​The WSIB recently released their By the Numbers: 2016 Statistical Report. Further to WSIB-specific statistics like how many RTW visits were made last year, this report also contains broader information that provides insight into the general health and safety being achieved within Ontario workplaces.  New to the resource is the ability to run your own reports using their Report builder app and a few other helpful changes. 

User-Friendly Changes  

The WSIB made a few changes to By the Numbers this year in order to make it increasingly user-friendly. The website was redeveloped so that users can now interact with the charts and graphs, making it easier to understand the data being shown. Reports and specific information can now be downloaded in a variety of formats, ultimately making the site more accessible. They also added new focus chapters that profile both Schedule 1 and Schedule 2 employers, helping to categorize and explain the statistics in a clearer and more definitive manner.
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Perhaps the most useful tool on the site is the Report Builder. This allows visitors to select the specific data they’d like to see and the site automatically creates a custom report accordingly. Changes made to the Report Builder include the added ability to recall data that’s specific to a rate group classification, along with fatality data which is now an additional option for viewing. 

Using the Data

The overall intention of the WSIB in providing this information and updating its functions is to give employers and workers a resource that will help them identify how they can make their workplaces safer and healthier.
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This resource is a great way to benchmark how your company is performing in comparison with the provincial numbers, and finding out specific information that can help you identify risks associated with your industry and plan for how to mitigate them before they become an issue (or larger one) for your business.

It’s also helpful in spotting both provincial and WSIB trends that may impact how you approach claims management, as well as what steps you’ll take in the future to further improve your position within the system. Ultimately, By the Numbers is a resource that employers and workers should look at to stay updated with the WSIB and claims management in Ontario. 

Conclusion
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If you have any questions about the WSIB, health and safety, or other HR topics, we would be happy to help you. You can contact Anna Aceto-Guerin at anna@clearpathemployer.com or by phone at 519-624-0800. 

You can view the WSIB By the Numbers report here: http://www.wsibstatistics.ca/

Image Sources
WSIB By the Numbers Webpage -  ​http://www.wsibstatistics.ca/

Have you noticed any changes at the WSIB lately? At Clear Path, it has become evident that the WSIB is working hard to move away from a bureaucratic agency toward an increasingly personalized and accessible organization. Initiatives like the WSIB’s Small Business Health and Safety Leadership Awards, as well as a personal blog by CEO, Tom Teahen, both indicate its efforts to connect on a more meaningful level with employers and employees.

Rather than focusing on claims management, it’s also actively addressing topics like safety and prevention, which typically fall under the responsibility of the Ministry of Labour. By simply visiting the WSIB website, you’ll find articles on workplace violence prevention and how to avoid occupational diseases.

The WSIB also appears to be dipping its feet in innovation initiatives in order to lead the industry with new advancements. Coming from an agency that refused to allow emails to the outside world until just recently, this is an amazing turn around.

Health and Safety Index

Along this theme, the WSIB recently introduced a Health and Safety Index that will come out in the summer of 2018. The index is planned to be published annually and measures the overall health and safety of Ontario’s workplaces.

The index will use five categories of data to determine the final measure, which includes: prevention, worker empowerment, workplace culture, enforcement, and injuries. It is the first tool in North America that has been put together to communicate this information in an easy-to-understand and measurable way. The intention is that a single measure will allow for a better understanding of how Ontario’s workplaces are performing in health and safety, as well as how they can continuously improve.

In addition, the WSIB is launching a corporate innovation lab at the Communitech Hub in Kitchener. This will involve a team of developers working to create practical solutions that will help improve workplace health and safety.

Evidently, the WSIB is moving in the direction of innovation, perhaps redefining the relationship that insurance boards have with those in the workforce. With an obvious effort to provide additional resources to employers and their workers, it is commendable that the WSIB is growing it’s initiatives to achieve this.

If you have any questions about the WSIB or comments about these new projects, we’d love to hear from you! You can tweet us @Clear_Path, or contact Anna Aceto-Guerin at Clear Path directly.  Thanks for reading! 

The WSIB recently introduced a Work-Related Chronic Mental Stress Policy to support Bill 127 which the Ontario government passed on May 17, 2017. With 39% of Ontario workers indicating that they would not tell their managers if they had a mental health problem (Source: CAMH), this policy is a positive step towards ending the stigma surrounding mental health diagnoses, particularly in the workplace.

