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Summarizing WSIB's Proposed Rate Framework (Pt. 3)

6/5/2017

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Employer Level Premium Rate Adjustments  

This blog is the final chapter of a three-part series which examines the fundamental proposed changes to WSIB’s method of business classification and application of premium rates.  Part one of this series explored how WSIB proposes to re-categorize Ontario businesses into 34 industries, based solely on “business activity”.  Part two dove into how the WSIB planned to maintain a fair premium rating through the implementation of a “Class Level Premium Rate Setting.”

The final question on everyone’s mind is how the new system will affect potential rebate and surcharges.  This blog will outline how the WSIB proposes on rewarding and encouraging employers to improve their health and safety outcomes. 

If I have minimal claims, will I still receive a rebate?

No, but you will also no longer receive a surcharge! Remember in Part Two of this series when we talked about the cabinet making company’s competitor who was recently showcased in the media for a string of serious workplace accidents?  One would expect the company to receive a hefty surcharge from WSIB come September. Not anymore! Under the proposed system, the WSIB is now planning on setting employer centric premium rates that will consider the individual employer’s own claim experience for the upcoming year and will gradually move the employer toward a premium rate that is more reflective of their own claim experience.  Simply put, any increase or decrease in one year’s claim costs will be reflected in the following year’s PREMIUM RATE, as opposed to a rebate or surcharge. 

In Part Two of this series, we briefly touched on how WSIB will calculate this adjustment through risk.  The remainder of this chapter will provide a high-level look at WSIB’s proposed nine-step process calculating Employer Actual Premium Rates.  
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Step A: Determining an Employer’s Actuarial Predictability 
In this step, WSIB will determine how much an employer’s premium rate will be affected by their own individual claim experience versus the collective experience of their respective class and will be based primarily on insurable earnings and the number of allowed claims in a given year. For example, employers with high insurable earnings and a high total number of claims will have more consideration placed on their individual experience, as opposed to those with lower insurable earnings and a low number of total claims, whose consideration will be more heavily placed on the collective experience of their class. ​

Step B: Determining an Employer’s Weighted Claims Cost
The WSIB is proposing to review all of the claims costs that occurred over a rolling six year period. This means that for the 2017 premium year, WSIB would use 2010 to 2015 injury years.

Step C: Determining an Employer’s Weighted Insurable Earnings 
The WSIB would then obtain the insurable earnings for the same six year period. ​
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​​Step D: Determining an Employer’s Risk Profile
Using steps B and C, the WSIB would then determine an employer’s risk profile using the following formula.





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​Step E: Determining the Class Risk Profile
In order to compare how the employer’s risk profile stands against the class risk profile, the WSIB will need to obtain the total claims costs and insurable earnings within the employer’s class​.


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​Step F: Determining an Employer’s Adjusted Risk Profile
The WSIB would then multiply the employer’s Actuarial Predictability Factor (Step A) against their Risk Profile (Step D) in order to obtain an employer’s Adjusted Risk Profile. By using an adjusted Risk Profile, the WSIB is better able to generate a premium rate that is reflective of the employer’s own past experience, while not subjecting them to unpredictable premium rate fluctuations. 
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Step G: Determining an Employer’s Risk Profile Index
The WSIB would then assess the employer’s results against the class risk profile (Step E) to determine how this employer performed versus the average of all the other employers in the same class.​

Step H: Determining an Employer’s Projected Premium Rate 
In order to calculate this, the WSIB will need to determine the employer’s target RISK BAND relative to the Class Target Premium Rate, as well as the collective cost component of the class.  

​What’s a RISK BAND? Under the proposed system, each employer’s premium rate will be adjusted higher or lower than the Class Projected Premium Rate based on the risk that the employer brings to the system.  In short, Risk Bands are hierarchical series of divisions within each class where each division represents a different level of risk where employers will be placed, relative to the risk band corresponding to the Class Projected Premium Rate.  Employer therefore with similar risk profiles would be grouped together and pay a common premium rate.
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Step I: Determining an Employer’s Actual Premium Rate
In this step, the WSIB will gradually move an employer toward their Project Premium Rate in a manner that would enable them to better predict their WSIB premiums from one year to the next using a “three risk band limitation movement”.
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A Gradual Approach
This gradual approach to what WSIB considers greater employer accountability will arguably provide an opportunity for employers to take steps to address workplace drivers of their high claims costs. The WSIB is proposing to structure the gradual approach as follows:
  • Year One: Awareness – employers will be informed of their position to ensure they understand the extent that their experience is out of the step with their industry, or current premium rate.
  • Year Two: WSIB Health & Safety Services Engagement – If the employer does not make improvements or demonstrates worse performance than the previous year, the employer would be offered support from WSIB.
  • Year Three: Risk Bank Increases – If the employer continues to not make improvements or demonstrates worse performance, they will begin to see progressive increases in their risk band and premium rates.
 
We want to hear from you! Contact Anna Aceto-Guerin from Clear Path Employer Services with your questions on the Proposed Rate Framework’s Employer Level Premium Rate Adjustments.  Want to learn more about how to get yourself in a prime position on your NEER prior to the implementation of this new system?  Join us for our upcoming NEER workshops to learn more. 

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Why You Should Look at Your NEER Statements

5/29/2017

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​What do you do when you get your March NEER statement? Throw it in your desk and hope it disappears? Stare at it for hours trying to make sense of what the numbers mean? We know that these statements can appear intimidating at first glance, but understanding them and paying attention to what they mean for your company is important for various reasons.

These are a few things you should know when it comes to your statements: 
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Forecasting your September NEER position

Upon receiving this statement, it is important to know if you currently have any active claims or claims that are receiving Loss of Earnings (LOE) that could negatively impact your September NEER statement. Your claims management process and actions regarding return to work and accommodation will influence whether you are in a rebate or surcharge position.

Current NEER position will impact your place in the new system

There are only two September statements left before the new WSIB system is implemented. The new system will place companies in a new rate group based on their historical experience and claim costs. Consequently, it is important for your company to improve their upcoming NEER results as this will impact the premiums they pay in the new system. To read more about the new WSIB rate framework, click here.  

The WSIB’s eService system  faster and more convenient

The WSIB has an eStatement system that allows you to access your statements and view changes in a faster, more convenient way. Creating an account can save your company weeks of time when it comes to understanding your current NEER position and how to improve it before the September statement. You can sign up for this system on the WSIB website.

Clear Path can help

Clear Path’s approach to claims management is to return injured employees to work with suitable modified duties at full wages as soon as possible. We work to foster an early and safe return to work plan that is accompanied by medical management to ensure that the best and most effective steps are being taken for you and the employee. Clear Path will continuously communicate with your WSIB adjudicator and the employee, alleviating much of the stress that managing these claims can cause.

Clear Path has an upcoming Introduction to NEER Workshop in Cambridge on June 15. Our workshop explains the NEER system in an easy to understand way, and we provide you with useful resources that will help you better manage your claims, ultimately saving your company time and money. To register click here.

We are also happy to offer a complimentary NEER review of your most recent statement. Our consultants will forecast your costs for this year and identify areas of potential savings. To receive this review, you can book here. 

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Summarizing WSIB's Proposed Rate Framework (Pt. 2)

5/16/2017

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Class Level Premium Rate Settings

This blog is part two of a three-part series which examines the proposed fundamental changes to WSIB’s method of business classification and application of premium rates.  Part one of this series explored how WSIB proposes to re-categorize Ontario businesses into 34 industries, based solely on “business activity”. 

A major question now that needs answering is whether premiums will change due to this re-categorizing.  This blog will outline how the WSIB plans to maintain fair premium rating through the implementation of a “Class Level Premium Rate Setting”.  Let’s dive in…

Will my Premiums Change?

