Most employers know that WSIB-related costs can be very expensive. However, not everyone knows about (or are taking advantage of) cost relief programs offered by the Board. We asked Anna Aceto-Guerin and the claims managers at Clear Path for some insights into successfully acquiring SIEF cost relief.
What is the SIEF program?
In order to encourage companies to hire workers with previous injuries or disabilities, the WSIB created a program called SIEF (Secondary Injury Enhancement Fund). SIEF provides financial relief to employers when an injured worker's pre-existing condition either enhances or prolongs recovery from a work-related disability. Receiving SIEF cost relief does not impact the amount of benefits paid to the injured worker.
The amount of cost relief applied is based on the combination of the severity of the pre-existing injury against the severity of the workplace accident. For example, an injury that occurred as a result of a "minor" accident (one that would typically not cause impairment) due to a "major" pre-existing injury would receive the highest level of cost relief for the employer.
What is the problem?
As part of its focus on cutting costs and eliminating its unfunded liability, the WSIB has become increasingly conservative in its allowance of SIEF requests over the past 5 years. Requests that would have been routinely approved in the past are now regularly rejected.
As WSIB consultants, we have noticed that approximately 95% of SIEF requests are being initially denied regardless of merit. This means that our team has needed to become much more persistent in our pursuit of cost relief for our customers. Even when one is lucky enough to get SIEF approved on first request, it is probably the minimum they can possibly award. As a result, our basic rule of thumb is object, object, object.
Why object when you have received some SIEF
Objecting to a straight-out denial of your SIEF request may seem obvious to some, but what do you do if you did receive some level of cost relief? Should you be satisfied and stop there? Definitely no! Now you know that there has been some level of pre-existing condition identified to justify the allowance of cost relief and you must dig deeper. Your next step is to find out exactly why and with what information that decision was made by the WSIB.
Assessing both of the elements
As mentioned, approval of SIEF is built upon two criteria: severity of accident and the impact of a pre-existing condition that may have prolonged the recovery from said accident.
In requesting SIEF, each of these two elements must be tacked individually. Deciding the severity of the accident should be based on the facts you have uncovered. Determining the impact of the pre-existing condition can be more complicated. Obtaining the Access File is a key part of SIEF cost retrieval and it contains the relevant medical information on which the decision was based.
Also, you must realize that making a SIEF decision can be a very subjective one for the WSIB. Determining the exact severity of an injury and precisely to what degree the pre-existing condition has affected recovery are not always easy to assess. Who can really measure those two criteria objectively? Are you able to say with certainty that a slip or a trip is moderate accident, likely to cause a disablement as opposed to minor accident, not likely to cause a disablement?
So we have discovered that SIEF case managers are just like us - human! They use their best judgment to decide and because the group of SIEF case managers is very small, less than 20 in total, getting to know which case manager making the decision will really help you to understand their logic.
Accessing the medical
The other factor to consider is all based on medical evidence. The first trick is to ensure the right medical records get included in the file and that the claims manager actually reviews it.
In a recent file one of our consultants reviewed, the WSIB claims manager had based their decision on an operative report they said they had reviewed. But when we objected to the denial and reviewed the access file ourselves, the said operative report was nowhere to be seen, it didn't exist in the file. In this case, we were able to make sure that the claims manager actually obtained the report from the treating physician and we used it to support our reconsideration request. We would have never been able to do that if we were not persistent, objected to the decision and requested the access file.
Timing is everything
There is a lot to be said for timing of the request as well. Too early, the case manager may rule that the recovery is not sufficiently prolonged to warrant SIEF. Too late in the game and they will tell you that the accident severity now is higher than previously determined due to the prolonged recovery.
Should you bring in the experts or try it yourself?
Think you would like to try your hand at pursuing cost relief? We definitely encourage it, but with one word of caution. Be aware that you only get a few kicks at the can:
Our recommendation is if you want to try, put in the first request and then once you get denied (because you probably will) then object to the denial. You will then get the case file and can get an expert to review the medical to build a solid argument for reconsideration or appeal.
Benefits of 3rd party medical
Lastly, remember that you can only move to the other stages of appeal if you have something new to provide to the decision maker. We have had a lot of success in obtaining 3rd party independent medical opinions on the case file to "connect the dots" with the medical.
On a recent file we managed, after we first received a denial we provided further medical opinion (obtained by engaging the services of a 3rd party independent medical provider) along with our reconsideration.
As a result, we were able to we obtain 75% SIEF cost relief! Minor accident and moderate pre-existing was determined after an initial denial for SIEF. That saved our client over $283,000 in NEER savings and decreased their pending actual surcharge for Sept 2014 by $283,000! That deserves some applause!