About Bill 127

Also referred to as the Stronger, Healthier Ontario Act, “Bill 127 includes amendments to the Workplace Safety and Insurance Act…to allow entitlement to chronic mental stress for workplace injuries that occur on or after January 1, 2018”. The amendment was a result of the Ontario Workplace Safety and Insurance Appeal Tribunal finding that part of the WSIB’s Operational Policy “violated the equality guarantee in section 15 of the Canadian Charter of Rights and Freedoms and were unconstitutional”.
Source: Hicks Morley

WSIB’s Policy

The drafted policy would provide entitlement for traumatic mental stress (ex. someone witnessing a horrific workplace accident), and chronic mental stress (ex. someone being bullied by co-workers). Stress caused by changes to the worker’s employment (ex. change in job duties) would not be covered under the new policy.

According to the WSIB, “work-related chronic mental stress is caused by a substantial work-related stressor or series of stressors”. When evaluating the seriousness of a stressor, its intensity and duration are often examined. Situations such as harassment and bullying in the workplace are definitely seen as stressors that would contribute to chronic mental stress.
In order for a traumatic mental stress or chronic mental stress claim to be ruled on, there has to be a diagnosis in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM). Examples may include:

• Acute stress disorder
• Posttraumatic stress disorder
• Adjustment disorder, or   
• An anxiety or depressive disorder

The drafted policy states that the claim for adjudication will be accepted if an appropriate health care professional provides the DSM diagnosis. However, a WSIB decision-maker can require an assessment by a psychiatrist or psychologist at a later point to confirm entitlement. 
Source: WSIB Ontario

Your Input and Feedback

The WSIB has an open consultation on the policy until July 7, 2017. If you’d like to provide your feedback on the proposed policy, you can do so by emailing consultation_secretariat@wsib.on.ca.

If you have any questions regarding WSIB claims management, policy development, or other mental health or other workplace issues/topics, our team at Clear Path is happy to provide you with assistance. You can contact Clear Path President, Anna Aceto-Guerin at anna@clearpathemployer.com or by phone at 519-624-0800. 

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.  

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. ​

​​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​.

​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.

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. 

​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. 

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.

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. ​

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. 

Ontario's Workplace Safety & Insurance Board (WSIB) made headlines this month by announcing that employer premiums would decrease an average of 5% in 2017, the first such decrease in over 15 years. ​ This will result in approximately $250 million less being collected from employers, making the average premium rate $2.46 per $100 of insurable payroll, down from $2.59 in 2016.

However, not all industries will see the benefit of the decreased premiums. In fact, the WSIB's 2017 premium rates show that more than half of all industries will see no change at all in 2017 -- which many will argue is still a positive thing when compared to years of regular increases.

Only two rate groups (industries) will see an increase, Ambulance Services (Rate Group 590) and Local Government Services (Rate Group 845), which were both impacted with higher claim costs following the new presumptive Post Traumatic Stress Disorder legislation, which supports first responders with PTSD.

According to the WSIB, rate groups (industries) that have shown the most positive performance will see a decrease of up to 14%. Some examples include:

• Form Work & Demolition (Rate Group 748): $15.75 per $100 of insurable payroll (down from $18.31 in 2016)
• Siding & Outside Finishing (Rate Group 751): $8.82 per $100 of insurable payroll (down from $10.25 in 2016)
• Warehousing (Rate Group 560):  $2.95 per $100 of insurable payroll (down from $3.43 in 2016)

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The decrease in average premium rates is a result of an improved financial position for the beleaguered organization, according to Chair Elizabeth Witmer and president/CEO Tom Teahen in their recently released WSIB Economic Statement 2016. The WSIB has been able to reduce its ominous unfunded liability (UFL) from $14.2 billion in 2009 to $5.6 billion this year and attributes its success to:

• Increased premium revenue from employers since 2009 collected specfically to decrease the UFL
• Fewer claims as a result of improved health & safety measures across the province
• Improved recovery and return-to-work results for injured workers

Not all stakeholders are celebrating the news. The Ontario Network of Injured Workers protested the WSIB's annual general meeting and is critical of the WSIB's ongoing cost-cutting measures that they believe come at the expense of injured workers.  Organization spokesperson Catherine Fenech said: "It's horrifying that the WSIB is reducing employer premiums at a time when their policies are causing so many injured workers to go into crisis." (Source)

The WSIB counters by claiming that average employee benefits have remained stable since 2009 and that average health care spending per injured worker claim has grown slightly from $1,511 in 2009 to $1,595 in 2016. The WSIB also states that 92% of injured workers return to work with no wage loss within 12 months of injury.

