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Many assume that Amazon’s decision to cease operations in Québec was driven solely by the unionization of 200 employees at its DXT4 warehouse in Laval last spring. While this explanation is widely accepted, a critical question remains unasked: Could there be other contributing factors?
One overlooked possibility is the financial burden imposed by Québec’s workplace healthcare system, particularly the excessive costs associated with CNESST claims. Based on years of experience managing these claims for Québec employers, we believe this issue warrants serious consideration in Amazon’s decision-making process.
A Troubling Pattern in Workplace Healthcare
To understand this potential correlation, one must look at a concerning trend in Québec’s workplace rehabilitation practices. In 2009, La Presse exposed the HTB Rehabilitation Clinic for administering hundreds of unnecessary treatments, violating established rehabilitation guidelines. The clinic was subsequently sued by the CSST and the SAAQ and eventually shut down.
Yet, rather than ending, this pattern of overtreatment seems to have proliferated across both large corporate clinics and smaller physiotherapy centers. Our detailed review of 11 recent CNESST claims, using the Reed Group MD Guidelines—a globally recognized standard for effective treatment—revealed staggering discrepancies:
- Total number of treatment sessions: 2.5 to 68 times the recommended standard.
- Total duration of treatment: 2.1 to 9 times longer than necessary.
- Frequency of treatment sessions: 1 to 8 times the suggested rate.
The impact of this overtreatment is devastating. Injured workers suffering from musculoskeletal conditions—such as sprains, strains, and minor fractures—are subjected to excessive therapy, often worsening their conditions and resulting in chronic pain, permanent disabilities, and diminished quality of life.
For employers, this translates to prolonged work absences, soaring CNESST premiums, costly accommodations for disabled employees, and administrative burdens—all of which increase the financial strain of operating in Québec. For society, these unnecessary treatments lead to long-term healthcare and social costs, while reducing the employability of affected workers.
The Business Impact: Was This a Factor for Amazon?
Given these realities, it is reasonable to question whether Amazon, a data-driven corporation with a relentless focus on cost efficiency, factored these systemic issues into its decision to exit Québec. While unionization may have been a major factor, could the province’s burdensome workplace healthcare system have been the final straw?
If so, this raises urgent questions for Québec’s economic future:
- Could other foreign corporations follow Amazon’s lead, especially amid rising U.S. tariffs that could add further financial pressures?
- Should the Québec government launch an inquiry into unnecessary healthcare costs that inflate the cost of doing business in the province?
It is time to move beyond speculation and start a real conversation. MedExtra is prepared to work with the business community to shed light on the extent of this issue and propose solutions to mitigate the risks associated with Québec’s workplace healthcare system.
The departure of a global giant like Amazon should serve as a wake-up call. Québec cannot afford to ignore the structural challenges that may be driving businesses away.
In recent years, claims for mental health issues and workplace harassment; these invisible conditions have been increasingly accepted as workplace injuries by the CNESST.
Unlike physical injuries, these cases are often opaque and frequently arise after negative performance evaluations, workplace conflicts, or personal struggles.
Unlike visible musculoskeletal disorders, where work aptitude can be objectively assessed, there are currently no clear guidelines for evaluating the ability of employees with mental health claims to return to work.
Data validated by MedExtra shows that a significant number of cases involve employees exploiting a system that lacks control, whereby doctors do not see their role as adjudication and fearing complaints to their professional orders, readily accede to all requests to grant work stoppage too easily.
Occupational health and safety consultants and CNESST mutuals have few tools to speed up temporary return-to-work or streamline case resolutions.
Early intervention by the Virtual Medical Director verifies and validates claim legitimacy and identifies potential abuse. Our collaborative, collegial Best Practice Guidelines medical approach to treating physicians, always leads to a faster return to health and work.
Mental Health Should Be Treated Like Physical Health
Mental health deserves the same level of attention as physical health in the workplace. However, to maintain a sustainable system, it is crucial to balance employee well-being with effective medical claim management. Employers and occupational health professionals must work together to foster a culture of transparency and support within companies.
Implementing early intervention Best Practice Guidelines medical management and strategies, like those proposed by MedExtra, helps accelerate case resolution, reduce prolonged absences, and maintain business productivity—while ensuring employees who truly need help receive appropriate support.
How should companies handle mental health claims? Learn how this is affecting you, by clicking here for a free complementary audit.
Recent years have seen the resurgence of a deeply concerning trend in the rehabilitation of minor workplace musculoskeletal injuries (sprains, tendinitis…) as revealed by MedExtra’s validated data, based on the 5-5-5 HTB Rehabilitation Clinic model.
Compared to the Reed Group MD Guidelines, the global authority on workplace musculoskeletal injury rehabilitation, even the most minor conditions are now being over-treated in nearly all rehabilitation/physiotherapy clinics:
- 2.5 to 68 times the number of treatment sessions
- 2.1 to 9 times the duration of treatment
- 1 to 8 times the frequency of sessions
Astonishingly, doctors are often unaware of this over-treatment. And with limited expertise in musculoskeletal injury rehabilitation, they rely primarily on occasional reports from treating physiotherapists to continue, modify or discontinue treatment, creating an obvious conflict of interest.