The two keys to success
So what can we learn from all this? Being persistent is critical for sure. But also knowing how to "speak the WSIB's language" is definitely another. Knowing WSIB policy and really understanding what their decision is based upon -- so you can come back with a solid argument -- is key to getting what you want.
We would love to assist you and you organization in being more successful with your cost relief requests and reducing your WSIB costs. Remember that acquiring SIEF is the last resort, focusing on RTW and objecting to initial entitlement will ultimately get you further in the long run.
If you have any WSIB or SIEF related questions, feel free to contact Anna Aceto-Guerin directly at firstname.lastname@example.org or (519) 624-0800.
Did you know that Clear Path offers a free, no-obligation review of your company's NEER statement.
Learn more by clicking here. We look forward to hearing from you.
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The Toronto Star recently published a profile on David Marshall, president and CEO of the Workplace Safety and Insurance Board (WSIB), whose tenure at the top of Ontario's workers' compensation board was just extended for two more years.
The newspaper labelled him the man injured Ontarians "love to hate" due to his focus on cost-cutting and other fiscal efforts. But does that label misrepresent the nature of changes at the WSIB, particularly if it implies its financial turnaround is at the expense of injured workers not other factors?
Over the past four years, Marshall and WSIB chair Elizabeth Witmer have been successful in tackling some of the Board's substantial financial challenges. He has reduced the WSIB's unfunded liability by several billion dollars (Source). He has also assisted in improving return to work rates for injured workers over the past 5 years, demonstrated by a 50% drop in the number workers not back to work after a year.
The Star also quotes Marshall as saying it is “the combination of fewer injuries, better return to work, better management of our investment fund and higher premiums than we need for day-to-day [that has the WSIB] well ahead of schedule to become fully funded by 2027." (Source)
This track record has made Marshall popular among the ruling Liberal party. A spokesperson for Minister of Labour Kevin Flynn stated:
“Over the last five years, David Marshall has led the WSIB through a significant transition toward improving outcomes for injured workers and returning the board to financial stability. He has refocused the board’s objectives in helping injured workers return to work, diversified the WSIB’s investment portfolio, and transformed its medical strategy, work transition and return-to-work programs.” (Source)
As a response to a critical Toronto Star editorial written by former WSIB chair Odoardo Di Santo in June 2014, a WSIB spokesperson wrote that financial improvements since 2009 have come from 3 sources:
Union and worker response to changes
Injured workers and labour leaders are far less complimentary, accusing Marshall of cutting costs on the back of workers struggling to get benefits. Ontario Federation of Labour president Sid Ryan is critical of Marshall, saying "“His job is to disqualify injured workers from receiving their rightful benefits.” (Source)
The article also quotes Catherine Fenech of the Ontario Network of Injured Workers' Groups who is also critical of the Marshall regime:
“We’ve seen a steady decline in the number of claims being accepted . . . and an increase in workers being told the board thinks they can go back to work no matter how badly injured they are.” (Source)
The Star also quotes John McKinnon of Injured Workers Consultants community legal clinic, who disputes the WSIB's claim that improved workplace safety measures have led to decreased workplace accidents and a 22% drop in benefits being paid out to workers since 2009. McKinnon states that the number of traumatic fatalities has actually gone up by 43%, up from 68 on-the-job deaths in 2009 compared to 97 deaths in 2013. He also claims there has been a 37% reduction in the recognition of permanent impairments since 2012. (Source)
What about the impact on employers?
There may some validity to injured worker claims that the WSIB is working to reduce benefit payments for long-term claimants and seems to have a new-found dedication to return-to-work efforts as a cost-cutting measure. But it could be argued that those changes are a welcome shift towards a more balanced approach after a decade or more of "pro-worker" policies that have escalated the Board's debt levels.
In addition, Clear Path's Anna Aceto-Guerin implores that it is important to consider these six significant changes for employers over the past years, all of which have contributed to improved financial results for the WSIB (and increased headaches for business owners and claims managers):
So it seems that although it may be popular to blame David Marshall and others at the WSIB as balancing the budget on the backs of vulnerable workers, a more comprehensive look at the issue demonstrates that the significant impact on Ontario's employers is likely a larger factor in the WSIB's turnaround.
Do you have questions about your WSIB claims costs? Contact us today or click here to learn how to take advantage of our incredible free NEER review offer. We look forward to speaking with you soon.
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Hollywood loves to depict couples meeting and falling in love in the workplace. There are literally hundreds of examples to choose from. Think Sam & Diane from Cheers, David & Maddie on Moonlighting, or Mel Gibson & Helen Hunt in What Women Want.