The WSIB says that further premium rate reductions are possible in 2018 and 2019, depending on financial results and the health of the provincial economy. 

Next steps:

Do you have any questions about your company's WSIB premium rates or claims management process?  Want to learn more about upcoming changes at the WSIB, including the proposed Rate Framework Modernization project, which could merge the NEER, CAD-7, and MAPP programs into one unified system by 2019?  

Contact Anna Aceto-Guerin, president of Clear Path and WSIB NEER expert for a complimentary consultation today. You can reach her at anna@clearpathemployer.com or (519) 624-0800 xt. 106.

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.

​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.

​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. 

Clear Path was recently awarded an objection to initial entitlement for one of our customers based on the WSIB's Traumatic Mental Stress policy (15-03-02).  Even though our efforts proved successful, this case provides a valuable lesson for other employers helps to illuminate what meets -- and what does not -- the definition of a traumatic event according to the WSIB. 
 

What is policy 15-03-02?

The WSIB policy on Traumatic Mental Stress entitles a worker to benefits for traumatic mental stress that occurs suddenly in an event arising out of and while in the course of employment.

The event that occurs may involve actual or threatened death or serious harm against the worker, a co-worker, a worker’s family member or others. For the event or incident to be considered traumatic it must be clearly and precisely identifiable, objectively traumatic, and unexpected in the normal or daily course of the worker’s employment or work environment.

There are some restrictions to this policy. There is no entitlement for traumatic mental stress due to an employer's decisions or actions that are part of the employment function such as terminations or demotions. As well, workers who develop mental stress gradually over time due to general workplace conditions are not entitled to benefits.
 
What is the criteria to be covered under policy 15-03-02?

• Witnessing a fatality or a horrific accident
• Witnessing or being the object of an armed robbery
• Witnessing or being the object of a hostage-taking
• Being the object of physical violence
• Being the object of death threats
• Being the object of threats of physical violence where the worker believes the threats are serious and harmful to self or others (e.g., bomb threats or confronted with a weapon)
• Being the object of harassment that includes physical violence or threats of physical violence (e.g., the escalation of verbal abuse into traumatic physical abuse)
• Being the object of harassment that includes being placed in a life-threatening or potentially life-threatening situation (e.g., tampering with safety equipment; causing the worker to do something dangerous).

 
What was the scenario for this particular claim?

The worker claimed that he was suffering from stress after a physical altercation that was started by another employee. Following the altercation, he left the workplace and returned later in the day to deliver a doctor’s note that would allow him a month off.

The worker returned to work the following week, providing his employer with a Form 6 stating that he wished to commence a WSIB claim. The employer offered the worker modified work with arrangements to work from home after the employee indicated through a Functional Abilities Form (FAF) from his doctor that he would be too stressed to come to work. The worker rejected the modified work further stating that he would be unable to work from home as a result of the stress.
 
Possible outcomes for this case?

A claim for Traumatic Mental Stress can cost a company hundreds of thousands of dollars. Here’s what Clear Path team member Jessica Masse says about it.

“One month of loss of earnings is the tip of the iceberg. Those who are granted LOE under this policy, Traumatic Mental Stress can rack up costs in the form of healthcare and LOE benefits. In this case, one month could have easily turned into two and so on. The result of all these costs will stay on a company’s NEER statement for four years.”

Why doesn’t this case translate into entitlement for the employee?

In the Form 6, the worker stated that he "had merely brushed the arm of the work crew member after he had received his work assignment." When the employer investigated the incident, witnesses told a different story. Five witnesses that had seen the event claimed that the worker was providing inaccurate information and that the worker in question grabbed the arm of the other employee -- which initiated the altercation.

The altercation described above does not meet the criteria of the WSIB's policy, as it does not qualify as traumatic and a person feeling insulted by another employee does not translate to harassment.

The WSIB agreed that there was no basis for the worker’s claim of being approached aggressively or harassed. The worker who filed the claim was the individual who initiated inappropriate physical contact by grabbing the work crew member’s arm.

As a result of this false claim and the company's policy related to workplace violence and harassment, the employer found grounds for termination of the employee.
 
What other HR lessons can we learn from this case?

Even though the company avoided the potentially high WSIB claim costs when the claim was denied, there are some additional things to consider from an HR perspective.

When a situation occurs that involves workplace violence or harassment, employers will be in a better position to take action if they are fully compliant with the amendments to the Ontario Occupational Health & Safety Act in 2010 (also known as Bill 168). By having up-to-date policies realted to workplace violence and harassment, you have a policy in place to ensure the termination of a violent employee. In this case, the company did have such a policy in place and was able to take appropriate actions against the offending employee.