The answer to this question is… likely.  Here is where things are going to become very different. Under the current system, employers in the same classification and rate groups pay the same premiums, regardless of their own claim experience.  For example, our cabinet making company from Part 1 had very few claims over the last couple of years, and yet they know they are paying the same premiums as their competitor even though the competitor may have been repeatedly showcased in the media for serious workplace accidents. Is that fair? The proposed new system says no. Instead, WSIB proposes to assess employers individually on their own claim experience to determine their premium rate.  How?  Through the implementation of “Class Target Premium Rates”.

​The Class Target Premium Rate System is exactly what it sounds like – a target rate within each of the previously discussed 34 industry classes that would reflect the collective experience of all employers. This “rate” is based on three components and is not unlike the current system in that it covers administration costs (legislative/overhead), new claims costs (expected future costs) and past claim costs.  These amounts would obviously vary between each of the 34 proposed classes, as demonstrated by the below figures.
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So… what’s the difference?

The distinct difference between the current system and the proposed lies in the “Employer Level Premium Rate Adjustments”.  This “adjustment” is WSIB’s proposed method of adjusting the Class Target Premium Rate for each individual employer to arrive at an employer’s individual “Actual Premium Rate” relative to the “Employer Target Rate”.  How is this calculated?

This is another major difference.  The WSIB is proposing to calculate adjustment based on RISK, which would be represented by an employer’s own claim experience and insurable earnings relative to their Class Target Premium Rate.  This adjustment will be known as a “risk band” and will represent a series of divisions within each class where employers will be placed relative to their Class Target Premium Rate.  “Risk bands” will be discussed in more detail in part three of this blog.

What is Rate Disparity?

The idea of charging Ontario employers with premiums at the class level (Class Target Premium Rate), as opposed to the rate group level, brings several questions to mind. One being the possibility of “risk disparity” or when premium rates vary significantly from the average experience of the class. In other words, risk disparity sets the stage for the possibility of newly grouped businesses being subjected to a premium rate that misrepresents their risk.  For example, under the proposed 34 classification structure, our cabinet making company may now be grouped with other business activities not previously included under the current “manufacturing” definition. 

What if your company is now required to pay a premium rate at the class level that is either significantly higher or lower than your current rate group premium?  The WSIB plans to address said disparity by including premium rate limitations on upward and downward movement through minimum and maximum risk bands within each industry class. 

This measure is intended to achieve fairness in the premium rate process and will be explored further in part three of this three-part series. Check back soon for further information on Employer Level Premium Rate Adjustments.

We want to hear from you! Contact Anna Aceto-Guerin from Clear Path Employer Services with your questions on the Proposed Rate Framework’s Class Level Premium Rate Setting. 

Want to learn more about how to get yourself in a prime position on your NEER prior to the implementation of this new system?  Join us at one of our spring NEER workshops. ​

We'd love to connect with you!
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Summarizing WSIB's Proposed Rate Framework (Pt. 1)

4/19/2017

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 Classification 

If you’ve read Clear Path’s most recent blog, you know that WSIB is heading toward fundamental change, not only to its method of business classification, but also to its application of premium rates. 
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So many questions to consider with these new changes. Will my business’ classification change? Will my premiums change? Will I still receive a rebate?  We plan to explore all of these questions and more in our three-part blog series that will focus on the new method of Employer Classification (part one), Class Level Premium Rate Settings (part two) and Employer Level Premium Rate Adjustments (part three). 

Will my Business’ Classification Change?

The answer to that questions is….maybe.  One of the key goals of the proposed Preliminary Rate Framework is to implement a “streamlined and simpler classification structure”.  The word “simpler” is key! In order to determine premium rates, WSIB’s current system groups businesses into nine Classes, 155 Rate Groups and 840 Classification Units.  The proposed new system would replace this with a simplified 34 Class Structure.

With the elimination of the 155 Rate Groups, WSIB plans on grouping businesses based predominantly on business activity.  This change is key!

Unlike the current system, the new system will determine a company’s predominate class (fit) by the largest percentage of your insurable earnings.  For example, your company makes cabinets (manufacturing) and 80 per cent of insurable earnings are dedicated to its production. However, you also install cabinets (construction) and 20 per cent of insurable earnings are dedicated to this business activity.  Under the new system, your cabinet making company would be classified only under manufacturing.  Seems simplified, right? Maybe. But what are the implications to your company?

This change will likely not affect smaller companies who have only ever been classified under one Classification Unit in the current system. However, in the case of the above cabinet making company, WSIB will use the last three years of insurable earnings to determine the company’s predominate class. 

If you are a company with multiple business activities, you may wish to think about how your “predominate class” may be categorized. Will this significantly change where you fit in the 34 Classification Structure? Did you move from manufacturing to construction and will one of these categories have primarily higher premiums? Or perhaps you moved to a different classification with historically lower premiums and yet it’s likely you may have higher claims costs simply due to the nature of one of your business activities. How might this affect your experience? Will this be a positive or negative change for your company?

Part Two will explore how WSIB plans to address these potential pitfalls through the implementation of Class Level Premium Rate Settings.  Check back soon for that update!

We want to hear from you! Should WSIB consider other factors when determining a predominate class? What about risk? What do you think?  Contact Anna Aceto-Guerin from Clear Path Employer Services with your opinion or any questions on how the Proposed Rate Framework’s classification method.
 
Want to learn more about how to get yourself in a prime position on your NEER prior to the implementation of this new system?  Join us at one of our spring NEER workshops to learn more. 

We'd love to connect with you!
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Update: Getting a Handle on Coming Changes to WSIB System

4/6/2017

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What's being proposed and how you can prepare

There’s no better time than the present to get a firm handle on the brand new system being proposed by Ontario's Workplace Safety & Insurance Board (WSIB), which will replace the existing NEER, CAD7 and MAP programs.  The new system is slated to come into effect as early as January 2019 and would be the most significant change to the WSIB in decades. 


This new system, when introduced, will impact employers across Ontario.  Most importantly, your results on your September 2017 and September 2018 review will affect where you enter on the new system. By acting now, you still have time to better your position by improving your NEER results. 

Some of the proposed changes include: 
  • New unified system to replace the current NEER, CAD-7, and MAPP experience ratings programs;
  • Current 200+ rate groups (industry groups) reduced to approximately 34;
  • Each employer will be placed into one group, based on its predominant business activity;
    • WSIB will assign a range of premiums for the entire group, with your company falling into one of 40-80 distinct "risk bands" within that range, depending on your company's performance. 
    • Increases or decreases in claim costs will result in an increase or decrease in next year's premium (as you move up or down that "risk band" continuum).
  • No more ‘predicting’ expected claim costs for a given year and then allocating a refund or additional surcharge if your actual results are different than what was expected;
  • Further expansion of the review window from 4 years to 6 years (with higher weight given to more recent results).

Why you need to act now

As the WSIB transitions to the new system, it will need to determine your company’s new rate group by placing it along the new "Risk Band" range. This decision will be made by looking at your historical experience and claim costs, so it is important to improve your company's NEER experience now and increase your chances for lower premiums in the new system.  

​How to improve your NEER experience:
  • Practice good safety. If you don’t have a claim, you don’t have to worry about claim costs. 
  • Have a process to manage claims when they occur. It should include a toolkit with all the forms you need to report claims in a timely and effective manner.
  • Object to claims you believe may not be legitimate so you limit your exposure.
  • Have an effective return to work program in place to limit the lost time on any one claim. 
  • Medically manage claims to understand and remove any barriers around returning to work, again reducing the amount of time lost and your claim costs.

At Clear Path, we specialize in helping employers implement good claims management practices, which in turn directly improve your NEER experience.  We would love to help you prepare so you’re not left scrambling. Join us at our one-day workshops that provide an Introduction to WSIB and NEER as well as updates on the new system slated for 2019.

