Lost in a loophole

Deana Stokes Sullivan
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Photo by Gary Hebbard/The TelegramJerome Lawlor, an injured worker, holds a long list of massage therapists he was given by the province's workers' compensation commission. He says the problem is that none of them will treat him for $25 per half-hour, the coverage limit set by the commission. They all charge $45 and up. -© 2011 The Telegram (St. John's). All rights reserved.

Jerome Lawlor of Paradise is an injured worker who's received special authorization from the workers' compensation commission to have more than its limit of six massage therapy sessions.

But he's facing other roadblocks because of new regulations adopted by the Workplace Health, Safety and Compensation Commission (WHSCC) in June 2010 that limit the number of treatments to six half-hour sessions with coverage capped at $25 per session.

Lawlor's approval for 15 sessions was based on "extenuating circumstances." Since 2008, he says, regular massage therapy has enabled him to deal with his chronic back pain without taking narcotics.

But Lawlor says he can't find a massage therapist who will treat him for only $25 a session. Most charge $45 and injured workers can't pay anything above the WHSCC limit because of another regulation that prohibits therapists from charging injured workers the difference.

Leslie Galway, chief executive officer of the WHSCC, said last week the latter regulation is to protect injured workers from being charged amounts above its set rate.

Lawlor, who worked as a school board maintenance employee/janitor, sustained his first back injury during renovations to a school in Paradise almost 23 years ago, and was injured a second time while clearing snow around the school. He's had three back surgeries and is now waiting to have another operation.

In his first workplace incident, Lawlor said, he was asked to help another man move a piano that was left in a corner of a room when new carpet was being installed.

"We rolled it over to the carpet and picked it up and lifted it probably 10 feet or so and laid it down," he said.

The following day, he felt a bit stiff, but didn't think much of it. The next morning, he couldn't even put his socks on.

Lawlor had back surgery, was off work for about two months and then returned to his job.

"I was working for probably two to three months with a pocketful of Atasol 30s and did more damage," he said.

Lawlor said part of his job was clearing snow on sidewalks and walkways around the school.

He brought his own snowblower there at first to make the job a bit easier, but said he was told the school board wouldn't pay to have it repaired or replaced if anything happened to it, so he had to resort to clearing snow with a large metal scoop.

One day, he said, the scoop dug into a crack in the walkway. "The handle came back and struck me in the stomach and drove the back out, and I haven't been back to work since," he said.

That was in January 1989 and Lawlor said he hasn't been able to work since then.

He said the WHSCC approved physiotherapy sessions for him, but he didn't feel it was doing him any good.

In order to deal with his pain, his doctor prescribed numerous medications, including narcotics like OxyContin.

After his third back surgery in 2008, Lawlor said he told his family doctor he wanted to get off this medication.

He said he didn't like the idea of taking OxyContin and was always worried that the drug would increase the risk of his home being broken into by drug addicts.

His doctor began weaning him off the medication. Lawlor said when he got to the end of the process, the withdrawal was almost unbearable. He spent six nights unable to sleep and was extremely restless during the day.

"I was down in the shed with the fire going all night long, sitting in front of the fire, smoking. I couldn't sit down to watch the TV, I couldn't sit down to read, I couldn't sleep," he said.

When he asked the commission whether there was any help available, he said he was told he could go to a hospital emergency department and be admitted to a psychiatric ward.

"I said, 'No, I'm sorry, I'm not going in off the street and be treated like a common drug addict,'" Lawlor said.

Once he was successfully off the narcotic, his doctor suggested he try massage therapy.

Lawlor said the first therapist he went to did nothing for his pain, but his chiropractor referred him to one in Kelligrews who specializes in deep tissue massage.

He began feeling so good that he was able to do some gardening in preparation for his daughter's wedding.

Then in June 2010, when he had to get re-approved for his massage sessions, he found out about the new regulations that limited the number of sessions to six.

His family physician and chiropractor wrote supporting letters about how well he was doing with massage therapy and how he could go without any pain medication.

Lawlor said the commission finally approved 15 sessions a year, and said it would reassess his situation at the end of the sessions.

Lawlor said when he learned the coverage would be capped at $25 for a half-hour session, his biggest beef was "why should I have to pay for treatments? They're already taking back all my Canada Pension, 100 per cent of that goes back to them. I'm losing dollar for dollar on that, and they expect me to turn around and pay part payment for my treatment."

At a recent review hearing, however, Lawlor said he was told that although there's a gap between the coverage and the actual fees charged by therapists, he's not permitted to pay the difference even if he wanted to.

