The RIGHT care, at the RIGHT time, for the RIGHT outcome.

Transcription

1 The RIGHT care, at the RIGHT time, for the RIGHT outcome.

2 The New WSIB Surviving the Changes? Unlocking the Secret to WSIB Management Liz R. Scott, PhD Principal Organizational Solutions Inc.

3 AGENDA Introduc/on Informa/on you need to know about the WSIB Changes: Summary of Changes Examples of Cases About NEER - BoEom Line Concerns WSIB Management Tips and Techniques OSI s Solu/ons for your Clients / Organiza/ons

4 Over 85 employees Services provided in both official languages Over 800 corporate clients across Canada Regulated healthcare professionals & Paralegals Organizational Solutions Inc. offices High level of experience in the Disability Management and Workers Compensation field Invited Speakers & Authors of publications in the field Committed to the Power of DM to reduce human and financial cost through the provision of the RIGHT care, at the RIGHT time, for the RIGHT outcome

5 OSI CORE BUSINESS AND RESULTS OSI has exceeded our expecta/ons of service to our employees. Great Results!

6 WSIB 101 Workers Compensa/on legisla/on was first ini/ated in 1915 The basic premise of the system is a no fault, collec/ve liability system to compensate those injured at work as a result of a workplace accident The original premise remains arising out of and in the course of employment

7 Employer Concerns Over 50% of employers pay a surcharge to WSIB every year Over 20% of employers are misclassified Over 30% of employers are not using cost reduction programs that are available within the legislation

8 About WSIB Premiums

9 The WSIB System Collective Liability Rate groups Experience rating

10 Premium Rates Rates are set annually Rates are determined to fully fund cost of accidents that occur in the year the assessments are paid Rate considers: Accident frequency Long term run off of benefit payments Administra/ve costs Insurance limits

11 Experience Ra/ng Experience ra/ng is to provide appropriate mo/va/on to through financial incen/ves to: improve workplace health and safety eliminate workplace injuries, illnesses and fatali/es improve early and safe return to work

12 Two Major Changes Extending the NEER (experience ra/ng) window to four years Implement work reintegra/on policy The WSIB has introduced these as interim and for discussion purposes but in reality they are in effect.

13 WSIB has terminated the outside LMR Providers

14 Interim Policy

15 Major Changes Combines RTW, Reemployment and LMR Brings LMR in house New policy and new expecta/ons Significant employer non- coopera/on penal/es NEER extending window to 4 years inten/on to go to 6 years

16 Guiding Principles Appropriate and early RTW that maintains dignity and produc/vity Where recovery and RTW barriers occur, they must be responded to quickly through early support /interven/on A worker s prospects for successful work reintegra/on (WR) best achieved by maximizing opportuni/es for RTW with the injury employer, including retraining for a suitable occupa/on (SO) WSIB will play an ac/ve role A worker should be offered programs that are high quality and prac/cal, and the WSIB must provide the worker with meaningful input and choice of programs

17 Overview of Changes Five new policies and one new NEER policy These will replace the previous 24 policies WSIB indicates they are to; produce beeer return to work outcomes emphasis on greater accountability by workplace par/es including early involvement by WSIB (WSIB, 2010)

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19 WSIB Guidelines RTW is a process integra/on of effort and co- opera/on of the workplace par/es, trea/ng health professional, authorized representa/ves and the WSIB ac/ve recovery in the workplace accessible, /mely and intensive services goal- oriented work transi/on(wt) plans leveraging statutory RTW obliga/ons (i.e., co- opera/on and re- employment), and the RTW opportuni/es hierarchy.

20 WSIB Indicates; RTW is a Process Starts as soon as the employer learns that a worker has suffered a work- related injury / disease Con/nues throughout the work- related injury / disease recovery and impairment period, Adapts to changes as they arise.

21 Board Involvement Increased significantly Will meet with workplace par/es within 12 weeks of an injury to ensure suitable and available work is arranges Proac/ve engagement Dispute resolu/on

22 Responsibili*es The WSIB is manda/ng co- opera/on of all par/es and early contact, appropriate communica/on, iden/fica/on of return to work and eleva/on of relevant informa/on disputes.

23 Timely Assessments WSIB has indicated if workplace par/es are unable to arrange suitable and sustainable RTW, they will provide an assessment to determine what assistance the worker may need to enable RTW with the accident employer

24 Experience So Far Discussion

25 Actual Case Contacted by a Work Transi/onal Specialist (WTS) in January 2011 regarding a claim with the date of injury from To add another layer to the situa/on, this worker resigned from his posi/on with the company in 2008 for unrelated reasons and did not leave on good terms. The WTS requested a workplace mee/ng to see if there could be a permanent modified job available. Obviously, the employer did not want this worker back for reasons noted above. We convinced the employer to have the work place mee/ng due to the previously men/oned penal/es associated with non- coopera/on. The mee/ng was held, it was determined that currently there is no suitable work for this worker. This worker will go for re- training / re- skilling and then the employer will probably be contacted again by a WTS for another work place mee/ng. The WSIB will keep going back to the injury employer. It does not maeer how old the claim is. If someone in the company is off work and collec/ng full LOE benefits, chances are a WTS will be contac/ng the company.

