"This Bill Means Reduced Treatment and Compensation"

Félix Lapan is a community organizer with the injured workers' defence organization the Union des travailleuses et travailleurs accidentés ou malades (UTTAM)..

Workers' Forum recently spoke with him about the consequences that the Quebec government's Bill 59 will have on injured workers if it is adopted. Due to the length of the interview it will be published in two parts. Today we are publishing information on the impact of Bill 59 on workers with regard to the recognition of occupational diseases and their entitlement to medical assistance, treatment and rehabilitation services. We will publish information on the impact on the right to monetary compensation in a later issue.

Workers' Forum: According to UTTAM's investigation, what consequences will the Legault government's Bill 59 have on injured and sick workers if it is adopted?

Félix Lapan: Generally speaking, this bill means reduced treatment and compensation benefits for injured workers.

For example, the bill will make it more difficult to have many claims for work-related illnesses accepted. It attacks the right to medical assistance, the right to treatment, medication, devices like orthotics and prosthetics that are supplied by the Labour Standards, Pay Equity and Workplace Health and Safety Board (CNESST) and it attacks the right to rehabilitation for workers who have suffered permanent disabilities.

With respect to victims of occupational diseases, barriers are being created for people suffering from hearing loss and lead poisoning. It will be much more difficult to have hearing loss and lead poisoning recognized as occupational diseases.[1] The CNESST is being given regulatory power to add barriers to the recognition of all occupational diseases, which is of great concern to us. Moreover, the Ministry of Labour, in its document on the impact of the bill, is projecting millions of dollars in savings due to rejection of workers' claims for occupational illnesses and injuries, hearing loss in particular. In introducing the bill, the Minister of Labour touted it as a measure that will produce $4.3 billion over 10 years in "savings" for employers who fund the CNESST through their premiums.

So, for victims of occupational diseases, there is a reduction in access to treatments and compensation.

Once a claim is accepted, whether related to an illness or an accident, the new legislation reduces the worker's entitlement to medical assistance. What is included in medical assistance is changed. There is an article in the current legislation that says that it is the responsibility of the CNEEST to provide all medical assistance. The CNESST currently pays 100 per cent of the cost of medication, orthotics, prosthetics and a whole list of treatments in private clinics. Bill 59 changes this article, article 194 of the Act respecting industrial accidents and occupational diseases (LATMP), which states that medical assistance is paid for by the board, that no fees can be charged to a worker for medical assistance needed as a result of an injury. The bill removes this section and says that the CNESST will be entitled to adopt a regulation permitting it to charge part of the medical assistance costs to the workers. With respect to drugs, and this is a first in the history of the plan, with this regulation they will no longer pay for all drugs.

According to the bill, only orthotics and prosthetics specified in a regulation still to be created will be paid for, so not all necessary devices will be paid for. The CNESST already applies internal policies that limit access to medical assistance, even though the law does not allow this, and these decisions are therefore often overturned by the courts. Now it's not just going to be an internal policy, it's going to be a regulation. Will the regulation be that they reimburse drugs at 80 per cent like a private insurer? Are there going to be drugs that are excluded from the plan? We don't know. The day after the law is passed, the CNESST will be able to publish its regulations in the Official Gazette and specify how access to medical assistance will be limited. Anything that is taken out of the law and put into regulatory powers for the CNESST will be out of our control. They can change the rules of the game at any time without going through a debate in the National Assembly, without amending legislation. When a regulation is published in the Official Gazette we have 45 days to comment on it, after which the regulation comes into force by a cabinet order.

With Bill 59 there are many things that move from the legislation to regulations made by the CNESST. For example, the list of occupational diseases that are protected by the Act will move from the legislation into a regulation that the CNESST can amend as it sees fit. The obstacles that workers face if they have claims for occupational deafness and lead poisoning could be put in the way of workers with many other injuries and illnesses. They have just set a blood lead level, which has nothing to do with science, that must be reached to have lead poisoning recognized. They could do the same thing for a lot of metals, almost all metals, for many toxic substances. All of a sudden, the CNESST becomes the legislator.

We have a system that is supposed to provide treatment for workers' injuries and illnesses. To put part of the costs of treatment on sick and injured workers is unacceptable.

The scenario that we are currently seeing with the regulation on medical assistance is the same scenario that was in the CNESST`s plans in 2012. At that time it was Bill 60 which would have provided for lump-sum treatment envelopes, a set amount for each illness or injury, with treatment provided until the designated amount was spent. [Bill 60 died when the Quebec government of the day called a general election -- WF Ed. Note]. We're going to possibly end up with a similar type of regulation.

WF: The bill also eliminates physical rehabilitation altogether.

FL: Yes, there is also an attack on the right to rehabilitation. The current law provides for three types of rehabilitation with specific programs. Rehabilitation is for workers who have permanent after-effects. There is physical, social and professional rehabilitation.

Physical rehabilitation consists of treatments after the treatment of the injury itself is complete, treatments for permanent consequences of the injury. These are no longer treatments to heal, but to control and relieve pain, to reduce the consequences of a loss of quality of life. The bill simply abolishes physical rehabilitation. In other words, medical treatment, physiotherapy, occupational therapy or even psychotherapy in the case of psychological injuries will only be aimed at recovery or return to work. If a worker has permanent after-effects from his or her injury that affect his or her quality of life, this is no longer important according to the bill. That is the logic. There are also limitations to what can be received in terms of social and vocational rehabilitation. Social rehabilitation concerns rehabilitation measures such as home assistance, or home renovations, while vocational rehabilitation concerns measures such as training for vocational reorientation. The bill now provides for a specific list of measures covered, whereas currently the list is qualified by the word "including," which opens the door to other measures.

For us, these attacks on the rights of injured and sick workers are unacceptable and are deeply disturbing.


1. Hearing impairment caused by noise is one of the occupational diseases specifically named in the Act respecting industrial accidents and occupational diseases. Currently, the only requirement to qualify for the presumption for this disease is to have performed "work involving exposure to excessive noise." With the amendments to the Act in Bill 59, it will now be necessary to demonstrate exposure to a threshold of more than 85 decibels for eight hours per day, over a period of at least two years, by means of evidence specified by the regulation.

A new condition is also imposed for the recognition of lead poisoning. The only condition at present is that the person must have worked in a job involving the use, handling or other exposure to lead or its compounds. The bill now adds the condition of having "a blood lead level equal to or greater than 700 g/L (micrograms per litre of blood)."

(Translated from original French by Workers' Forum. Photos: UTTAM)

This article was published in

April 7, 2021 - No. 25

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