WCB’s endless circles of treatment
Dante opens the Inferno with a man in the middle of his life who has lost his way. In Longfellow’s old translation it reads: “Midway upon the journey of our life / I found myself within a forest dark, / For the straightforward pathway had been lost.”
I think about that line whenever I sit across from a veteran first responder. Most of them are somewhere around the midpoint of their lives, lost in a forest they never chose to walk into. The straight path out, the one the workers’ compensation system is supposed to provide, has gone missing.
What follows in Dante is a descent through nine circles of hell. It’s a god-awful journey, but it has a guide and a map. More importantly, it has a bottom, and Dante eventually reaches it and climbs out the other side, where he sees the stars again.
The first responders I’m writing about are stuck in a version of hell that has no bottom. Every time they think they’ve finally reached the end of it, the file gets another referral and they find themselves back at the gate.
Who I’m talking about
WCB does this to injured workers of every kind. Anyone with a long-running claim, whether it’s a back injury or chronic pain, can end up cycled through assessment after assessment with no decision at the end of it. For most of them it’s exhausting and demoralizing. For workers with PTSD, and especially for those who are already at risk of suicide, it’s dangerous, because every reassessment forces them to live through the trauma all over again.
That’s why this article focuses on first responders. I mean the police officers, firefighters, paramedics and dispatchers who’ve been on the job long enough to have seen almost everything. By the time they call me, they’re usually somewhere between their fifteenth and twenty-fifth year of service, and they’ve attended hundreds of the calls the rest of us only hear about secondhand.
Their PTSD rarely arises from one bad day. It builds from an accumulation of bad days, stacked on top of each other over a career, until the weight becomes more than any person can carry. That kind of injury is often the hardest to treat.
The system already accepts that these injuries are real. In 2012, Alberta became the first province in Canada to presume that PTSD in first responders is caused by the job, and that presumption has since been extended to other groups. So the fight is rarely over whether the injury is work-related. Where files get stuck is what happens after the claim is accepted, and specifically when the board will stop sending people for more treatment and make a decision about their future.
What good therapy is actually for
I want to be clear about where Blue Collar stands, because this is an easy article to misread. We are not against therapy. For a lot of people, working through what happened with a skilled clinician is exactly the right thing to do, and it can change their lives.
A good trauma therapist will deliberately open Pandora’s box, but they do it with a plan. They help the person look at what happened from a different angle. They work on the guilt over the one they couldn’t save, and on the belief that they should have been faster or done something differently. The goal isn’t to forget. The goal is for the memory to lose its grip, to reframe the experience so the person isn’t constantly triggered.
When it works, the alarm that used to go off every time that memory surfaced starts to quiet down. The person can close the door on it, not by pretending it never happened, but because it no longer runs their life. That’s what treatment is supposed to accomplish, and when there’s a real prospect of getting there, we want our clients to have every opportunity to do it.
The circle that starts over
Some people don’t get better. After years of treatment, with different therapists using different approaches, a meaningful number of long-serving first responders are still stuck. This isn’t a failure of effort or character on their part. Years of cumulative trauma can produce PTSD that simply doesn’t respond the way a single-incident injury might.
At that point the honest clinical question is whether more of the same is going to help. What often happens instead is a loop. The board sends the worker for an assessment, the assessor recommends more treatment, the worker does the treatment, and then the board sends them for another assessment to see whether it worked. When it hasn’t, the recommendation is more treatment, and the whole thing starts over.
To be fair, this loop isn’t unique to first responders. Injured workers of every kind get cycled through assessment after assessment, and the problem of perpetual reassessment shows up on almost any long-running claim. With PTSD, though, it’s at its most acute and its most dangerous, because every reassessment forces the worker to live through the trauma all over again. For these workers the stakes are life and death.
Every assessment requires the worker to walk a stranger through the worst moments of their career. That stranger’s job is to evaluate them, not to help them heal. There’s no ongoing relationship and no plan for the drive home afterward, when the worker is alone with everything they just dredged up. A therapist opens the box so they can help close it. An assessment opens the box to look inside, and then leaves the lid off.
In Dante’s hell, every punishment is built to mirror the sin that earned it. The WCB version follows the same logic. The worker’s only offence was seeing the worst things a human being can see, on our behalf, for most of their adult lives, and their punishment is being made to describe those things again and again, to one new stranger after another.