The workshop is jam-packed with useful information and dives into 10 real-world scenarios to help demonstrate how everyday decisions can significantly impact your NEER claim costs. It also delves into the proposed Rate Framework changes so you'll have a better understanding of what's coming in the future and how you can prepare.

Upcoming Workshops: 

Cambridge – May 3, 2017
Clear Path Employer Services training room
295 Thompson Drive, Unit 2
Register for this Workshop

Mississauga – May 4, 2017
Holiday Inn Mississauga West - Meadowvale
2565 Argentia Road
Register for this Workshop

For more information on the workshops, visit our website here.


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Understanding WSIB's NEER More Important Than Ever

7/22/2016

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JS Bidal from the WSIB
Clear Path was fortunate to have the Mr. Jean-Serge (JS) Bidal, Executive Director of Strategic Revenue Policy at the WSIB, speak at our recent customer appreciation event.

Mr. Bidal provided some insights into the proposed Rate Framework changes at the WSIB, which are expected to come into effect in 2019 and will significantly change the way employer premiums are set and will eliminate the current process of giving surcharges and refunds.

​A more detailed look at the proposed changes can be found  here.

Here are a few of the highlights of the Rate Framework changes:
  • The new system will eliminate the current NEER, CAD-7, and MAPP experience ratings programs and replace them with one unified system.
  • It will reduce the number of different rate groups (industry groups) from the current 200+ to about 34 and each employer will be placed into one group, based on its predominant business activity.
  • No more "predicting" expected claim costs for a given year and then allocating a refund or additional surcharge if your actual results are different than what was expected.
  • Now the WSIB will assign a range of premiums for the entire group, with your company falling into one of 40-80 distinct "risk bands" within that range, depending on your company's performance. Increases or decreases in claim costs will result in an increase or decrease in next year's premium (as you move up or down that "risk band" continuum).
  • Expansion of the review window from 4 years to 6 years (with higher weight given to more recent results)

If the NEER system is being replaced, why should employers care about it?

Excellent question. In fact, understanding and improving your NEER experience is more important than ever.

As the WSIB transitions to the new system it will need to determine where to place your company along the "Risk Band" range for the premiums in your new rate group. Mr. Bidal shared with our group that a significant factor in that decision will be made by looking at your historical experience and claim costs.

Here are some ways to improve your company's NEER experience now and increase your chances for lower premiums in the new system:
  • Reduce the frequency of workplace accidents by actively encouraging an environment of safety
  • Provide modified duties immediately to any injured workers, thereby reducing the number of lost-time claims (make sure that your employee's doctor knows you have modified work options available that you will customize for their individual abilities and limitations)
  • Gain enterprise-wide support for return-to-work options
  • Object to any WSIB claims that you feel are not legitimate or may be non-occupational in nature (i.e. injured themselves outside of the workplace)
  • Request SIEF cost relief when you suspect a pre-exisiting condition contributed to the injury (or is delaying recovery)

How can you learn more about NEER and claims management best practices?

Clear Path offers an one-day workshop that gives an Introduction to the NEER Program and WSIB Claims Management.
It is jam-packed with useful information and dives into 10 real-world scenarios to help demonstrate how everyday decisions can signficantly impact your NEER claim costs. New for Fall 2016, it also delves into the proposed Rate Framework changes so you'll have a better understanding of what's coming in the future.

Sessions are held in Cambridge and Mississauga in September 2016. Register now to take advantage of early bird savings! Click here to learn more or to register.


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How HR Best Practices Can Save Needless WSIB Costs

6/13/2016

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HR Best Practices
​There are a lot of moving parts when managing a WSIB claim, especially one that has become prolonged or complex.  

Ensuring that your company is compliant with Health & Safety best practices and procedures will likely result in reduced workers’ compensation costs. 

The same can be said with respect to regular Human Resources practices and procedures. The problem is that busy claims managers sometimes lose sight of this while they attempt to juggle all the moving pieces of a claim.

Here’s one tip that may help save busy HR professionals from incurring needless costs:

Filling in Record of Employment form correctly:

Record of Employment or ROE is a form that employers complete for employees receiving insurable earnings who stop working and experience an interruption of earnings.  The ROE is the most important document related to accessing the Employment Insurance (EI) program.  Regardless of whether the employee intends to file a claim for EI benefits, an employer must issue an ROE when:
  1. An employee has had, or is anticipated to have, seven consecutive calendar days with no work or no insurable earnings from the employer.  This is called the seven-day-rule.
  2. An employee’s salary falls below 60 percent of their regular weekly earnings because of illness, injury, quarantine, pregnancy, the need to care for a newborn child placed for the purposes of adoption, the need to provide care or support to a family member who is ill with a significant risk of death, or the need to for a parent to care for a critically ill child.
If an employer issues a hard-copy ROE, it must be issued within five calendar days of the first day of an interruption of earnings, or the day the employer becomes aware of an interruption of earnings. 

Connection to the WSIB's Re-Employment Obligation:

WSIB policy states employers have an obligation to “re-employ” their injured workers when a claim closes as long as certain criteria are met. This is known as the re-employment obligation. If a worker is medically able to come back to work, the employer is required to offer to “re-employ” the worker in the position that they held on the date of injury or offer to provide comparable work in both nature and earnings.

In situations where a worker may not be medically capable of returning to their pre-injury job, but can do suitable work, the re-employment obligation requires employers to offer the worker the first opportunity to accept suitable employment that may become available. However, if the employer does not have suitable work available at that time, the obligation still applies every time a suitable job becomes available throughout the period of the re-employment obligation.

In order to enforce this policy, the WSIB levies penalties on employers who are in breach of their obligation. If a worker is terminated within the first six months of the re-employment obligation, WSIB will automatically presume that the employer did not fulfill the obligation.  Generally, the penalty is based on the worker’s actual net average earnings for the year before the injury and is not subject to a ceiling.

Example of ROE Form
What if worker maintains they have been terminated within the first six months?

There are many times when a claim can become contentious. Perhaps the employer feels the injury was never work-related, there may have been return to work issues, one of the workplace parties may have been non-cooperative, or there could have simply been a misunderstanding. 

Whatever the reason, what do you do if a worker states maintains that they have been terminated and yet was not?

Even though WSIB will automatically presume a breach to the re-employment obligation within the first six months, they will allow the employer a chance to rebut the accusation before they determine whether to levy a penalty.  Under policy, it is the employer’s responsibility to prove a breach did not occur. 

This is where the Record of Employment (ROE) comes into play!  By submitting an issued ROE indicating the worker remains off work for medical reasons (Code D) as opposed to being terminated (Code M), the WSIB will consider this sufficient proof that the employer did not breach their re-employment obligation. 
 
Interesting example:

A worker received loss of earning (LOE) benefits from the WSIB for a workplace injury because the employer did not have modified work suitable for the worker’s restrictions and limitations. The WSIB later determined the worker’s compensable injury recovered and terminated her benefits.  However, the worker continued to have limitations and restrictions related to a non-compensable, pre-existing condition.

The worker in question did not understand that her employer still did not have suitable modified work available for her and that she now needed to apply for E.I. benefits. The worker also had not heard from her employer regarding her employment status and told her WSIB case manager that she thinks her employer may have fired her.

To rebut the accusation, the employer provided the WSIB with a copy of the ROE issued when the worker started to receive LOE benefits (under the seven-day-rule). That ROE indicated the worker experienced an interruption of earnings (LOE benefits) due to medical reasons (Code D).  The employer further explained that no other ROE (such as one stating the worker was dismissed or Code M was issued, proving the employer did not terminate the worker. From the employer's perspective, the worker merely continued to remain off work for medical reasons.

Ultimately, the WSIB agreed that the employer was not in breach of their re-employment obligation and the company was saved from being levied with a significant penalty.
 
