|
|
|
|
Revisions
Published January 5, 2010:
|
|
|
Revisions published January 5, 2010
|
|
|
13-01-02, Workwell Program
|
|
|
15-01-02, Employers’ Initial
Accident-Reporting Obligations
|
|
|
18-01-05,
Table of Rates
|
|
|
18-01-06, Redirected Benefit Payments
|
|
|
24-01-01,
Hearing Fees and Expenses
|
|
|
|
|
|
Revisions
Published October 14, 2009:
|
|
|
21-02-04, Disclosure of Claim
File Information to Worker or Employer Representatives
|
|
|
21-02-06, Disclosure of Claim
File Information to Health Care Providers, LMR Providers, and Research
Entities
|
|
|
17-06-03, Independent Living
Devices
|
|
|
15-04-02,
Psychotraumatic Disability
|
|
|
15-04-03, Chronic Pain
Disability
|
|
|
15-04-04, Chronic Pain
Disability Rating Schedule
|
|
|
18-03-07, Loss of Retirement
Income Benefits (Accidents on or after January 1, 1998)
|
|
|
18-04-17, Loss of Retirement
Income Benefits (Accidents from January 2, 1990 to December 31, 1997)
|
|
|
19-01-04, Job Search Assistance
|
|
|
19-03-02, LMR Assessments
|
|
|
|
|
Revisions published January
5, 2010
|
|
Revisions to five WSIB policies were
published on January 5, 2010. Changes are indicated by boldface font.
|
13-01-02, Workwell Program
|
|
Minor editorial changes to the text under the Law
heading were made to more closely mirror the language in the Workplace Safety and Insurance Act, 1997. The wording was changed from:
The WSIB may increase or
decrease the premiums otherwise payable by a particular employer in such
circumstances as the WSIB considers appropriate including the following:
- in
the opinion of the WSIB, the employer has not taken sufficient
precautions to prevent accidents to workers or the working conditions
are not safe for workers, or,
- the
frequency of work injuries among the employer's workers and the accident
cost of those injuries are
consistently higher than that of the average in the industry in which
the employer is engaged.
to:
The WSIB may increase or
decrease the premiums otherwise payable by a particular employer in such
circumstances as the WSIB considers appropriate including the following:
- If, in
the opinion of the WSIB, the employer has not taken sufficient
precautions to prevent accidents to workers or the working conditions
are not safe for workers.
- If the
frequency of work injuries among the employer's workers and the
accident cost of those injuries is
consistently higher than that of the average in the industry in which
the employer is engaged. 1997,
c. 16, Sched. A, s.82.
In the Guidelines section under the heading “General,”
the reference to “and/or rate groups” was added to clarify that some
employers may be classified in more than one rate group, depending on the
nature of their business:
Workwell identifies employers
with particularly poor accident records and/or high accident costs compared
to their rate group and/or rate
groups, or who have a history of non-compliance with the Occupational
Health and Safety Act and encourages them to improve their prevention
programs.
The heading “Identification of employers” in the
Guidelines section was changed to: “Identification of employers for a Workwell Evaluation.” In the text of this section, the
WSIB has clarified that a Workwell audit triggered by health and safety /
injury statistics pertaining to even just one of an employer’s rate
groups, in cases where an employer’s business activities involve more than one rate group, can lead
to a Workwell audit of the employer’s entire business:
Identification of
employers for a Workwell evaluation
The WSIB determines whether an employer is a candidate for a Workwell
evaluation by considering any of the following
·
the number and rate of Ministry of Labour
workplace orders that have been issued and the degree of compliance with
those orders,
·
the type of order and the severity of the
contravention of the Occupational Health and Safety Act,
·
prosecutions initiated for failure to comply with
Ministry of Labour orders,
·
injury frequency information,
·
injury cost information,
·
severity of injury information,
·
compliance with first aid regulations,
·
complaints or referrals from workers or other
parties, or
·
any information concerning deficiencies or
mitigating activities related to an employer's health and safety measures.
