Expert. Confidential. Free. 1-800-387-0774 The Office of the Employer Adviser Peterborough WSPS November 3, 2015 Lee Anne Farrow,

Expert. Confidential. Free. www.employeradviser.ca 1-800-387-0774

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


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


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


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


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!


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


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


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

Expert. Confidential. Free. www.employeradviser.ca 1-800-387-0774(

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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


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


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


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


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

Expert. Confidential. Free. 1-800-387-0774 The Office of the Employer Adviser Peterborough WSPS November 3, 2015 Lee Anne Farrow,

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