Bringing It All Together:
  1. Staying on top of regular HR practices, even as something as common as a Record of Employment, can help save you from needless WSIB costs.
  2. Maintaining regular contact with injured workers can help alleviate potential misunderstandings about return to work or a worker’s employment status.  
  3. Do not be afraid to discuss your concerns with WSIB.
  4. Recognize if you cannot continue to manage a claim and seek expert advice in order to avoid a re-employment obligation breach.
 
Do you have questions about the Re-Employment Obligation or about general HR practices? Contact Clear Path's Anna Aceto-Guerin for a free 15-minute consultation by email at ​anna@clearpathemployer.comanna@clearpathemployer.com or by phone toll free at (888) 336-0950.


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Doctor's Note Not Necessarily The Final Word in RTW

5/5/2016

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Doctor's Note
​How many times have you looked at your WSIB NEER Statement and thought “if only I had done things differently”?  

Clear Path recommends that employers utilize a number of different strategies to reduce WSIB costs.  One strategy is to ensure you have instituted effective Early and Safe Return to Work (RTW) practices and procedures, including making an offer of suitable modified work for those employees who require modified duties. 

One thing we often hear from new clients is that modified work was not offered to an injured employee because all they were provided was the frustratingly standard (and useless) doctor’s note that simply stated “off for two weeks.”  Many employers think that the medical professional’s word is law when it comes to WSIB claims, so when they are provided with such a note they assume doctor’s orders must be followed.  However, what many employers fail to understand is that the difference between a lost time and no lost time claim often lies in the suitability of modified work, despite the existence of a “two weeks off” doctor’s note.

Interesting case study:

Clear Path recently consulted on a claim where a worker lost the tip of his middle finger after accidentally crushing it in a machine.  The worker immediately sought medical attention and provided his employer with a surgeon’s note that stated the worker should remain off duties until he could be reassessed by the surgeon a week later.  The employer was not provided with limitations or restrictions for the worker (typically found in a Functional Abilities Form or FAF) and because of the severity of the accident, assumed that they were looking down the barrel of a costly lost time claim. Clear Path however instructed the employer to immediately offer the worker suitable modified work at modified hours, despite the surgeon’s note. 

What counts as suitable modified work?

WSIB policy is clear when it states that suitable work means “post-injury work that is safe, productive, consistent with the worker’s functional abilities, and that, to the extent possible, restores the worker’s pre-injury earnings.”

If I wasn’t provided with a FAF form,  how can I offer work when I don’t know what the worker can do?

This is a little trickier to answer, but sometimes the answer lies in common sense.  If a worker lost the tip of his finger he likely will not be able to use that hand and will likely have stitches.  Standard restrictions for an injury such as this suggests that the worker should refrain from repetitive movement or use of the hand and should remain in a clean environment until the stitches are removed to avoid infection. 

What did the client do?

Our client therefore offered the worker modified work at reduced hours both verbally and in writing in the form of a RTW Plan.  The worker however rejected the modified work and stated he wished to follow his surgeon’s recommendations. 

If a worker rejects modified duties, what do you do?

Clear Path submitted an objection letter along with the Form 7 and stated that loss of earnings should not be allowed in the claim as the employer offered modified work to the Employee and requested that it be reviewed for suitability.  The Eligibility Adjudicator reviewed the information and allowed the claim for health care benefits only and stated she was unable to support loss of earnings as the worker was offered modified duties.  She transferred the claim to a case manager however to rule on the suitability of modified work.  The case manager requested the surgeon’s report in order to obtain more fulsome information about the worker’s functional abilities and restrictions.  As one can imagine, this information takes time to obtain.

What do I do while WSIB is reviewing the information and the worker remains off work?

Clear Path recommended that the employer remain in regular contact with the worker and to encourage him to participate in RTW planning in order to mitigate his/her potential financial loss. The worker did eventually participate in the RTW planning and the employer, worker and union agreed on a suitable RTW schedule. 

What was the WSIB decision?

The case manager eventually ruled that the description of the original modified work listed in the RTW Plan was consistent with the functional abilities provided by the surgeon’s report.  She further stated that the loss of earnings the worker experienced when he remained off work based on the surgeon’s recommendations were therefore not in order.

​Bringing It All Together
  1. Early and Safe Return to Work practices will often save you from unnecessary lost time in claims. 
  2. Employers should always offer written suitable modified work to employees.
  3. If an injured worker has declined modified work, do not be afraid to discuss your concerns with WSIB. 
  4. Finally, remember that “two weeks off” does not always translate to suggest that the worker is totally disabled and is therefore incapable of completing suitable modified work.

Next steps:
Are you experiencing RTW difficulties with an injured worker? Contact Clear Path's Anna Aceto-Guerin to book your free 15-minute consultation. 


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Objecting to Initial Entitlement in a WSIB Claim

2/15/2016

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When you object to the initial entitlement of a WSIB claim, in effect having it denied outright, there are several considerations you should keep in mind. Clear Path’s Anna Aceto-Guerin answers some questions about the process:
 
What are some reasons that you would object to a claim?
There are several reasons why an employer objects to the approval of a WSIB claim, but the most common reasons are:
  • You believe that the injury is not compatible or consistent with the duties of the job
  • You suspect that the injury is not work related (the result of activities off the job)
  • You are concerned the claim is fraudulent

When should you object to the validity of a claim?

If you wish to object to initial entitlement, it is important that you do so immediately. Ideally, you are including your intention to object on the Form 7, along with the results of your internal investigation and witness statements.

At minimum, indicate on the Form 7 that the investigation is ongoing and that you will be submitting documentation shortly. Once the WSIB has decided to accept entitlement in a claim, it is very difficult to have it overturned. You have a much better chance of having it denied outright then having an accepted claim overturned. Once benefits are flowing, the case manager is not likely to stop those easily.
 
What is the best way to have success with your objection?

Include as much evidence as you can along with your objection. That means performing an investigation after every accident or injury. Go to the actual location of the incident. Get pictures. Get a written statement from the injured worker as to exactly what happened (in addition to their Form 6) as well as any witnesses, ideally using your company’s own worker or witness statement forms. Review video surveillance footage if it exists.

This is where a lot of employers fall down. They just take the Form 6, fill out a Form 7 and submit it. Later, they may discover that they have concerns, but it may be too late.
 
What if you feel the injury or illness is non-occupational?

Just because you don’t agree that an injury is work-related doesn’t mean that the worker isn’t having an issue or that you shouldn’t support them through their recovery and return to work.

f you think the worker’s issue or injury may be not work related or compatible to their normal work duties, you should let the worker know and point them towards your company’s sick days or Short-Term-Disability (STD) benefits programs if they require lost time. Let them know that you will accommodate them (as per Human Rights obligations) and support them in their recovery regardless of it this is work related or not.

We recently helped a client to object to a claim for a worker who had injured himself playing baseball. He was later diagnosed with a ganglion cyst and claimed this was work-related. We argued against this and the claim was denied.
 
How do you prove that an injury is not compatible with the duties of a job?
​
Having a Physical Demands Analysis (PDA) for each position in your company will provide you with clear evidence to provide to a WSIB Adjudicator, so they can more readily determine compatibility. It also can serve as an effective tool during the Return-To-Work process for an injured worker.

In the absence of a PDA, an employer can still argue that an injury is not consistent with the duties of a job. Provide as much evidence as possible to support your argument, including pictures and written description of the job.
 
Do you have a real-world example of an injury that was not compatible?

We recently helped a customer with an employee claiming that the exertion he needed to “turn” the steering wheel in the company’s forklift caused him to injure his shoulder. However, we successfully argued that the turning mechanism on the machine can be moved with the effort of one finger and does not require any “cranking.” We were able to provide pictures of the machine and more detail of how it is used in different applications so the case manager had a better idea of the effort required. The claim and initial entitlement, was denied.
 
