Tips
Registration
WSIB fact sheets are available in alternate formats
The WSIB has a variety of audio fact sheets available on its web site at: http://www.wsib.on.ca/en/community/WSIB/230/ArticleDetail/24338?vgnextoid=1f9be35c819d7210VgnVCM100000449c710aRCRD. They provide general information in both English and French on topics for employers and workers, and they also provide specific information concerning prevention and occupational disease. The fact sheets are in an audio MP3 format that can be downloaded and listened to on your computer. The WSIB also has fact sheets available in Braille, audio CD and Daisy formats. You can request other languages or formats by calling the WSIB at 416-344-1000, toll free at 1-800-387-0750, or by TTY at 1-800-387-0050.
Report all material changes in circumstances
Employers and workers are obligated to report a "material change in circumstances" to the WSIB within 10 days of the occurrence or be liable to a fine or imprisonment for the offence. Material changes in circumstances include any change that may affect an employer's obligations under the Workplace Safety and Insurance Act. A change in business activity, business name and business address are a few common material changes.
Access the Employer Classification Manual online
The Employer Classification Manual (ECM) is now online. The ECM contains the descriptions of the Classification Units (CUs) the WSIB uses to classify the business activities of employers in Ontario. This information is used to assign Schedule 1 employers to rate groups for premium purposes. The ECM is available on the WSIB's web site at: http://www.wsib.on.ca/en/community/WSIB/230/PolicyHome/24345?vgnextoid=1238b411be12e110VgnVCM1000000e18120aRCRD.
Access the Operational Policy Manual online
The Operational Policy Manual (OPM) is now online. The OPM contains detailed policies that the WSIB use to make decisions on all worker and employer issues. Employers who want to review a WSIB policy can view it at: http://www.wsib.on.ca/en/community/WSIB/230/PolicyHome/24345?vgnextoid=cc08b411be12e110VgnVCM1000000e18120aRCRD.
Costs & Audits
Offer your full cooperation to the WSIB during an audit
In order to determine if an employer is remitting the correct amount of premiums, the WSIB has the right to conduct a payroll and classification audit by going into an employer's workplace to look at its books and accounts. The WSIB field auditor (auditor) can investigate and ask any questions he/she considers necessary to determine the accuracy of the financial statements employers must provide to the WSIB and the amount of the employer's payroll. The WSIB requires employers to provide it with a significant amount of business information upon registration, and all of this information and more will be verified during the employer audit.
An employer is required by law to comply with an audit. If an employer is not cooperating, the WSIB can request an order from a judge of the Superior Court of Justice authorizing one or more WSIB employees to enter and search any premises to locate books and accounts of an employer, and can do so by force if necessary. The WSIB is also allowed to remove the books and accounts so they can be examined, and can keep them for as long as it takes to complete the audit. A person who obstructs or hinders an audit could also face a fine of up to $25,000, or up to six months imprisonment, or both, and a company found in breach could be fined up to $100,000.
Although a "desk audit" can take place in which the WSIB asks the employer to send its financial records to the WSIB, an on-site field auditor will conduct the work on the employer's premises in most cases. In either case, it is extremely important to properly prepare for this assessment. The employer should make it as easy as possible for the auditor to conduct the review. All of the information should be ready when the auditor arrives, ideally organized chronologically and in subject folders to make it easier to process the volume and complicated nature of information that is typically involved. If possible, it is helpful to provide the auditor with a workspace where he/she can work without interruption. It is advisable not to argue with an auditor. Try to keep in mind that the auditor is just doing his/her job.
As with most other WSIB issues, an employer has the right to object to an auditor's decision. This must be done formally, in writing, within six months of the date of the auditor's decision letter. If you have any questions about how to prepare for an employer audit, or if you have received an audit decision that you do not agree with and have questions, please call the OEA for advice and assistance. You can find more information about employer audits from the OEA's web site at: http://www.employeradviser.ca/en/Construction-Employer/Costs-Audits/index.htm, or from the WSIB's web site at: http://www.wsib.on.ca/en/community/WSIB/ArticleDetail?vgnextoid=2fe9e35c819d7210VgnVCM100000449c710aRCRD.
Employers with optional insurance can discontinue premium payments if they incur a work-related injury/illness for which they are receiving WSIB benefits and their business stops as a result of their compensable injury.