The information received from
these various sources is reviewed and assessed by the WSIB's Workwell
Program. When reviewing and assessing injury frequency and/or injury cost
information, the WSIB adopts a comparative approach by evaluating an
employer's record relative to the record of other employers of a similar
size and industry. This comparative
approach is applicable to any and/or all of an employer's rate groups; all
of an employer's business activities are subject to evaluation.
These changes apply to all Workwell evaluations with a
notification date on or after January 1, 2010.
|
15-01-02, Employers’ Initial Accident-Reporting Obligations
|
|
The changes to this policy clarify that the special
rules for the handling of infectious disease claims are restricted to those
involving needle stick injuries as opposed to those involving other
infectious diseases for which the WSIB has separate policies or practices.
When discussing the rules in cases where an employer
does not need to report a work-related injury, “(see below)” was
replaced with “through needle stick injury”:
There are special rules if the
worker is exposed to, or it is suspected that the worker has been exposed
to, an infectious disease through
needle stick injury.
A new section called “Reporting of Diseases” was added
to clarify the employer’s responsibility to file a Form 7 with the WSIB if
a worker claims he/she developed an illness/disease as a result of
workplace exposure(s), just as would be done for a traumatic injury:
Reporting of diseases
If a worker is claiming to have developed a disease as a result of workplace
exposure, an employer is required to report to the WSIB as previously
outlined under the section entitled "When notice is required".
The former “Exposure to infectious diseases” section now
falls under the above new “Reporting of diseases” section, with changes related
to specifically identifying needle stick injuries as the means by which
compensable infectious diseases are acquired:
Exposure
to infectious diseases through needle stick injury
Some employers, such as hospitals, follow a surveillance protocol (a
procedure for testing and monitoring) when a worker has been exposed to, or
is suspected of having been exposed to, an infectious disease through a needle stick injury.
These employers must maintain records of the incident, and any testing and
monitoring.
If a worker of an employer that
follows a surveillance protocal [sic] tests negative for exposure to an
infectious disease through a needle
stick injury, the employer is not
required to submit an accident report. However, if the worker tests
positive for an infectious disease, or requires any type of treatment
related to the incident, the employer must report to the WSIB.
If a worker tests negative, but claims an emotional or anxiety-related
response following the accident, the employer must report the accident.
In cases where HIV infection is suspected, the employer must report the accident if a
health care practitioner provides a post-exposure prophylaxis (PEP) (see 23-01-01, Post-exposure Prophylaxis for Occupational
Exposure to HIV).
If it is suspected that a worker has been exposed to an infectious disease through a needle stick injury, but
the worker chooses not to participate in the surveillance protocol, the
employer must report the
accident to the WSIB.
Employers who do not follow a surveillance protocol must report when a worker has been exposed to, or is suspected
of having been exposed to, an infectious disease through a needle stick injury.
The following three examples were removed from the
above section:
Example (Accident report not required)
Potentially infected blood from a patient splashes on the arm of a
hospital worker. The worker is
tested for exposure to infectious diseases and the test results are negative. Although the hospital must keep a
record of the incident, it does not have to submit an accident report to
the WSIB.
Example (Accident report required)
While disposing of a used syringe, a worker suffers a puncture
wound. The worker is tested
for exposure to infectious diseases, and follow-up tests are positive for
Hepatitis C. Even if the
worker’s doctor does not recommend any immediate treatment, the employer
must submit an accident report to the WSIB.
Example (PEP [post-exposure prophylaxis ] required)
While purifying the HIV virus from a culture medium, the
contaminated medium is splashed over an open wound on the worker’s
forearm. The worker is given a
PEP. Once the worker receives
the PEP, the employer must submit an accident report to the WSIB.
The first example described an incident that does not
require the employer to file a Form 7. The second involves a needle stick injury and is
therefore covered by this revised policy. The third is covered by OPM Doc. No. 23-01-01, “Post-exposure
Prophylaxis for Occupational Exposure to HIV,” to address claims in which
“there is a percutaneous, mucous membrane or non-intact skin exposure to
material known to be infective for HIV”: http://www.wsib.on.ca/wsib/wopm.nsf/Public/230101.
