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The Office of the Employer Adviser
Peterborough WSPS November 3, 2015
Lee Anne Farrow, Employer Specialist
Claims Tips and Work Reintegration
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Claims Management Tips For 2015• Hiring Practices • Day of Injury
• Accident Investigation• Forms• Work Reintegration• Return To Work• Document, Document,
Document!• Appeals• WSIB Clearance Certificates
• Claims Cost Management• Record of Employment• Legislation• WSIB eServices
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Tip No. 1 - Hiring Practices
• Request professional references, not personal contacts • Worker Orientation is essential:
- Verbally communicated- Follow-up with written policies
- What to do if accident occurs, RTW program- Physical demonstration of position- Proper use of personal protective equipment- Health and Safety chats- Annual update and review of policies
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Tip No. 2 – Day Of Injury
• Determine severity of injury
• First Aid vs Medical Attention
• Return To Work envelope
• Taxi account
• Individual who accompanies injured party reminds
Worker and Health Care Practitioners of RTW Policy
and Procedures at workplace
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Tip No. 3 – Accident Investigation
• Purpose is to obtain details of what happened for WSIB
reporting and Prevention
• Photographs and/or videos of work area
• Witness statements from Co-Worker(s) and Supervisor
• Interview Injured Worker and have Worker write incident
report
• Use of translator, if required
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Tip No. 4 – Forms
• Form 6
• Form 7
• Form 8
• FAF
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Tip No. 5 - Work Reintegration• Return To Work Obligation• Re-Employment Obligation• Penalties• WSIB Work Transition Specialist• WSIB Return To Work Specialist
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Tip No. 6 – Return To Work• Time of Hiring - Orientation• Day of Injury• Next Scheduled Shift• Verbal Return To Work (RTW) Job Offer• Follow-Up With Written RTW Job Offer• Regular Contact With Worker• Weekly Return To Work Plans / Journals• Weekly/Bi-Weekly Functional Abilities Form• WSIB Return To Work Specialist• WSIB Work Transition Specialist• Annual Review of RTW Successes, Failures and Trends
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Tip No. 7 – Document, Document, Document• Critical to document everything, particularly all
Return To Work efforts, conversations with the worker and WSIB
• Always keep WSIB informed!
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Tip No. 8 - Appeals• Know Your Time Limits• WSIB Direction Of Authorization• New Forms
Intent To Object Form (ITO)
Appeal Readiness Form (ARF)
Participant Form (PF)
Respondent Readiness Form (RRF)• Oral vs. Written Hearing• Downside Risk• Workplace Safety & Insurance Appeals Tribunal
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Tip No. 9 - WSIB Clearance Certificates• Who is your worker?• Clearance Certificate Mandatory for Construction
workers (Bill 119)• WSIB Independent Operator Questionnaire (non-
construction)• E-Clearance Certificate
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Tip No. 10 – Claims Cost Management• MAP• NEER• CAD-7• Cost Relief - Second Injury Enhancement Fund (SIEF)
- Cost Transfer - Third Party Cost Transfer
• Monitor WSIB Monthly Accident Cost Statements • Rebate vs. Surcharge• Workwell
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Tip No. 11 – Record of Employment
• Use of appropriate code:• “illness/injury”• “quit”• “other”
• “provide further information / explanation”
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Tip No. 12- Legislation
• Workplace Safety and Insurance Act• Human Rights Code• Occupational Health and Safety Act• Employment Standards Act• Human Resources Service Canada
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Tip No. 13 – WSIB e-Services
• eForm 7• eClearance• ePayment• ePremium• eRegistration• eStatement• eWISR
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Tip No. 14 – Office of the Employer Adviser
• Confidential service
• Advice
• Representation
• Education
• Presentations and Webinars
• Website
• Follow us on Twitter!