If you are an independent operator, a sole employer, a proprietor or a partnership with no workers and purchase optional insurance from the WSIB, and your business is “discontinued” while you are recovering from a compensable injury or illness, you must report this material change in circumstances to the WSIB within 10 days after the change occurs. As a result, you will not be required to continue to pay premium remittances while recovering from your compensable injury and receiving loss of earnings benefits if you can verify the business was “discontinued” during that time, according to OPM Doc. No. 12-03-02, “Optional Insurance”:
Business ceases
If the business of an independent operator, sole employer, proprietor, or partnership without workers is discontinued, optional insurance is cancelled effective the date operations stop. This closure of a business is a reportable material change in circumstance (see 22-01-01, Material Change in Circumstances - Employer.)
If you are awarded 100% cost relief for a claim, write a letter to the WSIB and ask it to remove that incident from your experience rating record so it does not count as a frequency.
If a CAD-7 or MAP employer is awarded 100% cost relief through the Second Injury and Enhancement Fund (SIEF), the frequency should be removed from their experience rating record. However, unless the Appeals Branch or the WSIAT directs this to be done, the WSIB may not automatically make the adjustment. Therefore, it would be prudent for employers to write a letter to the WSIB to request a manual adjustment to ensure the frequency is removed from the employer's record in all such cases.
Remove the cost of a FAF that adds no value!
The WSIB encourages the communication of the worker’s functional abilities information between the workplace parties and the health care professional. The worker and employer will use the information from the Functional Abilities Form (FAF) for Early and Safe Return to Work as a tool to help plan the worker’s suitable return to work. The WSIB says, “These forms should only be initiated by the employer or the worker and, ideally, should only be completed when the worker is functionally able to return to work.” The WSIB pays health care professionals $40 for the completion of the FAF. If the employer believes the FAF does not provide value, it can ask the decision-maker to reverse the charge of the FAF to the employer’s WSIB account.
Use the IAPA’s Small Business Safety Calculator to find out how much workplace injuries are really costing your company
The Industrial Accident Prevention Association has designed a calculator to help employers with fewer than 50 workers to estimate the real out-of-pocket costs that flow from a workplace injury. That includes the costs that exceed those identified on WSIB claim cost statements, i.e., costs associated with hiring, relocating and/or training a replacement worker, lost productivity costs associated with the time required to manage the injury claim, and the reduced productivity of the injured worker who returns to work. You can access the calculator at: http://www.iapa.ca/sbc.
Segregated Payrolls
Employers that carry on two or more lines of business activity that fall under different WSIB rate classifications should ensure that the wage records for each is segregated. This can save you money on premiums for employees that should be assessed at a lower premium rate based on the work they perform. For more information on segregated payrolls, please visit the WSIB Web site at: http://www.wsib.on.ca/en/community/WSIB/OPMDetail?vgnextoid=1354fcea9bfc7210VgnVCM100000449c710aRCRD.
Check your statements
Employers enrolled in NEER should always check their Claim Cost Statement to ensure the following information is correct: account number; firm number; rate group; claim numbers; the names of injured workers; and the accident dates.
Employers enrolled in CAD-7 should always check their Accident Cost Statement to ensure the following information is correct: account number; firm number; rate group; total WSIB premiums paid; insurable earnings; and total number of actual injuries.
Exclude executive officers' earnings from the premium calculation
"Executive Officers" earnings do not have to be included in the calculation of premiums unless you want to be covered by the WSIB. If you are overpaying the WSIB, you may be eligible for a premium adjustment.
How can I manage my worker’s claim effectively?
As the WSIB assumes the worker’s short-term and long-term earnings are the same, you may need to ask the decision-maker for a recalculation of the worker’s average earnings if his/her short-term average earnings do not reflect his/her long-term average earnings. If a recalculation results in a lower rate, a benefit-related debt is created and the worker may have to pay that amount back to the WSIB.
Make sure the worker’s NEL award covers only the new work-related impairment
When calculating Non-Economic Loss (NEL) benefits for workers who have a pre-existing permanent impairment, Operational Policy Doc. No. 18-05-05, “Effect of a Pre-existing Impairment” (http://www.wsib.on.ca/en/community/WSIB/OPMDetail?vgnextoid=d63ac0d9ca3d7210VgnVCM100000449c710aRCRD) instructs decision-makers to rate the permanent effects of the work-related injury only. In so doing, the WSIB rates the area of the worker’s body that is affected by the new permanent impairment (PI), disregards any pre-existing PIs that affect other areas of the body, and factors out pre-existing PIs that affect the same area of the body. (For occupational disease claims, a permanent impairment for a non-work-related disease is factored out of a work-related occupational disease rating only if the diseases are the same and if the pre-existing non-work-related disease is measurable.) The WSIB considers pre-existing permanent impairments to be non-work-related impairments or work-related impairments for which a permanent disability pension or NEL benefit has been awarded. If you believe the WSIB did not apply the policy correctly by including only the effects of the new work-related injury in the calculation of the new NEL award, you have six months to appeal the WSIB’s decision under s. 120(1)(b) of the Workplace Safety Insurance Act, 1997 (http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_97w16_e.htm).
