Injury Management Solutions

CASE MANAGEMENTReturn to Work & WSIB

Injury Management Solutions

Components of Case Management

• Understanding the employee’s needs (why he or she is unable to work).

• Assessment of return to work obstacles (both physical and psycho-social).

• Development of the return to work plan.• Negotiating, implementing and coordinating internal and

external resources.• Monitoring the program.• Documenting and evaluating the process and outcomes.

Injury Management Solutions

WSIB Service Delivery (2010)

You also have to understand the WSIB process.

The WSIB implemented a new Service Delivery Model in 2008 and completed the transition of their Service Delivery Teams during 2009.

 

Injury Management Solutions

WSIB CENTRAL CLAIMS

PROCESSING Codes &

assigns claim number

Employer completes WSIB Form

7

Form 7 must be received within 7

business days

Form 7 must be received within 7

business days

Eligibility Adjudicator (7 – 14 Days)

Accident/ illness

Reported

Short-term Case Manager

(26 weeks))

Long-term Case Manager

(+ 6 months until claim closure)

Assigned in order of available

Adjudicator – NO DEDICATED ADJUDICATOR TO EMPLOYER

Assigned in order of available

Adjudicator – NO DEDICATED ADJUDICATOR TO EMPLOYER

Injury Management Solutions

WSIB ROLES• Eligibility Adjudicator determines eligibility upon receiving a claim

for benefits; • Case Manager concentrates on the opportunities and obstacles to

return to work, determines ongoing benefits to be paid to the worker, and arranges and monitors Labour Market Re-entry services wherever and whenever needed;

• Return to Work Specialist facilitates return to work and case resolution at the workplace.

Injury Management Solutions

OBJECTIVES• Return to regular job.• Comparable job (pre-injury wages, similar

skills/ responsibilities, physically appropriate).

• Suitable job (may be wage loss, fewer skills/ responsibilities, physically appropriate).

Injury Management Solutions

PROGRAM• Document your program and process in Policy (Human Resources and/ or Health &

Safety).• Obtain commitment from stakeholders: management, employees, union.• Ensure everyone in the organization is knowledgeable and aware of their roles.• Know all the jobs in your organization; be aware of the tasks in each job and the

risks associated with them; document the physical demands of each job.• Have plan of action in the event of an accident/ injury: Include roles and

responsibilities for supervisors, managers and employees; job offer – regular or modifies; Functional Ability Form for worker (http://www.wsib.on.ca/wsib/wopm.nsf/Public/190204) if appropriate; follow-up plan – communication; documentation – Form 7, Accident Investigation, return to work plan.

• Evaluation.

Injury Management Solutions

PROCESS

A) When a workplace accident occurs resulting in injury or illness

• 1. Provide First Aid • Provide first aid according to standard first aid practices, and make an accurate record

of the incident and first aid given.•

2. Arrange Transport to Medical Treatment (as necessary) and Pay for It • If more serious treatment than first aid is required, transport the worker to the

appropriate medical facility. You may need to assign someone to accompany the worker, or call an ambulance.

• • Provide your employee with a letter offering suitable employment immediately,

regardless of injury or illness, documenting your willingness and ability to provide physically suitable work.

Injury Management Solutions

PROCESS (cont’d)• 3. Pay your Employee a Full Day’s Wages • You must pay your employee a full day’s wages on the day of the incident. WSIB loss

of earnings (LOE) benefits start the working day after the incident occurs. •

4. Investigate the Incident • Identify the cause of the accident or illness and keep a record of steps taken to

correct the problem.• • 5. Complete Form 7 if your employee requires health care and/or:• is absent from regular work• earns less than regular pay for regular work (e.g., part-time hours)• requires modified work at less than regular pay• requires modified work at regular pay for more than seven calendar days following

the date of accident.• The completed Form 7 must be received by the WSIB within 7 business days of the

injury/ illness.

Injury Management Solutions

B) Return to Work Meeting

• Review medical and work information.• Discuss all barriers/ issues to a return to the pre-injury job.• Discuss work hours.• Set the return to work objective (see hierarchy).• Complete the return to work plan.• Review and have all stakeholders sign the plan – include the treating

practitioner.• Set a follow-up date.• Submit return to work plan to WSIB, where applicable.

Injury Management Solutions

C) Implement return to work plan• This requires consistent follow-up, regular

communications and cooperation. Always maintain focus on objective and address issues and barriers immediately.

Injury Management Solutions

D) Evaluation• At the completion of the plan evaluate and

document all findings.