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WORK REINTEGRATION (WR) PRINCIPLES
• Combines RTW and re-employment as a process• Brings WT assessment in-house (formerly LMR
assessment)• High expectations for employer participation• Non-cooperation penalties• Maintain dignity and productivity of a worker • Respond to RTW barriers with early support and
intervention • Best prospects for successful WR achieved by maximizing
opportunities with the accident employer17
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RTW Co-operation Obligations
• Initiate early contact and maintain appropriate communication throughout the worker’s recovery
• Identify and secure RTW opportunities for the worker • Give the WSIB all relevant information concerning the
worker’s WR• Ensure that appropriate documentation is maintained• Notify the WSIB of any dispute or disagreement
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The Board’s Role
• Meet with the WPPs at the worksite within 12 weeks after the date of injury if parties unable to arrange suitable and available work
• WSIB proactively engages appropriate medical support• Help worker overcome his/her health recovery barrier• Provide dispute resolution services• Enforces WPP obligations• Provides Work Transition (WT) if WPP unsuccessful
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• Pre-injury job with the injury (accident) employer • Pre-injury job with the injury employer, with accommodation• Work comparable in nature and earnings to pre-injury job with the
injury employer, with accommodation where required • Alternate suitable work with the injury employer, with
accommodation where required • Work comparable in nature and earnings to pre-injury job in the
labour market with accommodation where required • Alternate suitable work in the labour market, with accommodation
where required
RTW Hierarchy
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Suitable Work• Post-injury work that is
• Safe - worker has the functional ability to perform the tasks safely and to travel
• Productive – necessary skills to perform the tasks that provides objective benefit to employer’s business
• Consistent – with the worker’s functional abilities, and that, when possible, restores the worker’s pre-injury earnings
• In a unionized environment, the WSIB strives to respect the terms of the collective agreement whenever possible.
• Human Rights Code trumps collective agreement21
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ACCOMMODATION
• WSIB expects employers to provide accommodation if it results in suitable work becoming available
• Any modification to the work or the workplace, including• reduced hours• reduced productivity requirements• provision of assistive devices
• WR must respect human rights legislation
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Resolving Disputes• Worker notifies employer that job is not suitable and
provides reasons • Employer considers the reasons, and discusses issue with
worker• If WPPs unable to resolve a dispute themselves, the WSIB
will • assist the WPPs to reach agreement on the issue, or • make a determination as to whether or not the offered
work is suitable • A dispute over job suitability does not mean WPPs
being unco-operative in RTW activities 23
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Written Notice of Non-compliance
• Prior to making a finding or non-compliance or re- employment breach WSIB warns WPP about penalty
• Done orally (where possible) and in writing• Non-cooperation penalties effective 7 WSIB business
days after the date of the written notice• Small Business (< 20 workers, 14 WSIB business days)
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Non-Co-operation Penalties
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Penalty starts 7 business days from date on written notice
Initial Penaltyfirst 14 days of
breach
Ongoing Penalty15th day of
breach +
Worker 50% LOE 100% LOE
Employer 50% LOE100% LOE +100% WT CostsUp to 12 Months
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Re-employment in WR• Distinct obligation in addition to RTW • Worker has a re-employment right if
1. worker unable to work because of a work-related injury
2. worker employed with the injury employer for at least one year before the date of injury, and
3. employer regularly employs 20 or more workers injury/disease
• # 2 and #3 do not apply to Construction industry26
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Duration of Re-employment Obligation
• Employer must re-employ worker until the earliest of • the second anniversary of the date of injury • one year after the worker is medically able to perform
the essential duties of their pre-injury employment, or • the date on which the worker reaches 65 years of age
• In the Construction industry the above applies plus:• the date the worker declines an offer from the employer
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Concurrent WR andRe-Employment Obligations• An employer that breaches both a co-operation and re-
employment obligation in the same claim will get a single penalty
• The WSIB will choose the penalty which will most likely lead to positive RTW outcome for the worker
• If breach at different periods in claim, may get more than one penalty
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QUESTIONS?
Office of the Employer Adviser (OEA)Toll Free Telephone: 1-800-387-0774 Toronto Telephone: 416-327-0020Email: [email protected]: www.employeradviser.ca Follow us on Twitter: @askoea
C. Office of the Employer Adviser 2015