Accidents, Illnesses & Claims
You may want to consider providing signed statements from the worker, and any witnesses, to the WSIB.
You should always investigate an accident immediately after first aid/health care treatment has been provided to the worker. Obtain a signed statement from the injured worker as soon as possible or, if a signed statement is not possible, obtain a statement by phone. Interview everyone who may have seen the accident and get witness statements. Ensure the witness reads and clearly understands the statement, and have the witness sign and date it. If statements are provided in a language other than English, identify the interpreter and the language used. Have a third person witness the interview – a union representative, where applicable. Also get written statements from any worker who was in view of the accident, but did not see anything. Visit the site of the accident to prepare drawings of the layout of the area and to take photographs of any equipment and materials involved. Do not clean up or re-arrange the site until after the investigation has been completed. Sending this information to the WSIB to include in the claim file may be helpful if any contentious issues arise at a later date.
Ensure workers are cooperating in appropriate health care.
Section 34 of the Workplace Safety and Insurance Act, 1997 (WSIA) requires the worker to cooperate in any health care treatment the WSIB considers appropriate. Failure to do so can result in the reduction or suspension of WSIB benefits during the time of breach. If you have reason to believe this may be an issue in a claim you are managing, you should bring this to the WSIB Case Manager’s attention. The WSIB Nurse Consultant and/or Medical Consultant may be asked to intervene and address any obstacles in the return to work process.
Refer to the WSIB’s “Initial Entitlement (Disablement)” adjudicative advice document when reviewing a claim.
According to OPM Doc. No. 15-02-01, “Definition of an Accident,” disablement injuries are conditions that emerge gradually over time and/or are the “unexpected result of working duties.” To assist Case Managers with the interpretation of this term in the decision-making process, the WSIB created an Adjudicative Advice document called, “Initial Entitlement (Disablement).” It points out that unlike accidents involving acute injuries, the presumption clause does not apply to injuries involving disablement. It is up to the worker to prove the disablement arose out of and in the course of his/her employment in order to receive WSIB benefits. The employer can assist the Case Manager in the decision-making process by providing him/her with detailed information about the specific work the worker performed, including the mechanics of how the work was done. This will enable the Case Manager to make a well-informed decision about whether the nature of the worker’s injury is consistent with the type of work performed, and whether the disablement was, in fact, a result of the worker’s employment.
Consider whether hiring an ergonomist may be helpful when dealing with potentially costly claims, or those that may be appealed to the WSIAT
As the WSIB has eliminated Ergonomists from its New Service Delivery Model, employers may want to consider hiring an ergonomist to ensure there is an ergonomic report in the claim file. This might be particularly helpful if it is a complicated case that will potentially generate significant claim costs or which may lead to an appeal situation.
Larger employers who staff an in-house Ergonomist with the dual role of representing the employer at WSIAT hearings should be aware this involves a conflict of interest. Individuals cannot be both a representative and an ergonomic consultant at a WSIAT hearing, and an Ergonomist who generates his/her own ergonomic report that will be relied on as evidence will therefore be excluded as an employer representative at the WSIAT.
The WSIB has a link to the Association of Canadian Ergonomists on its Health and Safety Partners page at: http://www.wsib.on.ca/en/community/WSIB/ArticleDetail?vgnextoid=fa0ee35c819d7210VgnVCM100000449c710aRCRD.
Include any concerns you have with a claim on the Form 7
Section 12 in Block C of the Form 7 says, “If you have concerns about this claim, attach a written submission to this form.” If you do have concerns about a particular claim, check the box in section 12 that says “submission attached” and either include your concerns on page 4 of the Form 7 or attach a separate sheet that explains your concerns about the worker’s claim for benefits. This will require the Eligibility Adjudicator to contact you to discuss the issues, before a decision is made.
