Effectively Managing Difficult WSIB Claims

Transcription

1 Effectively Managing Difficult WSIB Claims October 8,

2 Agenda Session Objectives Why Manage WSIB Claims Components of an Effective Program Setting Up a Claim for Success Managing Individual Claims 2

3 Session Objectives By the end of this session, we will understand: Why it is important to manage workplace injuries How to balance legal obligations and organizational culture when offering modified work Some critical ways to identify and resolve barriers that may hinder or delay a successful return to work 3

4 Why Manage WSIB Claims 4

5 % Probability for RTW Why Manage WSIB Claims Months Away from Work Immediate employee engagement is imperative 5

6 Why Manage WSIB Claims $450,000 The Cost of a Claim - Schedule 1 Employers $400,000 $350,000 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 $- 1 week 4 weeks 8 weeks 16 weeks 32 weeks 52 weeks 104 weeks Direct Salary Costs ($) $1,615 $6,458 $12,917 $25,834 $51,667 $83,959 $167,918 WSIB Actual Surcharge ($) $1,740 $31,434 $59,427 $145,862 $291,724 $416,000 $416,000 It costs between 2.4 and 5.6 times more to have someone collecting WSIB benefits beyond 1 week, rather than performing a non-value add role. 6

7 Annual Cost of a Claim Why Manage WSIB Claims $140,000 The Cost of a Claim - Schedule 2 Employers $120,000 $100,000 $80,000 $60,000 Cost of LOC Admin (27%) LOE (+2.5%) $40,000 $20,000 $ Years from Date of Injury Loss of earnings and health care payments account for only 51% to 63% of the overall annual cost to a Schedule 2 employer. 7

8 Why Manage WSIB Claims Legal Obligations & Risk Management Maintain Culture & Corporate Image Financial Impact Labour Relations & Employee Engagement Employment Standards & Collective Agreement 8

9 Components of an Effective Program 9

10 Components of an Effective Program A structured process - complete with responsibilities, activities and decisions 10

11 Components of an Effective Program Well defined documentation rights, responsibilities, forms, training tools, etc. 11

12 Components of an Effective Program Employ/consult a well trained program champion 12

13 Components of an Effective Program Engage the union 13

14 Setting Up a Claim for Success 14

15 Setting Up a Claim for Success Interview ALL witnesses and/or injured workers separately Review first aid logs and nonoccupational factors Perform an onsite assessment without injured worker participation Determine if and/or what degree of the injury is work-related Complete a thorough accident investigation 15

16 Setting Up a Claim for Success Gather OBJECTIVE medical documentation 16

17 Setting Up a Claim for Success Document, document, document! 17

18 Managing Individual Claims 18

19 Managing Individual Claims Claims Management Accident Prevention Employment Standards Labour Relations Financial Impact Maintain a holistic approach 19

20 Managing Individual Claims Establish claim legitimacy Oversee employee recovery Ensure claim resolution Time, place activity activity? Is there compatibility of diagnosis with accident history? Are there witnesses to substantiate the event? Did a pre-existing, underlying or other issue cause the injury? Request appropriate and objective medical documentation Maintain suitable modified work within the worker s restrictions Ensure the worker is cooperating in the process Provide information and ask for continuous feedback Obtain medical verification of full recovery Request written communication from the WSIB Follow up with worker regularly and document communications Take a holistic approach to determining if/what work is available 20

21 Managing Individual Claims Engage all available resources 21

22 Managing Individual Claims What is a workplace accident Define modified work What is a pre-existing condition What workplace modifications are required Do not re-adjudicate the claim Think outside the box 22

23 Key Factors to a Successful Program Summary: Strategic Planning Clear accountability and role definition Skilled Case Management Effective & Timely Communication Support for Other Return to Work Barriers Collaborative Return to Work Planning & Support People Leader Support and Involvement Effective Issue Resolution 23

24 Rick Mahoney National Director Morneau Shepell Thank You and Questions 24