Would there ever be a time that you wouldn’t submit a PDA, even if you have one?

Interesting question and difficult one to answer. You may object and have a verbal conversation with the claims manager, but you may not want to send the PDA if it doesn’t support your argument. If someone has only been doing the job for a short period of time and claims a repetitive strain and the PDA actually identifies a potential risk of that, then the WSIB is going to automatically approve -- regardless of the fact that the duration in that job does not support the claim. In those instances, we would recommend considering not submitting the PDA.
 
Any final thoughts?

​Consider utilizing a medical professional as part of your claims management process. If you have access to a nurse or other medical professional onsite, have them get a health history from the worker (especially for gradual onset claims). If you don’t have access to one, consider utilizing external medical resources.  They will assist with return to work and at time can also assist with determining compatibility with a job and the injury itself.  At minimum an investigation is always a good idea. If all fails don’t hesitate to reach out for assistance, sooner rather than later. 

Where can employers come for assistance with this process?

If you have any questions about WSIB claims management, including how to object to the initial entitlement of a claim, we would love to hear from you. Contact Anna Aceto-Guerin at anna@clearpathemployer.com or toll free at (888) 336-0950,

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Big WSIB Changes Ahead for Employers

1/22/2016

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Ontario's Workplace Safety & Insurance Board (WSIB) has proposed a brand new system for funding our workers' compensation system that would change the way WSIB premiums are set and would eliminate the current process of giving surcharges and refunds.

This new system is said to come into effect by January 2019 and promises to be revenue neutral and the most significant change to the WSIB in decades. It would reduce the number of rate groups from over 200 to about 34 and eliminate the current NEER, CAD-7, and MAPP experience rating programs and replace them with one unified system. The updated reform proposal can be found here.

​Here are some of the key points you need to know. (Remember that details are subject to change since the WSIB's consultation process is ongoing):
​
New ways to categorize employers:
  • Currently, companies are categorized with similar businesses into one of 200+ rate groups (mining firms grouped together, retail stores grouped together).
  • The new system will streamline the process and categorize businesses into one of 34 rate classes based upon NAICS codes (that is up from the original 22 classes proposed in 2015 that was adjusted due to stakeholder feedback).

Say goodbye to refunds and surcharges, say hello to 'risk bands':
  • The WSIB will move away from 'predicting' expected claim costs for each employer and then allocating a refund or additional surcharge each September based on actual costs.
  • The new system will assign a premium rate based on the collective experience of all the employers in their rate class and where the particular employer falls on the 'risk band' or range of premium rates within that rate class.
  • Increases or decrease in claim costs for that employer will result in an increase/decrease in the next year's premium rather than a surcharge/refund of that year's premium.
  • The range of premium rates within each rate class will be quite extensive, with up to 40-80 different risk bands in each class.  Regarding increases/decreases in premium rates, no employer will be able to be moved up or down more than three risk bands per year (capping any increase/decrease to +/- 15% in any one year). This will help protect employers from catastrophic claim costs in one year.
  • Maximum risk band is not to exceed 3x the average premium rate for the rate class.

(Possibly the) End of multiple rate groups for one company:
  • Currently, companies with business activities that cross into more than one rate group (i.e. company has both manufacturing and trucking divisions) can assign individual employees to different rate groups (which may have different premium rates) and receive NEER reports for each rate groups.
  • The new system will establish a 'general rule' that assigns each employer to a single rate class based upon the company's predominant business activity. This change will simplify the administration of claims but will most likely result in premium increases for an employer who currently has a portion of its workforce in lower-cost rate groups (assuming that their predominant business activity is in a high-cost rate class). 
  • The WSIB has responded to concerns from employer groups saying that "it is interested in further exploring some exceptions to this general rule for separate classification and multiple rates for a single employer, if an employer engages in more than one business activity, and a business activity is not dependent on the other activity(ies)." It is still unclear, but there may be some wiggle room in this general rule.

Exception for staffing agencies:
  • An important exception to this 'general rule"'of one rate class per employer will be created for staffing or temp agencies.
  • The WSIB is proposing that staffing/temp agencies will have separate WSIB accounts for each industry or rate class they serve, rather than one rate class for the firm itself.

Expansion of experience window to 6 years:
  • Employers will remember that the WSIB previously expanded the NEER window from 3 to 4 years in 2010.  The new system would further expand the experience window for the unified system to 6 years of review.
  • Initially, the WSIB proposed that all claims within that window would be treated equally when determining premium rates. After consulting with stakeholders, that has been changed to a formula that gives higher (two-thirds) weight to claims within the most recent three years and lower weight (one-third) to those in the previous three years. This should help employers see changes in their premium rates if they have recently implemented changes to their health & safety practices. The image below depicts this weighted formula:

Depicting WSIB's Weighted 6 Year Experience Window
WSIB's Weighted 6 Year Experience Window
What about the Fatal Claim Adjustment Policy or other punitive measures?
  • In 2008, the WSIB instituted the Fatal Claim Premium Adjustment policy, which essentially voided out any potential NEER refund on an employer who had a traumatic fatality claim in that year.
  • The new system will not have refunds that could be voided, so the application of that policy as it now stands will not be feasible. However, the WSIB has proposed that such a company be assessed an amount consistent with the rolling five-year average of the cost of a claim to maintain the 'spirit' of that policy.
  • The WSIB also says that it is open to a 'special surcharge"'for bad performers. When an employer has an accident history over several years that is consistently significantly worse than others in their rate class, they may be subject to an undetermined surcharge of some kind. 

What about SIEF?
  • The WSIB's Secondary Injury Enhancement Fund (SIEF) provides employers with a discount on claim costs if it is determined that an employee's injury is caused or prolonged due to a pre-existing condition. It does not impact whether benefits are provided to the injured worker, it only provides cost relief to the employer.
  • The outcry from stakeholders at the potential removal of the SIEF program has resulted in the WSIB's acknowledgement that some form of cost relief measure is necessary. The SIEF cost relief program will be kept as an interim measure until there is a better cost relief structure for employers to mitigate costs.

How will these changes be implemented?
  • The WSIB plans to seek approval for the new framework proposal from its Board of Directors in late 2016. Implementation is planned for no earlier than January 1, 2019.
  • The WSIB has committed to publishing a written policy framework one year prior to the implementation of the new system.  In the interim, it will prepare a transitional plan to support stakeholders through the implementation process. Exact details of how the transition will unfold are still unclear.
  • Additional stakeholder discussions are occurring in 2016-2017. 
  • Stakeholders have their opportunity to share further thoughts on the updated framework until March 2016. This can be done by providing a written response to the Consultation Secretariat (consultation_secretariat@wsib.on.ca). 

Want to learn more?
  • Read more about the Updated Rate Framework here
  • Seek additional information from active participants in the consultation process, including the ​Office of the Employer Advisor (OEA)
  • Contact Clear Path President, Anna Aceto-Guerin or register for one of our upcoming Introduction to the WSIB and NEER Workshops, that will include an overview of proposed changes.

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Capture WSIB Claim Details With Your Own Company Forms

11/4/2015

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​There is one particular strategy which is often overlooked and undervalued by businesses when looking to reduce their WSIB claims costs. We're referring to the critical importance of completing an organization's own Incident Report/ Worker’s Statement, Supervisor’s Report of Injury and Witness Statements. 

One of the ​ways to reduce claims costs recommended by Clear Path involves developing and actually using a “toolkit” that is ready in the event of a workplace injury. What is sometimes discounted as unimportant is the Worker’s Statement and other similar statements, which should be contained in an organization’s toolkit. What is often misunderstood is the value these forms play in not only the management of claims post initial entitlement, but also in the objection of a questionable claim. 