"So, they gave me special circumstances - I can have it but I can't have it," he said.

The WHSCC gave him a list of massage therapists to contact, including some outside Newfoundland. He said the commission argues that some clients are receiving therapy under the new regulations.

But he doesn't understand how. Lawlor said he had no luck finding anyone who would accept $25 for a half-hour session and in Nova Scotia, two therapists he contacted are charging more than $50 a session.

Through all this, he said his back pain has gotten worse without the massage therapy and he's had to resort to taking pain medication again, but he's adamant he'll never again take OxyContin because of the serious withdrawal he experienced when he stopped taking the drug.

"I get up here in the mornings and I can't stand to the counter to make a slice of toast," he said.

Lawlor said if he had been allowed to see a chiropractor 21 years ago, he probably wouldn't be in this situation now.

"But at that time," he said, "the WHSCC was treating chiropractors like voodoo doctors until the chiropractors proved they could do something other than surgery. Now they're doing the same with the massage therapists."

The WHSCC says it has no scientific evidence that massage therapy has a positive influence on injured workers' return to work and their functional capacity, but it would welcome any peer-reviewed research the massage therapists' association can provide.

dss@thetelegram.com

 

Organizations: WHSCC, Workplace Health, Safety and Compensation Commission

Geographic location: Paradise, Kelligrews, Newfoundland Nova Scotia

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Recent comments

  • joe simms
    November 27, 2011 - 20:57

    The telegram usually runs a story like this once a month, it is an interesting piece but what is the purpose? I am having trouble with the contractor who built my house will the telegram like to do a story on it?

  • Kelly
    November 27, 2011 - 17:27

    Might i suggest seeing a chiropractor, they may be able to offer a long term plan that would be less expensive over the year. A friend of mine has a chronic back problem aggravated by a fall about 6 years ago. She was seeing a physiotherapist who charged $60 an hour. She has not begun to see a chiropractor, the long term plan is1 year and her back issues will be cleared up.

  • Betty Tobin
    November 27, 2011 - 13:42

    I beg to differ with the WHSCC regarding massage therapy not having any positive influence on injured workers' return to work. I, too, spent years fighting with WHSCC regarding issues on chiropractic and massage treatments along with a host of other roadblocks. I would like to mention that I have re-entered the workforce and it is by the grace of God that I can thank chiropractic and massage therapy as both being the key components of keeping me here. I visit the chiropractor at least once every two weeks and continue with an hours massage at least once every three weeks. There have been times where I have made some extra visits depending on the physical aspect of my job. For the most part, things have been very positive. But I do not need any scientific evidence to determine if either is a positive influence on my functional capacity because my ability to stay in the workforce is proof enough for me. Good luck to you Mr. Lawlor and anybody else trying to deal with the commission!

  • We know how you feel
    November 27, 2011 - 10:15

    My fiancee had exactly the same situation, physiotherapy was what workers wanted him to do but massage was the only thing that would make his back feel better. They approved 6 massage therapy sessions and that was it.

  • Don II
    November 27, 2011 - 09:45

    The compensation system run by Government operates on the discriminatory and incorrect assumption that ALL injured workers are lazy, malcontents, malingerers and liars who are just trying to get money for nothing from the Government. As a consequence, injured and permanently disabled people are abused, refused and misused by the system. Once you become injured or permanently disabled you are considered to be a financial drag on the system. You are no longer a contributor to the productivity required to keep the economy moving ahead. The Government thinks that the sooner you can be removed from the compensation system the better. If you can be forced back to work or starved into submission, the system has won. If you die, the system has won. If you take the system to Court, the system will win. If you are a worker you must ensure that you never get sick, injured, disabled or killed on the job because the system is not there to help you or your family, it is there to help the system and the Government that created it. Governments are corrupt and there is no justice for the ordinary person.

  • Chiropractor Rochester NY
    November 26, 2011 - 16:38

    This is a sticky situation for sure. I'm sure there are plenty of cases just like this all across the us where people are injured in their workplace and then have to fight tooth and nail to get their work to cover the costs for their treatments. http://www.chiropractorrochesterny.com

  • Brian Richey
    November 26, 2011 - 08:29

    I can't believe this story. This is treatment that I would expect from an insurance company who are famous for looking for reasons to deny a claim. Why would the WHSCC treat someone in such a manner? When one hears stories like Mr. Lawlor's (who I do not know) it begs the question 'what is the purpose of WCB in the first place'? Should common sense not prevail at some point? For God sake... cover this man's treatment. He deserves it...his injuries occurred 'at work' and not by his own carelessness.