Another wrinkle in this case is the fact that the employee attempted to file a claim both through the WSIB and the company's Short-Term Disability program for the same incident (which was also denied). Employers should be aware of such "double dipping" attempts by employees and take appropriate actions accordingly.

Questions?

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.

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

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:

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.

 Do any of your employees also work for another company? Things could get complicated if your worker is ever involved in a workplace accident.

The fact that many employees are working more than one job can present interesting challenges if that worker has a work-related accident with one employer but is losing time from both. It also brings up issues regarding the obligations an employer has to accommodate disabled workers under the WSIB regardless of if they are the "Accident Employer" or not. 

Client example:

Recently a Clear Path customer was impacted by this situation. They had a part-time worker who was injured while working for them, making them the Accident Employer. Unbeknownst to our client, this worker had concurrent employment with another company on a part-time basis.  

While our client offered modified work and was accommodating the worker to try to save costs under WSIB, the concurrent employer was not. This resulted in loss of earnings (LOE) benefits being paid out to the worker by the WSIB and charged to our client (who, as the Accident Employer, became responsible for these additional costs even though it was as a result of the concurrent employer's actions.)

The WSIB has deemed that the Concurrent Employer in this case was excluded from the obligations under Policy 19-02-02 (Work Reintegration and Re-Employment).

In our recent submission to the Appeals Division at WSIB, we argued that a Schedule 1, Concurrent Employer should be party to the WSIB’s work reintegration responsibilities under Policy 19-02-02, as OPM Policies are governed by the WSIA.  

To support our argument,  we noted that the WSIB operates under a no-fault system, which provides that regardless of who may be responsible for an incident, employers are protected from other liability. We believe this should include protection from negligence on the part of Concurrent Employers.  Since the Accident Employer is financially responsible for workplace injury claim costs, the current interpretation of Policy 19-02-02 and the exclusion of Concurrent Employers from these responsibilities not only places Accident Employers at a financial disadvantage. It also is in contravention of WSIB’s “no-fault” system.

Human Rights perspective:

One can also look at this situation in relation to Human Rights legislation.  Under subsection 10(1) of the Code, a person who claims or receives benefits under the WSIA is deemed to have a disability for the purposes of the Code.  Therefore according to the Code, if a person with a disability requires accommodation to perform the essential duties of a job, “the employer must provide accommodation unless to do so would cause the employer undue hardship.” 

Interestingly, WSIB Policy 19-02-02 indicates the following in regards to accommodation:
“All employers have a duty to modify the work or the workplace to accommodate the needs of the worker to the extent of undue hardship.  This duty arises through the:

• Obligation to re-employ set out in the Workplace Safety and Insurance Act, 1997 and/or
• The Ontario Human Rights Code or the Canadian Human Rights Act."

Finally, the WSIB Policy 11-01-03 (Merits and Justice) states: "In situations where the application of a relevant policy would lead to an absurd or unfair result, a case manager may depart from said policy."  Taking this into consideration we can only conclude that current interpretation of Policy 19-02-02 to exclude Concurrent Employers from Work Reintegration and Re-Employment obligations can only lead to a prejudicial outcome, placing Accident Employers in a disadvantaged position. If the Code has primacy over conflicting legislation and policy, then the WSIB - as an administrative body - has a responsibility and jurisdiction to review the policy in question and apply the Code to ensure compliance. 

We argue that by removing this obligation from Concurrent Employers, it essentially provides an opportunity for them to ignore duties under both the WSIA and section 5 of the Human Rights Code, especially in situations when administrative bodies are not monitoring workplace parties for compliance. It also inadvertently allows workers the opportunity to both disregard their obligations and unfairly take advantage of the PLOE paid by the Accident Employer.  

What is the result?

What was the outcome of this?  You will have to wait and see – as we are awaiting the final decision from the Appeal Division of the WSIB.

What can we learn from this experience?

It is important to understand the full employment history and current situation for each of your employees. A quick review of the monthly cost statement also revealed the LOE were being paid while the worker was supposedly full accommodated at the injury employer.  

Lastly, offering modified duties to cover the time lost at the Concurrent Employer is a strategy we have used in the past if appealing to the WSIB to hold the Concurrent Employer accountable doesn’t work.

Need help in situation like these or other difficult claims – we are only a phone call away. Contact Anna Aceto-Guerin today.

​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. 
​
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!

​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.

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. 

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.

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.