Be aware of the different kinds of claim file information you can request from the WSIB
All WSIB claim file information is considered personal information under the Freedom of Information and Protection of Privacy Act (FIPPA). The following WSIB policies outline the different kinds of information you are allowed to obtain from the claim file in different circumstances:
- OPM Doc. No. 21-02-01, "Disclosure of Claim File Information - General": http://www.wsib.on.ca/en/community/WSIB/OPMDetail?vgnextoid=dbacc0d9ca3d7210VgnVCM100000449c710aRCRD
- OPM Doc. No. 21-02-03, "Disclosure of Claim File Information to Employers (No Issue in Dispute)": http://www.wsib.on.ca/en/community/WSIB/OPMDetail?vgnextoid=dcbcc0d9ca3d7210VgnVCM100000449c710aRCRD
- OPM Doc. No. 21-02-02, "Disclosure of Claim File Information (Issue in Dispute)": http://www.wsib.on.ca/en/community/WSIB/OPMDetail?vgnextoid=54bcc0d9ca3d7210VgnVCM100000449c710aRCRD.
Fax all WSIB claim-related information to the WSIB correctly to avoid processing delays
The WSIB recommends that you:
- Write the claim number and the worker’s name at the top right hand corner of each page being faxed;
- Set your fax machine to the highest possible resolution;
- Program your fax machine header information to contain your company’s name, fax number and the current date; and
- Check the fax confirmation sheet to make sure all of the pages were sent successfully.
Critical Injuries
Remember that in addition to completing a Form 7 for the WSIB, critical injuries must also be reported immediately to the Ministry of Labour. Under Regulation 834 of the Occupational Health and Safety Act, critical injuries means an injury of a serious nature that:
- places life in jeopardy
- produces unconsciousness
- results in substantial loss of blood
- involves the fracture of a leg or arm but not a finger or toe
- involves the amputation of a leg, arm, hand or foot but not a finger or toe
- consists of burns to a major portion of the body, or
- causes the loss of sight in an eye.
For more information on critical injuries, please visit the Ontario Government e-laws web site at: http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_900834_e.htm or contact our Advice Centre at 1-800-387-0774.
Prepare for the Pandemic Flu
A pandemic flu may have a serious impact on your business and on your employees' health. You should be proactive, learning as much as you can about how to control the spread of infection and clearly communicating this information to all of your workers. You should also take steps to plan for a possible pandemic. The WSIB has several resources available on it's web site to help you address this important issue at: http://www.wsib.on.ca/en/community/WSIB/ArticleDetail?vgnextoid=512ce35c819d7210VgnVCM100000449c710aRCRD
Looking for a Doctor?
If you are looking for a doctor in your area to treat your injured workers, or if you want to verify the credentials of a particular doctor, you can search the College of Physicians and Surgeons of Ontario web site at: http://www.cpso.on.ca/docsearch/.
Manage noise-induced hearing loss claims
The WSIB allows about 2,000 noise-induced hearing loss (NIHL) claims each year. Workers are entitled to receive a lifetime supply of hearing aids costing about $1,650 each. The WSIB's web site contains useful documents to help you prevent future NIHL claims.
- "A Guide to Noise Control and Hearing Conservation" (NCHC)
- The "Noise Control and Hearing Conservation Audit Tool"
For further information call the WSIB's Prevention Division at 1-800-663-6639 and ask to be transferred to the WSIB Noise Induced Hearing Loss Manager.
Gain a better understanding of how WSIB decisions should be made by reading the WSIB’s “Adjudication Support Documents”
The WSIB has a variety of “Adjudication Support Documents” that have been written to help WSIB decision-makers interpret and apply certain WSIB policies consistently and efficiently.
“Adjudication Advice” documents provide information about more challenging issues such as clarifying an employer's initial accident reporting obligations, determining maximum medical recovery, the protocol for decision-makers to obtain outstanding medical information, determining initial entitlement in disablement situations, adjudicating recurrence claims, and dealing with workers who have multiple claims. "Best Approaches Guides" were developed to help WSIB staff apply key adjudication principles such as writing decisions, assessing a "timely and safe” return to work, reconsidering decisions, returning workers with psychological and chronic pain conditions to work, and weighing medical evidence. "Training in Policy Summary (TIPS)" newsletters outline practical examples for specific policies and address issues such as re-employment obligations, LMR expenses, aggravations, reporting obligations and late filing.
To download copies of all of the Adjudication Support Documents available on the WSIB’s web site, go to: http://www.wsib.on.ca/en/community/WSIB/230/ArticleDetail/24338?vgnextoid=3017a5596b8d7210VgnVCM100000449c710aRCRD.
Return to Work & Re-employment
Ensure you meet your obligations in the WR process.
The WSIB’s new Work Reintegration (WR) policies provide that employers have a duty to accommodate an injured worker’s return to suitable work. Make sure you understand what your accommodation obligations are, and how to meet them.