Rules against supervisors and subordinates dating are largely non-existent or ignored (Grey's Anatomy). Relentlessly pursuing someone or making dramatic gestures in the office are just romantic, not inappropriate (Scandal). If someone loses their job (Love Actually, Bridget Jones' Diary) or behaves unprofessionally in response to a broken heart (The Good Wife, House M.D.), those are just obstacles for the couple to overcome before their happy ending. Oh yeah, and there never seems to an HR department asking any questions.
Office romance in the real world
Office romances have the potential to complicate business operations. Serious risks such as workplace violence and sexual harassment could become an issue. As well, lowered employee morale, accusations of favouritism, excessive gossip, and decreased productivity are potential complications.
Clear Path HR consultant Margaret Sullivan Williams has this advice:
"Folks engaging in workplace romance should consider the potential for issues to arise both during and after dating. Even if they don't share a reporting relationship (which may lead to awkward and legally difficult situations such as accusations of sexual harassment), things may sour and become quite complex during and post-relationship."
Any attempt to “ban” office romance is likely not going to succeed and may drive employees to take actions in secret. Your best defence is to outline clear written policies that define the parameters of workplace romances in your organization as well as what behaviour will be considered sexual harassment.
Clear Path's president Anna Aceto-Guerin states:
"Written policies will send the message that employees should not let romantic relationships affect the professional work environment. They will also clearly define what type of behaviour is inappropriate and what they should do about it if they are being harassed."
Margaret Sullivan Williams concurs:
"Employers should have policies to communicate their expectations about workplace romance that clearly identify when romance may become a problem. For example, if two employees suddenly need to frequently work in the same area, are secretive around others or are found spending inordinate amounts of time together at work, coworkers will notice. Rumours will begin and both employees may be perceived as less professional and less productive.
Importance of disclosure:
Employers should require employees to disclose to their manager when they have entered into a consensual romantic relationship. This allows for confirmation that the relationship is consensual and offers the opportunity to inform the two parties of your workplace harassment/sexual harassment policies, how to report complaints and most importantly expectations around conduct while in the workplace environment.
Clear Path HR consultant Michelle Strassburger agrees:
"It's all about disclosure. Office romances don't always cause a conflict. However, ensuring that a reporting relationship does not exist is paramount to guarding against potential complaints of preferential treatment or sexual harassment."
More information: You may wish to check out the interesting infographic on Office Romance from the team at OnlineBusinessDegree.org by clicking here.
Avoid the legal ramifications often associated with workplace relationships by planning ahead and providing your employees with guidelines and education on the topic of office romance in your workplace before Cupid’s arrow strikes.
Looking for advice on how to handle an employee situation or how to establish HR policies for your workplace? Contact us today.
Tongue-in-cheek video from Saturday Night Live
Of course, the issue of sexual harassment in the workplace is a serious topic. But we came across this amusing sketch from Saturday Night Live, featuring Tina Fey, Fred Armisen, Amy Poehler, and 2015 Super Bowl champion Tom Brady that we thought you might enjoy. It is in the style of an awkward 1950s era educational film and tries to humourously display how the actions of an attractive co-worker may be received quite differently than the same actions by a less attractive person. We share this video for entertainment purposes only and do not suggest that sexual harassment is ever appropriate or desired. We hope you have a chuckle:
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This blog post is part of an ongoing series where we feature one of Clear Path's incredible team members and help you get to know them a bit better.
This month, our spotlight is on Clear Path president Anna Aceto-Guerin, CHRL
Hometown: Etobicoke (Toronto), Ontario
Alma Mater: Ryerson University
Which person do you most admire?
My sister-in-law who recently battled cancer and kicked cancer's ass!
Fun Fact: I've sewn two of my friends' wedding dresses
Dog Person or Cat Person: Dog, cat, or anything furry
TV shows you never want to miss: Love It Or List It, Downton Abbey, Gilmore Girls
Favourite Movie: Return To Me, White Christmas
Book That You're Reading Right Now:
Eat That Frog? 21 Great Ways to Stop Procrastinating and Ger More Done in Less Time
Who are your favourite writers? Margaret Atwood and Margaret Laurence
What would you pick for your last meal? Nutella on a fresh Italian crusty bun
What is your greatest extravagance? Spa day, massage, or both!
What is your idea of perfect happiness? Sitting on a beach with a cold drink and a great book
What do you consider the most overrated virtue? Frugality! I love to live life to the fullest!
What talent would you most like to have?
Ice skating - never did learn to do it very well. I also just took up piano - perhaps I could get better at that.
What do you consider your greatest achievement? My children
If you were to die and come back as a person or a thing, what would it be? My dog
Where would you most like to live? Either in Paris, France or Victoria, B.C.
What is your personal motto? Always follow the directions!
You can learn more about Anna on her Clear Path bio page.
Other entries in our Spotlight Series:
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