The Value of The Worker’s Report

Part of successfully managing a claim is in the submission of a Form 7, which is the employer’s chance to paint an accurate picture of the workplace injury. Many companies complete the form from only one perspective – the employer’s. This can sometimes lead to an erroneous summary of the incident and often will result in a disadvantage to the employer. In our experience, especially when dealing with doubtful claims, an organization's own Incident Report from the worker's perspective can often come in handy when trying to convince an Eligibility Adjudicator of the claim’s merit. 
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Example: Clear Path managed to have a questionable claim denied after submitting the Worker’s Report of Injury along with a Form 7. The worker reported a workplace injury to his neck without providing concrete details or witnesses to the event. Upon completing the Worker’s Report of Injury (Form 6), the worker wrote that he believed the incident may have occurred because he “slept funny the previous night.”  The Eligibility Adjudicator denied the claim stating she was unable to establish a workplace injury due to the Worker’s Report of Injury. 
 
It is important to note that a worker often does not have an opportunity to complete WSIB’s Worker’s Report of Injury (Form 6) until weeks after the commencement of a claim.  Eligibility Adjudicators will send a blank form to the worker by regular mail, which sometimes does not make its way back to WSIB.   Eligibility Adjudicators also attempt to obtain incident details from workers by telephone, but again, this sometimes does not take place until days or weeks after the actual event.  It is easy for details to be misconstrued or forgotten, resulting in a costly claim for an employer. 

By having workers complete your own custom Incident Reports or Worker Statements, and submitting it along with a Form 7, Eligibility Adjudicators are provided with details the worker may easily deny or later change. 

Other Forms

Witness Statements can serve the same useful purpose.  As part of your investigation process after a workplace accident, it makes a lot of sense to question any workers who may have firsthand knowledge of the incident.  If a worker claims that another employee witnessed the accident, that employee should be interviewed for details that either confirm or deny the claim and this information could be provided to WSIB.   

The same can be said for Supervisor Reports. Since supervisors are usually the first person on scene, employers should train supervisors in their investigation processes and return to work program.  This program should include the initial investigation of a workplace injury, including the information and forms that should be completed for WSIB reporting purposes.

Clear Path consultant Jennifer Wright-Tahiraj explains that the possession of more than one workplace party statement increases the likelihood of potential discrepancies.  She further explains that discrepancies between statements can “assist an employer in proving a Worker Report to be false, and therefore convincing an Eligibility Adjudicator in the denial of a claim.” 

Example: Jennifer Wright-Tahiraj shares an example of an appeal decision which was denied loss of earnings (LOE) due to the information provided in a Supervisor Statement. The worker claimed a gradual onset injury to his right thumb after being advised that he, along with 26 other employees, would be placed on temporary lay-off due to a lack of work. In their statement, the supervisor was able to confirm that the worker could not report specifics of the alleged injury and nor were there witnesses to the incident.

​The ARO decision upheld the denial of LOE by stating there were inconsistencies in the Worker’s Report compared to details provided by the supervisor.  Specially, the decision stated that “…there is no evidence that the modified duties requested by the worker to the Supervisor were due to a workplace injury.  There is insufficient evidence to conclude that the right thumb injury arose out of and in the course of employment as there is no compatibility between the history of the right thumb injury and worker’s job duties.”

Bringing It All Together

Successful claims management begins with preparation. 
Prepared organizations utilize a “toolkit” which contains the documents described above, along with procedures for workplace injury investigations.  Part of this investigation should include obtaining details from all those involved, most importantly, the worker! Organizations should train their workforce in this process so that employees know what is expected of them when workplace injuries may occur. 

Never underestimate the value of the worker’s voice. 
WSIB policy is clear that when faced with a situation when each parties’ position weighs 50/50, the benefit of the doubt goes to the worker.  In order to help tip the scales in the favour of the Employer, provide facts and evidence that support your concerns, such as information provided by the worker’s own hand!

Compare and point out discrepancies.
If you come across discrepancies between statements, do not be afraid to discuss them with an Eligibility Adjudicator, especially if a claim is questionable.  An Eligibility Adjudicator’s role is to decide the merit of a claim and investigate yellow flags.  Remember that a worker is not likely to come forth with such information that may deny their claim! 
Have a question about WSIB claims management? Like some advice from someone with over 20 years of claims management experience? Why not book a free 15-minute consultation with Anna Aceto-Guerin? Book your appointment now!

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Victory for Transfer-of-Cost Employers with WSIB

10/12/2015

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Victory
​Clear Path recently challenged what could be considered a precedent-setting decision from the Workplace Safety & Insurance Board (WSIB) that would have put certain employers at a serious disadvantage.
 
Our red flags went up after we received a decision from a WSIB SIEF Case Manager denying our ability to request cost relief for a client who was a Transfer-of-Cost (TOC) employer. The reason? According to the WSIB, the TOC employer is not granted the right to even request SIEF because they are a TOC employer. Why? Due to the Board's disclosure (privacy) policies!

As a result of our objections, we brought this issue forward to senior management at the Board and we were ultimately able to get the SIEF team to review their interpretation of its disclosure policy, acknowledging that TOC employers satisfied the definition of an employer and are therefore entitled to request SIEF cost relief when applicable.
 
What is a Transfer-of-Cost (TOC) employer?
 
In the event that one company’s employee is injured at another company’s location or as a result of the actions of another company, responsibility for WSIB claim costs may be transferred to the “at fault” company.
 
What is SIEF cost relief?
 
The WSIB offers cost relief to employers through their Secondary Injury Enhancement Fund (SIEF) when they have an injured employee who has a pre-existing condition that enhances or prolongs the work-related injury or delays the worker’s recovery. Two important considerations about SIEF:
  • When applying for SIEF cost relief it is standard to receive a copy of the injured worker’s “access file” which contains relevant medical details that will be used to determine whether or not there is a relevant pre-existing condition.
  • As part of its strategy to reduce its “unfunded liability,” the WSIB has been much more conservative in approving SIEF cost relief requests from employers in recent years.
 
Details 
  • A client (“Company A”) had been deemed a TOC employer after a “Company B” employee had been injured on their property. The WSIB deemed “Company A” financially responsible for the injury and therefore for the worker’s WSIB claim costs. 
  • Upon investigation into the claim, Clear Path sought SIEF cost relief for "Company A" as we believed the worker may have had a pre-existing condition that prolonged the worker’s recovery.  In response, we received a reply from the SIEF Team at WSIB: “Company A” was not entitled to even request cost relief because “Company A” was a TOC employer.
  • The SIEF Department relied on its interpretation of Disclosure policies, 21-02-02 and 21-02-03.  According to their interpretation of policy 21-02-03 [Disclosure of Claim Information to Employers (No Issue in Dispute)], TOC employers are not permitted to request SIEF, but rather may only request limited claim information without an initial issue in dispute. 
  • What this meant was that a TOC employer could not request SIEF because the case manager would not be able to tell the TOC employer why they may have denied SIEF because the TOC employer was not entitled to certain details of the claim that are typically provided during the SIEF process.  To Clear Path, not only was this faulty logic, it was also an unfair interpretation that placed TOC employers at a disadvantage.
 
Clear Path’s argument
 
After obtaining an interpretation from WSIB’s own policy department and several attempts to discuss this with the SIEF Team without success, we brought this matter to the attention of WSIB’s Chief Operating Officer John Slinger.  We expressed our concern regarding the application of the SIEF Department’s unfair interpretation of disclosure policies, in essence advising that the TOC employer bears the cost of the claim and should be entitled to pursue cost relief if applicable. 
 