Claims in involving SARS and the H1N1 virus are
addressed on a case-by-base basis.
You can read the WSIB’s separate positions on these illnesses at http://www.wsib.on.ca/wsib/wsibsite.nsf/Public/policysars and http://www.wsib.on.ca/wsib/wsibsite.nsf/Public/H1N1
respectively.
|
18-01-05, Table of Rates
|
|
The following
rates were increased:
- escort
fee (to $82/day from
$76/day)
- guide
and support dog allowance (to $968.24/year
from $964.38/year)
- independent
living allowance (to $3,574.34/year
from $3,560.38/year)
- personal
care allowance -- general, personal and skilled attendant rates (to $10.25/hr, $13.19/hr and $19.35/hr
from $9.50/hr, $11.99/hr and $19.20/hr, respectively, and
- burial
expenses (to a minimum of $2,699.41
from $2,688.66).
The bookkeeping fee was removed from the “personal care
allowance” category and now stands alone, but was not increased.
The fees for professional and non-professional witnesses
have been removed from the Table of Rates altogether as the Appeals Branch
is now responsible for setting, administering and maintaining these
fees. The fees will be added to the WSIB’s “Appeal System Practice
and Procedures Guide” (http://www.wsib.on.ca/wsib/wsibsite.nsf/LookupFiles/
DownloadableFileAppealPP/$File/AppealsP&P.pdf),
which is currently under significant revision and soon to be released. There are no changes to these fees
for 2010. The WSIB’s
announcement regarding this change is at: http://www.wsib.on.ca/wsib/wsibsite.nsf/public/Policy2010BenefitRates.
|
18-01-06, Redirected Benefit Payments
|
|
The only change to this policy was an
editorial correction removing the reference to s. 107.2 from the
“Legislative Authority” heading.
|
24-01-01, Hearing Fees and Expenses
|
|
This policy has been deleted. As mentioned above, the Appeals Branch is now
responsible for setting, administering and maintaining all fees and
expenses related to WSIB hearings. According to the Appeals Branch, the
change is likely due to the fact that it is the only area in the WSIB to
which those fees are relevant.
In the future, the Appeals Branch will conduct an
external survey of marketplace costs to ensure the fees continue to be
appropriate. In the meantime,
all witness fees and related expenses (travel, accommodation, meals, etc.)
that were included in OPM Doc. No. 24-01-01 and the Table of Rates in 2009
will remain the same throughout 2010. The WSIB’s announcement
regarding this change is at: http://www.wsib.on.ca/wsib/wsibsite.nsf/public/Policy2010BenefitRates.
|
Revisions Published October 14, 2009
|
|
Here are the changes that were made to 10 WSIB policies
that were published October 14, 2009. They involved corrections, for
the most part. The only policies with substantive changes are the
first two, regarding access to claim file information. Changes are
indicated by boldface font.
|
21-02-04, Disclosure of Claim File Information to
Worker or Employer Representatives
|
|
Several changes were made to reflect the Law Society
Act licensing requirements for worker and employer
representatives. In the Definitions section, “authorized
representative” was changed from:
Authorized representative
means any person, firm or organization that has the worker’s or
employer’s consent to represent him, her or it in relation to a WSIB
claim file. Such representatives include, but are not limited to
·
lawyers
·
representatives entitled to receive claim file
documents under sections 57 or 58 of the WSIA (issue in dispute) [deleted]
·
union or bargaining agent representatives
·
representatives from the Office of the Worker
Adviser or the Office of the Employer Adviser, and
·
occasional/one-time representatives such as
Members of Provincial Parliament (MPPs) [deleted]
to:
Authorized
representative means a person, firm or organization that has been
licensed under the Law Society Act, or is exempt from the Law
Society Act licensing requirements, and who has the worker's or
employer's written consent (authorization) to represent him,
her or it in relation to a WSIB claim file. Such representatives include,
but are not limited to
·
lawyers
·
paralegals
·
union or bargaining agent
representatives
·
representatives from the Office of
the Worker Adviser or the Office of the Employer Adviser
·
Constituency Assistants working in
MPP offices
·
Aboriginal Court Workers
·
Injured Workers Outreach Services,
and
·
Ontario Federation of Labour staff
and consultants representing union members in workers' compensation matters
(under the Occupational Disability Response Team), including their work in
representing families of deceased workers.