26 Suitable Work Safe Produc/ve Consistent with func/onal abili/es Restores pre- injury earnings Available

27 Bundled Task work includes ; Combining tasks/du/es which together cons/tute a temporary or permanent job Short term training program which leads to a job with the injury employer

28 Available Work Work that exists with the injury employer at the pre- injury worksite or comparable worksite Will consider; Terms of applicable collec/ve agreement Whether job vacancy has been posted Evidence of hiring or transfers

29 Sustainable Does the job have reasonable prospects of being available on a long term basis Is it available to the general labour market (Applicable in cases of permanent impairment, cri/cal but stable condi/on, unable to return to pre- injury job)

30 Suitable Decisions WSIB says NOT suitable; Worker will get full LOE while co- opera/ng WSIB says suitable; WSIB deems worker able to earn wages associated with offered job Adjust LOE Confirms in wri/ng

31 Retraining Worker input will become a component Worker can choose Community College or Ministry of Training or Private School Work trials with new employers Provide educa/onal op/ons to young workers to increase earnings poten/al

32 Older Worker Op/on Over 55 years old; 12 month plan to focus on self directed work reintegra/on Full LOE for 12 months then benefits based on available jobs

33 Reloca/ons Assistance WSIB will pay reloca/on if job opportuni/es do not exist in the local labour market

34 Non- Coopera/on Penali/es Where either employer or employee refuses to co- operate Worker - Reduce of suspend benefits (reduces by 50% for 14 days then suspends) Employer fine the costs of providing benefits to the worker (50% of LOE for 14 days then full) PLUS 100% of any costs of any WT services to the worker

35 Re- employment Rights If worker is; Unable to work due to work related injury Employed with accident employer at least one year pre- accident More than 20 workers in workplace

36 Re- employment Obliga/on Fit for essen/al du/es Fit for alternate suitable du/es Duty to Accommodate Obliga/on last un/l second anniversary of the date of injury or one year ajer worker is medically able to perform essen/al du/es or age 65 Must be kept for 6 months

37 NEER Changes Extends the window to 4 years (from 3) Star/ng with the 2008 year!!!!! No impact on CAD- 7, MAP (small business)

38 HOW TO BE PREPARED Important to be ready for the changes

39 Return to Work Program KEY ELEMENTS

40 The Impact of Process

41 Claim Ini/a/on Appropriate paperwork Appropriate treatment Focus on RTW / capability

42 What is key? Appropriate treatment to resolve the injury The work community is an important element for all of us Set clear expecta/ons NO LOST TIME Make sure (s)he progresses to regular du/es

43 Influencing Factors

44 Treatment Problem Evidence based guidelines are not being followed Only 1 in 16. or 6 in 100 good care rate Over 40% of all Dr. notes are inappropriate * Coyne, 1995, Katon, 1995, Kessler, JAMA, April 2003

45 Disability Is a Ques/on of Func/on Not Diagnosis Collect the right informa/on customize the FAF Communicate - correct informa/on flow Monitor capability not disability Targeted therapeu/c interven/ons One objec/ve measure is worth a thousand opinions

46 Some Red Flags Unclear or no RTW date Repeated deferrals of RTW Stress / work conflict issues Frequent Users / unsuccessful RTWs No medical restric/ons on form Back Pain RTW > 2-4 weeks Mul/ple Diagnosis Changing physicians Doctor shopping

47 Lost Time Management REMEMBER: The injury applies only to the affected area; not the whole person Full recovery is not a prerequisite of return to work

48 Return to Work A return to work program is designed to achieve fair and consistent treatment of employees that have been off work with an illness or injury A early and safe return to work is the best approach for both the employee and the organization The employee benefits from having meaningful employment, gradual work conditioning and support associated with returning to work

49 Return to Work The key variables in the return to work process include: Understanding of the capabilities given the specific impairment Impact the impairment may have on the employee s ability to perform the essential duties of the job Services or treatments to be provided Barriers to full return to work Alternatives to return to work if the employee does not have the capabilities to return to this worksite Evaluation of the cost benefit of return to work interventions

50 Step by Step Process Minimize WSIB s involvement

51 Return to Work Program RTW Process Overview Intake/iniEal assessment RTW Plan Implement Post- plan EvaluaEon human oriented process of minimizing the impact of illness or injury

52 When to Rehabilitate In some circumstances transition back to the pre-injury job is not possible. In these situations it is important to ensure the employee becomes involved in appropriate rehabilitation This may only apply to a small portion - however it is important to understand the strategies

53 Does Return to Work Make a Difference YES! Decreased costs by 100% first year, addi/onal 50% by the second year Employees felt supported in disability and return to work process Co- workers felt the program was fair and consistently applied

54 Real Results Pre- OSI September 2007: WSIB Surcharge $850,000 OSI Care Management Process RESULTS: September 2008: WSIB Refund $940,000

55 Next Steps Analysis Complimentary Analysis of your NEER, CAD- 7, or MAP Experience Ra/ng Statement We will determine if there is an opportunity to intervene / reduce cost EVERYONE HAS A WSIB STORY We look forward to hearing yours!

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57 Q&A Q&A? Q&A Question? Q& A &Answer Q&A? Liz R. Scott Principal / CEO Organizational Solutions Inc. Please feel free to use and benefit from any of the materials provided. If you do reproduce please give appropriate credit / reference to the originating source / forum. Thanks.