By way of argument, we noted: “Regardless of whether there is an issue in dispute, a TOC employer is still required to bear the financial outcome of a claim.  Therefore to deny a request for SIEF is a denial of natural justice.  As such, this office finds WSIB’s reliance on disclosure policies as a way of baring requests for SIEF to be a prejudicial and irresponsible practice that denies TOC Employers effective participation in the decision-making process.”
 
Ultimately, the WSIB agreed!
 
Approximately four weeks after submitting the letter, we received a response from the Director of the SIEF Team on behalf of Mr. Slinger, which stated, “…in [cases] where a TOC employer has received a notice of decision (not a full decision letter), but nevertheless wishes to object to the decision itself, the decision making practices… requires that the TOC employer be provided with a copy of the actual decision letter, including reasons, findings of fact and evidence.  This is so the TOC employer can meaningfully participate in the discussion/reconsideration process with the case manager and exercise their right to have the decision reviewed by the Appeals Resolution Officer if they so choose.”
 
Bringing it all together
 
For those professionals who regularly deal with claims and are familiar with WSIB policy and procedures, it is clear why this issue is fundamentally important as it relates to not only SIEF cost relief but in the entire decision-making practice. 
 
While participating in claims management it is important to remember the following:
  • Do not be afraid to question a case manager’s decision! Case managers are not omnipotent; they are people who can make mistakes just like everyone else.  If you are provided with a decision that requires clarification or you altogether disagree, request written clarification and do not be afraid to object and escalate if necessary!
  • Become familiar with WSIB’s policies and adjudicative practices. Without having at least some knowledge of policy it may be difficult to recognize those decisions that may require reconsideration.  Case Managers will often quote policy that support their decisions. Read these policies to fully understand the case manager’s logic and do not be afraid to speak with other departments, specifically the policy department, for clarification.
  • Recognize if a claim has become too complicated!  If you do not have the resources or experience to handle a claim that may have multiple issues at hand, seek help from the experts before your company may negatively be impacted! 
 
Are you experiencing difficulties with a WSIB claim? Book a no obligation consultation with Clear Path's Anna Aceto-Guerin for some expert advice.


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Unrelated Death of an Employee Lead to WSIB Cost Savings

9/9/2015

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Clear Path consultant Michelle Strassburger recently achieved significant WSIB cost savings for a client facing an unusual situation: an employee that had a workplace accident in 2011 had since died of natural causes (not related to the accident).

Details
  • Clear Path consultants regularly review our customers' NEER Statements from the WSIB in order to provide an estimate on future surcharges or rebates.
  • A routine telephone conversation with this client triggered Michelle Strassburger to investigate potential NEER cost savings after the death of an employee from natural causes.
  • This particular employee had a 2011 WSIB claim which included projected future costs of approximately $27,000 as noted on the company’s September 2014 NEER Statement.  Since the employee passed away in June 2014, the WSIB's policy dictates that any projected future costs could be removed as they no longer applied.
  • After contacting Service Ontario for a death certificate, our consultant submitted it to the WSIB for review and requested that future costs be removed. The WSIB Case Manager ruled that in these circumstances a recalculation of the company’s September 2014 NEER results was appropriate.  
  • By removing the projected future costs of the deceased employee’s claim, the company's claim costs were reduced by approximately $40,000. The client moved from being in a surcharge position (having to pay an additional fee) to receiving a rebate of approximately $18,500.

Understand the NEER system

It is essential that all business owners, managers and HR professionals understand that the WSIB's NEER program and how various decisions can impact the company's claim costs. We recommend attending one of Clear Path's popular Intro to the WSIB's NEER Program workshop, which you can learn more about here.

Review cost statements for inaccuracies and anomalies

Reviewing both your monthly cost statement and quarterly NEER statement for any inaccuracies is important.  The WSIB will NOT identify these for you, as demonstrated in the vignette above. It is important to remember that WSIB policy dictates that should the employer identify any mistakes, they must provide the details to the WSIB as new information and request any costs to be removed or recalculated. 

Understand when things have become too complicated

Manaing your company's Worker’s Compensation is a job in itself and many employers have added this stressful responsibility to already busy HR professionals.  If you do not have the time or experience to accurately manage WSIB claims, consider outsourcing to the experts!  Clear Path Employer Services provides experienced claim management and NEER Experience Rating advice to help employers reduce their disability claim costs. 

Contact one of our consultants to request a complimentary NEER review. 

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WSIB Proposing Radical Changes for Employers

5/8/2015

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The WSIB recently released a paper outlining its ambitious proposals that would change the way employers are classified, how premiums are set, and integrate the various experience programs. 

WSIB Chair Elizabeth Witmer and President & CEO David Marshall, have built upon the previous recommendations in the Harry Arthurs Review and Douglas Stanley's Pricing Fairness report -- which suggested that the WSIB develop an Integrated Rate Framework. 

The Board has posted the consultation documents, executive summaries, and backgrounders on www.WsibRateFrameworkReform.com.



Some highlights among the proposed changes:
  • Replace the current NEER, CAD-7, and MAP experience rating programs into one "Employer Level Premium Rate Adjustment" process. This new system would be prospective in nature, not retrospective. Premiums would be adjusted up or down on an annual basis, removing the need for rebates and surcharges.
  • Expand employer cost liability to a 6 year window (from the current 4 year window in NEER, which was previously a 3 year window).
  • Eliminate the SIEF cost relief program, which currently reduces costs for employers with an injured worker who had a pre-existing illness or injury that contributed to or prolonged the recovery from a workplace accident.
  • Replace the current classification model with the NAICS codes. There would be 22 NAICS classes, including three construction and three manufacturing classes.
  • Companies would no longer be able to have multiple rate groups (with the exception of the temporary work sector). Employers would be classified based on their predominant business activity (determined by which activity has the greatest proportion of assessable payroll).
  • Long latency diseases (cancers, COPD, asbestos-related diseases) will continue to have their costs assigned to the class level.

Download the WSIB Consultation Paper
Time frames and consultation periods
  • Initial phase of consultations runs from April 1 - June 30, 2015
  • Phase 2 will run from Summer-Fall 2015
  • WSIB plans to hold a "What We've Heard" session in the Fall of 2015 to share the feedback of key stakeholders and participants in the consultation process

How to get involved
  • Read the materials on the Rate Reform Website: www.WsibRateFrameworkReform.com
  • Comment directly to the WSIB by email at consultation_secretariat@wsib.on.ca
  • Seek additional information from active participants in the consultation process, including the Office of the Employer Advisor (OEA)
  • Watch for updates from Clear Path or contact Anna Aceto-Guerin for more information

What do you think about these proposed changes? Share your comments below.

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WSIB Announces New Look For Monthly Statements

3/17/2015

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The WSIB just announced a brand new look for Statement of Account forms for employers, hoping to make it easier to read and understand.
New WSIB Monthly Statement Format
New WSIB Monthly Cost Statement for Employers

​Want to learn more about the WSIB's NEER program? Come out to one of our upcoming NEER sessions (offered in both Introductory and Advanced levels). We can be reached at (519) 624-0800.

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How to Have Success with SIEF

2/13/2015

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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. 

Subjectivity

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: 
  • Initial request,
  • Reconsideration,
  • Appeal to WSIB, and finally
  • WSIAT Appeal
Don't squander your attempts trying to figure it out. 

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.

Next steps

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 anna@clearpathemployer.com or (519) 624-0800.

Special offer

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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Newspaper Says Injured Workers Love To Hate WSIB Boss

2/4/2015

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David MarshallPhoto by R. Brennan/Toronto Star
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?