Use the WSIB’s Physical Demands Information Form to help return injured workers to work
The WSIB’s Physical Demands Information Form (PDIF) can be a very helpful tool for employers in the early and safe return to work process. The PDIF is not a complete Physical Demands Analysis, but it does help you gather and document specific information about the physical demands of the particular job (for either pre-injury or accommodated jobs) that are relevant to the specific area(s) of a worker’s injury. It can help you identify potential risk factors for injuries in a particular job and give you an opportunity to be proactive by modifying the job to reduce risk factors and/or to accommodate an injured worker's restrictions so they can return to work, thereby reducing claim duration. It can also help WSIB adjudicators make more timely entitlement decisions with respect to injury compatibility and job suitability. To ensure the PDIF is accurate, it is best if the worker's immediate supervisor completes it and includes input from the injured worker and/or other people who are familiar with the physical demands of the job in question. An English version of the PDIF, including instructions, is available on the WSIB’s website at: http://www.wsib.on.ca/en/community/WSIB/ArticleDetail?vgnextoid=a7f9e35c819d7210VgnVCM100000449c710aRCRD, where you can also access examples of how to complete Sections 2, 3 and 4 of the PDIF.
Clearly communicate to doctors that you have a modified work program in place
With the introduction of the WSIB’s new Functional Abilities Form for Planning Early and Safe Return to Work (Form 2647A) on March 1, 2007, the WSIB no longer provides employers with copies of the functional abilities form. Employers must print a copy of the form from the WSIB’s web site to give to the worker to take to his/her doctor for completion. Some employers are adding their own pre-printed label(s) to key areas in the sections of the WSIB’s form that will be completed by the worker’s health care provider to clearly communicate to the worker’s doctor that the employer has a modified work program in place, and will be able to accommodate the worker’s restrictions. It is hoped that this will further encourage dialogue between all parties involved in the return to work process. For a copy of the new form and a guide to help you complete it, visit the WSIB’s web site at: http://www.wsib.on.ca/en/community/WSIB/ArticleDetail?vgnextoid=7466e35c819d7210VgnVCM100000449c710aRCRD.
Try to avoid the need for Labour Market Re-entry
Employers should try to avoid the need for workers to obtain Labour Market Re-entry (LMR) services by providing suitable or comparable work that restores the worker's pre-injury earnings. If LMR services are provided, inform the WSIB that you intend to participate in the LMR process to ensure the LMR plan offered is both appropriate and cost effective. If you disagree with a proposed LMR plan, file an appeal within 30 days from the date of the LMR plan letter. Let the WSIB know if suitable work becomes available while the worker is participating in the LMR plan.
Ask the Nurse Consultant to help you get functional abilities information
If you are having difficulty obtaining functional abilities information from your worker's treating practitioner, there are two things you can do. In cases where a Nurse Consultant is involved in "case management" for an injured worker, the Nurse Consultant will share the worker's functional abilities information with the employer. In other cases, if the injured worker's treating practitioner has not provided functional abilities information to the employer, upon request, the Nurse Consultant will follow up with the treating practitioner. The WSIB has a brochure on its web site that outlines the role of doctors in the return to work process at: http://www.wsib.on.ca/en/community/WSIB/ArticleDetail?vgnextoid=cbbee35c819d7210VgnVCM100000449c710aRCRD. - select the link for "Return to Work Message for Physicians."
Appeals
Always File Formal Objections in Writing and Include Your Reasons for the Objection
Any party objecting to a decision made by the WSIB must file an objection in writing, with reasons, within the applicable appeal period as required by s. 120 of the Workplace Safety and Insurance Act, 1997 (WSIA). Do not rely on “letters of intent” to appeal a decision even though the WSIB will accept these bookmark objection letters. A recent WSIAT decision concluded that bookmark letters may not be adequate to meet the statutory notice requirement.
File all appeals on time
The WSIB has amended its Appeal Guidelines to generally allow an appeal to be filed within one year of the decision. Employers should continue their best efforts to file return to work and labour market re-entry appeals within 30 days of the decision, and all other appeals within six months. If the appeal period is missed, file your appeal as soon as possible. Employers who encounter problems with appeal periods at the WSIB should contact the OEA for assistance. For more information, refer to "Appendix A" of the WSIB's "Appeal System Practice and Procedures" at: http://www.wsib.on.ca/files/Content/AppealsAppealSystemPracticeandProcedure/Appealsystempandp.pdf.

