 of the 41 recommendations from another report WorkSafeBC had commissioned from Paul Petrie, "Restoring the Balance: A Worker-Centred Approach to Workers’ Compensation Policy."
“Improvements have been made to the workers’ compensation system through implementation of the Petrie recommendations in 2019 and Bill 23 in 2020, as well as WorkSafeBC’s own operational and policy changes — and these have addressed many of the recommendations made in the Patterson report,” they said.
“WorkSafeBC has been taking significant steps over the past several years to improve its services and support for injured workers, with major initiatives undertaken to implement changes and to move towards a more worker-centric service model.”
More than four out of five injured workers surveyed in 2021 rated their overall experience with WorkSafeBC as “good” or “very good,” they said. “We are striving to improve on this.”
WorkSafeBC involves injured workers throughout the process and makes decisions about their cases based on the best available evidence, they said. “These decisions are based on reports from the worker, the employer, medical reports from the injured worker’s doctor and all other relevant medical information.”
In situations where there are differences of opinion between doctors or conflicting medical evidence, WorkSafeBC “must resolve that issue in a manner that favours the worker.”
The medical advisors working for WorkSafeBC do not make decisions on claims themselves, but instead provide the staff who make those decisions with clinical advice based on their review of the claim.
“It is generally not necessary to examine the worker in person to provide an informed opinion,” they said. “However, where required, our medical advisors do see workers and conduct examinations in person.” When needed they will also consult the physician who is treating the patient.
The spokesperson said WorkSafeBC staff understand how important it is to be responsive and transparent and to make sure they tailor support to the individual worker’s needs. “When work-related injuries or illnesses occur it is often an incredibly stressful time for an injured worker who may have pain, uncertainty about recovery, and uncertainty about the future and their continued employment,” they said.
In Cager’s case, there’s no question it has been a stressful time for her since the assault and the injury, though she’s determined to get better as soon as possible.
She heard back from Back in Motion, and learned they wouldn’t get her in until close to the end of May, another seven weeks.
“I plan to be back to work by then, regardless of feeling in [my] hand,” she said. “I have been in the pool everyday and strengthening my arm, but still have pain and feeling loss.” She was also still seeing her physiotherapist.
“This isn’t going to be a permanent thing I hope,” she said. “As long as the pain is gone, I can work on the other stuff, the strengthening and everything, while I’m still working. That way my benefits will cover everything.
“I don’t want to rely on WorkSafeBC,” she said. “They’re quite unreliable.”
Aside from work she likes to draw, paint, crochet and garden, all of which she’s been unable to do with the injury to her dominant arm. Shortly before the assault she got a new standup paddle board and hopes to be able to use it. “I better be on it by June,” she said.
Meanwhile she said she was more than willing to talk publicly about her WorkSafeBC experience in hopes that it might make a difference. “If it can change the system, you know, it needs to be changed.”