The difference is that everyone in Dante’s hell earned their place there. These workers did nothing except show up for their shifts.
We understand the money
We’re not naive about why this happens. Deciding that a first responder in their forties will never work again means committing to benefits that may run for decades. Psychological injury claims have grown considerably, and that growth puts real pressure on the system and on the employers who fund it through their premiums. Blue Collar works with employers too, so we see that side of the ledger every week.
But putting off a decision doesn’t make the cost go away. It pushes the cost down the road, and in the meantime the worker absorbs the damage. Sometimes that damage looks like a hospital bed. Ongoing temporary benefits and years of assessments and treatment aren’t free either, so it’s fair to ask whether the stall is even saving anyone money in the end.
Is the stall the strategy?
I have to wonder sometimes whether the endless loop is a strategy in itself. I can’t prove that, and I’m not going to pretend otherwise. Maybe it’s deliberate cost management, or maybe it’s an institution that’s reluctant to put a permanent label on a psychological injury and would rather keep the file open just in case.
From the worker’s side, the reason doesn’t matter much. The experience is identical either way.
What most people don’t realize is why this matters so much legally. In Alberta, a worker who disagrees with the board can challenge its decisions, first through a review and then at the Appeals Commission. But the decision the worker needs can remain out of reach. Another assessment or treatment referral doesn’t necessarily answer whether further recovery is realistically expected, or whether it’s time to assess permanent entitlement. Without a clear decision on that question, the worker has no clear answer to challenge.
The stall feels like a decision in its own right. For someone with treatment-resistant PTSD, indefinite limbo is its own form of cruelty.
What this looks like up close
In the past week, two of my clients ended up in hospital. Both are long-serving first responders who have been in the WCB system for years. In both cases I had told the board directly that more assessment and more trauma-focused treatment carried real risk for these particular people. One of them came very close to losing their life shortly after yet another assessment.
I can’t tell you that a single appointment caused what happened. A mental health crisis rarely has just one cause. What I can tell you is that the warning signs were there and had been raised with the board, yet the files kept moving in the same direction.
I don’t use the word torture lightly. But asking someone with treatment-resistant PTSD to relive their worst calls on demand, year after year, comes closer to it than anyone in the system would like to admit. At some point, continuing to do it after the writing is on the wall stops being caution and starts being reckless.
Getting people out
Dante didn’t get out of hell on his own. He had Virgil, who knew the terrain well enough to lead him down through every circle and out the other side. I’m no Virgil, but a good part of what Blue Collar does for these clients is similar. We know how the system moves, and we use that knowledge to find the way out for people who can no longer see it themselves.
In practice, that means forcing the question into the open. Has this person reached maximum medical improvement? If the board says no, it should be able to explain what treatment it expects to help and when it expects to see the result. If it can’t answer that honestly after years of treatment that hasn’t worked, then it’s time for a decision.
The treating team’s view needs to be on the record as well. The psychologists and psychiatrists who have worked with a client for years usually have a clear opinion about prognosis, and that opinion deserves real weight. Above everything else, we press for a decision in writing, so that if the board gets it wrong, there’s finally something concrete to challenge.
A permanent decision isn’t giving up on anyone. For a worker who has spent years in the loop, it’s permission to stop proving their injury and start building whatever life comes next.
Through the bottom and out
The strangest thing about Dante’s journey is the way it ends. He doesn’t escape hell by turning around and climbing back up the way he came. He gets out by going all the way to the bottom and through it, and the last line of the Inferno has him emerging on the other side to see the stars again.
For these workers, the bottom is a decision. It’s the point where the board finally acknowledges that treatment has done what it can, and lets them stop descending. The people I’m writing about spent their careers walking into the worst moments of other people’s lives so the rest of us didn’t have to. They deserve a way out that doesn’t run back through the gate one more time.
If you or someone you love is caught in this cycle, Blue Collar Consulting can help you push for the decision the board has been putting off.
If you’re struggling right now
If you’re a first responder reading this and you’re in a dark place, you don’t have to wait for the board to decide anything before you reach out. You can call or text 9-8-8 any time, day or night, anywhere in Canada. If you’re in immediate danger, call 9-1-1.