With the implementation of temporary assignment reducing monthly wage replacement, the greater burden of CNESST claims and virtually non-existent monitoring at CNESST level, the considerable costs of this over-treatment and its impact on delayed consolidation, and the increased incidence of functional limitations and permanent partial disabilities caused by this over-treatment go unnoticed by HR managers, medical experts and the BEM.
It is also crucial to highlight that many affected workers are often part of the working poor or recent immigrants. After undergoing this excessive treatment, in clear violation of international standards, they are left to fend for themselves with minimal compensation.
To learn how MedExtra’s Virtual Medical Director addresses this issue, click here.
The Paradox
There is a paradox for Canadian employers, namely the paradox of increasing benefit costs and absenteeism—particularly from mental health and other invisible conditions not objectively verifiable—in the face of increasing corporate spending on sophisticated, data- & technology-driven employee health promotion, prevention, support and wellness programs.
What the Industry is Saying
Some industry players have tackled this paradox: talking specifically about mental health in their comprehensive 2021 publication The Puzzle of Poor Workplace Mental Health1, MindBeacon points out that “28 million Canadians have access to mental health supports at work through Employee Assistance Programs (EAP)”, that “EAPs are quite effective in improving mental health outcomes” and “employees who access EAP services are less likely to miss work.” MindBeacon also cites the “TOP FOUR PROBLEMS WITH THE EAP (sic) STATUS QUO” as the cause of this paradox:
- Employee usage of products is low: Estimated to be 11% for ALL EAP services
- The products offered don’t cover all their needs
- Lack of tools needed to track efficacy
- A product approach vs a workplace mental health strategy
While this assessment of today’s EAPs rings true, another big player, Mercer Marsh, has identified that the cause of rising benefit costs is not the lack of benefit programs or their low utilization, but poor-quality medical care2 indeed, their 2022 publication Three steps to keep health and benefits plan costs under control states that “poor initial care […] add unnecessary cost and degrade the patient experience and outcomes.”
Amplified on one hand by the lack of sufficient data in the Canadian healthcare ecosystem—identified by the C.D. Howe Institute in 20153 —and, on the other hand, by overwhelmed doctors, seemingly compliant to all demands for time off work and with insufficient time to enable Best Care guidelines, it is clear how poor care leads to poor outcomes.
What is quality care?
The World Health Organization8 and Insitute of Medicine9 define quality medical care as healthcare services adherent to validated, evidence-based professional knowledge that increase the likelihood of desired health outcomes.
In other words, the increase in corporate healthcare costs is driven by the sub-optimal outcomes of poor quality care for mental health, specialty drugs4 and chronic diseases.
Focus on Quality Care: A New Solution to Address Rising Costs
Recognizing that only optimal, guidelines-based care brings optimal outcomes, Mercer’s Three Step solution5 cites the following to create value:
- Quality, cost-effective providers of medical care (plan design)
- A data-driven approach
- Driving of efficiencies
This has been confirmed by 75% of 210 global insurers of employer-funded healthcare, citing in the 2022 Health Trends report6 their top three strategic priorities to address rising healthcare costs:
- Data analytics—34%
- Provider management—21%
- Quality care focused benefit design—20%
In line with MindBeacon and Mercer Marsh, the 2024 workplace health solution for prevention, care and cost control must encompass:
- Access—Simple without wait lists
- Highest Quality Care—Holistic & comprehensive7 optimal outcomes for all health issues
- Data & data analytics
- Fluid multi-directional communications to break down and access siloed information
Conclusion
The paradox of increasing absenteeism—and associated benefit costs—from mental health and other invisible conditions, despite the vast array of corporate health support services and their proven positive outcomes on worker productivity and mental health, has prompted a search for the missing piece to resolve this paradox. High quality care is the piece that benefit, EAP & wellness providers are missing, without which corporate costs will keep rising regardless of what other changes are made, as history has shown. Controlling benefit costs requires the optimal outcomes of early return to health, which can only be obtained with optimal early initial care, adherent to disease-specific guidelines by treating physicians for the medical afflictions driving costs: Mental health, rheumatoid arthritic, Crohn’s disease, colitis and others.
Until such time that the Mercer Marsh solution is implemented into extended benefits, health issues and costs will continue to rise, due to the sub-optimal outcomes resulting from suboptimal care, despite health offerings made available in extended benefits services.
[1] https://info.mindbeacon.com/the-puzzle-of-poor-workplace-mental-health
[2] https://medextra.com/mercer-marsh/#mm-three-steps, “Three steps to keep health and benefits plan costs under control”
[3] www.cdhowe.org/sites/default/files/2021-10/Commentary_438.pdf Measuring Outcomes in the Canadian Health Sector: Driving Better Value from Healthcare
[4] https://healthlibrary.telus.com/en/health-benefits-hub/your-copy-awaits-the-2023-drug-data-trends-national-benchmarks-report
[5] https://medextra.com/mercer-marsh/#mm-three-steps, “Three steps to keep health and benefits plan costs under control”
[6] https://medextra.com/wp-content/uploads/2022-Mercer-Marsh-Health-Trends-Report.pdf
[7] Comprehensive versus holistic care. Case studies of chronic disease https://pubmed.ncbi.nlm.nih.gov/11847792/
[8] https://www.who.int/health-topics/quality-of-care#tab=tab_1
[9]https://www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/understand/index.html