Financial turnaround

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:
  1. WSIB premium increases and payroll growth have employers paying $1 billion more in revenue per year (despite the fact that injuries are down 20%).
  2. Prevention activities, fewer injuries and more timely access to medical care have reduced the cost of benefits by over $600 million. 
  3. Better investment portfolio management has seen it grow from $14 billion to $22 billion since 2009.
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):
  1. Premium rates have steadily increased for employers (some industries are hit much higher than others)
  2. The WSIB has significantly decreased the NEER Expected Cost factors for employers. Once you lower the expected cost, your rebate gets smaller and this also dramatically increases the chance you will hit a surcharge faster. Expected costs drive both sides of this calculation.
  3. The WSIB moved to a 4 year NEER window (from a 3 year) with little warning of its mplementation, essentially increasing an employer's liability by 33%
  4. Reserve factor tables are changing regularly now over the review year, which rarely happened in the past. This essentially changes the "multiplier" being used to determine the reserves and calculate future claim costs. Typically we saw Reserve factor tables lock in after the preliminary table was issued.  Now we have seen changes as late as August in the review year for claims that are 4 years old. This increases costs and the employer has no way to impact those costs so late in the game.
  5. Approvals for SIEF cost relief are now becoming a rarity, we estimate approvals are given less than 50% as often as in the past. The program provides cost relief for employers who have employed a worker with a previous disability or pre-existing condition. It reduces the amount the employer is financially responsible for but does not decrease the benefits to the worker. It may have been given out too generously in the past as a way of "pacifying" employers, but now it is increasingly difficult to acquire.
  6. Penalties for not meeting re-employment obligations and for non-cooperation with RTW have jumped significantly. If an employer was able to accommodate an injured worker for a while, but is no longer able to do so, they will be threatened with a penalty.  (Source)
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.

Next Steps

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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What is SIEF Cost Relief?

11/18/2014

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Picture
Ontario's Workplace Safety & Insurance Board (WSIB) offers employers a cost relief program called SIEF to encourage the employment of workers with a pre-existing injury or disability. Here's what you need to know about the program:

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).

Picture
Is it difficult to acquire SIEF from the Board?
  • 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.

Some advice:
  • 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).



Want to learn more?

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 anna@clearpathemployer.com with any of your WSIB-related questions. We look forward to hearing from you!

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Mistakes That Drive Up Your WSIB Claim Costs

10/16/2014

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Workplace Safety
Wonder why your WSIB claim costs are higher than you'd like them to be?
Is your organization making some strategic mistakes when it comes to dealing with workplace injuries?

Here is a quick list of the biggest mistakes companies make that can lead to increased WSIB claim costs for your organization:

1. Lack of a company-wide commitment to safety and accident prevention
  • Preventing workplace accidents takes more than platitudes and a few posters around your workplace
  • Making safety a real priority includes regular audits of your work spaces, keeping your Health & Safety policies and procedures up-to-date (and communicating them to your employees), ensuring your supervisors are vigilant, and dedicating sufficient time and resources to training your work force on safety practices.

2. Absence of documented modified work options for injured workers
  • As the Boy Scouts like to say, it pays to "be prepared"
  • Investing the time in researching a variety of modified work options for an injured worker in advance will put you in the driver's seat in the unfortunate event of a workplace accident (rather than scrambling to find something for an injured worker to do)
  • Performing a Physical Demands Analysis (PDA) for all high-risk positions will allow you to give vital information to medical professionals when they are determining what a worker is capable of doing when filling in a Functional Abilities Form (FAF)

3. Not understanding how claim status affects your costs
  • Lost-time claims, particularly when an injured worker is away from the workplace for 4 weeks or more, are the primary driver of increased WSIB claim costs
  • You should aim to have all claims be no lost-time claims (offering immediate modified work options for any injured worker if possible)
  • Additionally, when a claim remains "active" for even one day into the next calendar year (i.e. worker is not returned to regular or modified duties before December 31st). This makes your claim "active" in the next year, which means your costs will be calculated by a much higher "Reserve Factor"

4. Being uninformed about employer programs offered by the WSIB
  • The WSIB offers employers cost relief when a pre-existing injury contributed to the cause for an accident or is prolonging the recovery from an accident. The program is called Secondary Injury and Enhancement Fund (SIEF).
  • There is also an opportunity to transfer the costs related to an accident to a Third Party if that party was responsible for the accident (i.e. your employee was injured at a customer's site)
  • Not pursuing SIEF cost relief or 3rd party cost transfer when appropriate leads to unnecessarily high WSIB claim costs for your organization

5. Lack of regular communication
  • The most important strategy is the also the easiest to do
  • Lack of communication between HR and the worker, their manager, medical practitioners, and your WSIB adjudicator leads to delays and misunderstandings
  • Document all contact in writing for your records!


Want to learn more?

Consider registering for one of Clear Path's upcoming learning sessions:
  • Introduction to Disability Management: Oct 29th in Cambridge. Perfect for those new to claims management.
  • Introduction to the WSIB's NEER Program: Nov. 26th in Cambridge or Dec. 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: Dec. 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.

You can also contact Anna Aceto-Guerin at (519) 624-0800 or anna@clearpathemployer.com with any of your WSIB-related questions. We look forward to hearing from you!

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Ways To Reduce Your WSIB Claim Costs

10/15/2014

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WSIB logo
In the unfortunate event of a workplace injury, use of these "Essential 4" strategies, along with regular analysis of your company's NEER statements, are the best way to reduce your WSIB claim costs:


1. Effective claims management:
  • Regularly follow-up with all the relevant players involved in a claim: the worker, their manager, medical practitioners, and your WSIB adjudicator
  • Always review your Monthly Cost Statements (find out why) and your Quarterly NEER statements for inaccuracies
  • Object when you have any suspicions about the validity of a claim (when you suspect fraud, when a doctor's diagnosis does not seem to match with the nature of the accident, when the injury is a result of horseplay or from a situation where the employee was "removing themselves from the course of employment," or if you believe that an injury is due to a non-occupational situation. Note that there is a 6 month time limit on objections.
  • Utilize the WSIB appeal process when appropriate

2. Pursuit of SIEF cost relief:
  • If you believe that a worker's pre-existing condition may have contributed to the accident or is prolonging recovery, you should request SIEF cost relief
  • This will not impact the amount of benefits the worker will receive
  • Read our recent blog "What is SIEF" for more information

3. Active return-to-work efforts:
  • Ideally, aim to have all your claims as "no lost time" claims
  • Train your managers to refrain from saying "take a few days off"
  • Be prepared to offer modified duties
  • Any claim with over 4 weeks of lost time will incur significantly higher WSIB costs
  • Emphasis on early Return-To-Work (RTW) - this will increase the likelihood of a successful RTW and is better psychologically for the worker
  • Gradual RTW should focus on increasing a worker's stamina and ability to return to their previous duties if possible. Discourage workers from having physiotherapist appointments in the middle of the day (before or after work is preferred).
  • Communicate with the worker, their manager, treating practitioners, and the WSIB on a regular basis
  • Require the worker to meet their RTW obligations

4. Medical management of your claims:
  • Rather than passively waiting on the WSIB's resources, facilitate more timely execution of treatment through private medical providers. Although these will be out-of-pocket expenses, anything that keeps costs off your NEER statement and speeds up recovery will ultimately save you money
  • Utilize 3rd party expertise to help understand medical evidence and potentially question/challenge decisions. Medical consultants speak the "language" of medical practitioners and are more likely to engage them than lay people.
  • Medical consultant can be an advocate for the worker and encourage them through the RTW process

Conclusion:

By utilizing the "Essential 4" strategies + NEER analysis, you will achieve:
  • Optimal health outcomes for your injured workers
  • Financial savings for your company
  • Quick resolution to disability claims
  • Workers who understand your company’s policies and are committed to supporting your RTW programs


Want to learn more about WSIB claims management?

Register for one of our upcoming workshops (click to learn more):
  • Introduction to Claims Management
  • Introduction to the WSIB's NEER Program
  • Advanced NEER Strategies
Register today to take advantage of early bird pricing!

We'd love to connect with you!
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