What does SIEF stand for?
Secondary Injury Enhancement Fund
What is the objective of SIEF?
The program provides employers with financial relief when an injured worker's pre-existing condition "enhances or prolongs" a work-related disability. In lay terms, it means that an employer will not be held fully financially responsible for a workplace injury that was caused by a worker's pre-existing condition or if their recovery is delayed/prolonged due to that condition. This program was created to help encourage employers to hire workers who had previous injuries or disabilities.
What does the policy say?
SIEF Policy (14-05-03) states that if a prior disability caused or contributed to the compensable accident, or if the period resulting from an accident becomes prolonged or enhanced due to a pre-existing condition, all or part of the compensation and health care costs may be transferred from the accident employer in Schedule 1 to the SIEF. Both physical and psychological disabilities are included.
Does this impact the benefits a worker can receive?
No, acquiring SIEF does not impact the amount of benefits paid to a worker. It only provides financial relief for the employer. It is important that your worker understand that you are not (necessarily) objecting to the validity of their claim if you are asking questions about a pre-existing condition.
What are the potential cost savings?
The potential cost savings for employers is substantial, sometimes in excess of $150,000-$200,000 for a single claim. However, occasionally the built-in insurance features of WSIB (such as firm caps, claims limits) can minimize the impact of SIEF cost relief. A complimentary analysis of your NEER statement by Clear Path's experts will help determine if pursuing SIEF cost relief is worthwhile for your company.
What definitions does the WSIB use when determining SIEF?
- Pre-accident disability: A condition which has produced periods of disability in the past requiring treatment and disrupting employment
- Pre-existing condition: An underlying or asymptomatic condition which only becomes manifest post-accident
- Severity of accident: If minor, the accident is expected to cause non-disabling or a minor disabling injury. If moderate, the accident is expected to cause a disabling injury. If major, the accident is expected to cause a serious disability or probable permanent disability. **The severity of accident is evaluated in terms of the accident history and approved definitions.
- Medical significance of pre-existing condition: Assessed as Minor, Moderate or Major in terms of the extent that it makes the worker liable to develop a disability of greater severity than a normal person. An associated pre-accident disability may not exist.
- Psychological conditions: the possibility of prior psychic trauma resulting from life experience could be considered as evidence of vulnerability and justify recommending relief to the employer, even in the absence of pre-existing psychological impairment.
- Accident History Components: 1) Mechanics (life, push, pull, fall, blow, etc.), 2) Position (kneeling, standing, sitting, squatting, bending, etc.), and 3) Environment (lighting, temperature, weather conditions, terrain, etc.)
How does the WSIB calculate how much (if any) cost relief will be granted and "transferred" away from the employer and to the Board?
The WSIB uses a matrix which contrasts the level of medical significance of the pre-existing condition versus the severity of the accident (see below).
- Historically, the Board was fairly liberal in allowing for SIEF cost relief.
- Today, the Board is working diligently to cut costs and reduce its unfunded liability. As a result, it has become increasingly difficult to acquire SIEF cost relief.
- An employer needs clear, persuasive evidence of a pre-existing condition, not simply speculation
- Employers are not entitled to a worker's medical file unless you put an issue into dispute or object to a decision (beginning the appeal process). This may lead to conflict with a worker if they believe you are objecting to their entitlement to benefits. Explain that you are going through the necessary process to access the medical file in order to obtain cost relief.
What is the process to apply for SIEF?
- Review the case for evidence of a pre-existing medical condition. You may consider using a 3rd party professional to assess medical information.
- Assess file in terms of accident history: Would this specific accident have caused a disabling injury? Would it be considered minor, moderate or major?
- Make your argument in writing: Refer to WSIB policy and medical information obtained.
- Use "fishing" letters if you suspect there may be an issue and ask for cost relief. Keep your language in letters non-emotional and based on fact.
- Consider standard healing times as a rough guide, including useful material published by the Government of Alberta and Government of P.E.I.
- Always make sure your claim is in writing!
- Don't get frustrated if your claim is denied by the Claims Manager, you have two opportunities to proceed to appeal. If you are not confident in your skills to effectively represent your company during the appeal process, consider getting third party assitance.
- Consider the downside risk of appealing. If you already have 50% SIEF cost relief (e.g.) and believe that you should get more, if you appeal there is a chance that the amount granted may actually be reduced.
- Another consideration is that your company only has two opportunities to appeal a denial of SIEF cost relief, so if you are not confident in your ability to do so effectively, utilize external resources.
- Seek professional advice from external resources like Clear Path Employer Services or the Office of the Employer Advisor (OEA).
Consider registering for one of Clear Path's upcoming learning sessions:
- Introduction to the WSIB's NEER Program: November 26th in Cambridge or December 2nd in Mississauga. This practical workshop uses real-world examples in order to calculate the financial impact of a variety of return-to-work scenarios.
- Advanced NEER Strategies: December 4th in Mississauga. This hands-on course is for experienced claims managers who wish to deepen their knowledge and learn how to forecast WSIB costs. To learn more, click here.
Of course, you can always contact Anna Aceto-Guerin at (519) 624-0800 or email@example.com with any of your WSIB-related questions. We look forward to hearing from you!