Also in the Definitions section, “informal
representative” has been changed from:
Informal representative means
a friend or family member who helps the parties (usually workers)
gain information about a claim.
to:
Informal representative means
a friend or family member who helps the workplace party gain
information about a claim, but does not charge a fee for this
service.
|
21-02-06, Disclosure of Claim
File Information to Health Care
Providers, LMR Providers, and Research Entities
|
|
There were many changes to
this policy. The new policy is more specific about the types of
information that can be shared with/by different individuals/entities involved
in the WSI system. It also enables workers to obtain copies of the
information that has been collected about them. This policy applies
to all decisions relating to the disclosure of claim file information that
were made on or after October 14, 2009.
The definition of “secondary
service provider” was broadened from outlining the types of services
provided (“aptitude testing, vocational testing and vocational training/new
skills acquisition”) to the types of organizations providing LMR
services/programs:
Secondary service
provider means a person, group of persons, or firm that provides services
to injured workers at the request of an LMR service provider. Such secondary
service providers include, but are not limited to
·
vocational training agencies
·
educational institutions, and
·
providers of English as a second
language courses, academic upgrading, computer skills, or job search
training programs.
“Subcontractors” were added to
the list of groups/individuals who may have access to personal information
in limited circumstances:
All claim file
information is considered personal information under the Freedom of
Information and Protection of Privacy Act (FIPPA) and may be disclosed
in limited circumstances in accordance with various exceptions listed in
FIPPA. These exceptions permit disclosure of personal information to health
care providers, labour market re-entry (LMR) service providers, secondary
service providers, subcontractors and research entities, (for the
purposes of this policy collectively known as “WSIB service providers,”)
where
·
the consent of the person to whom the
information relates has been obtained
·
such disclosure is consistent with
the purpose for which the information was collected, or
·
disclosure is to a research entity
following a formal written Freedom of Information request.
The definition of “subcontractors”
that was therefore added to this policy states:
Subcontractor
means a person, group of persons, or firm that has a contract with an LMR
service provider for the performance of LMR assessment services. Such
assessment services include but are not limited to
·
aptitude testing
·
vocational testing (including
psycho-vocational evaluations)
·
ergonomic and other occupational
therapy assessments, and
·
cognitive and/or physical demands
analyses.
Note that some of the tasks
performed by “subcontractors” are actually those that were previously
covered under the former definition/role of “secondary service providers.”
A new section addressing
“Disclosure to LMR service providers” outlines the types of personal
information they require:
Disclosure
to LMR service providers
Examples of appropriate disclosure to an LMR service provider for a
collection purpose or a consistent purpose are where personal information
is disclosed to the LMR service provider for the purpose of allowing the
LMR service provider to perform an LMR assessment and/or complete an LMR
plan. The personal information disclosed in such circumstances would
normally include the worker's
- name, address, telephone number and date of birth
- functional abilities information
- pre-injury job description, and
- pre-injury wage information.
Whereas the old policy
outlined the rules surrounding disclosure by LMR service providers
and secondary service providers together, the new policy has one section
addressing disclosure by service providers, and a separate section regarding disclosure by secondary service providers, subcontractors
and health care providers. The rules for LMR service providers are
stricter, permitting access to personal information only to those members
of their staff who require such information to fulfill their role, rather
than relying on a blanket confidentiality policy for all staff of an LMR
provider. The new policy also says the worker can have direct access
to all of the information included in the service provider’s records about
him/her:
Disclosure
by LMR service providers
All of the contractual agreements that the WSIB has entered into with its
LMR service providers contain terms that require all LMR service providers
to
- honour the confidentiality of all information they
receive related to a worker's claim, and
- disclose a worker's personal information only to
those persons who require access to it to perform the LMR provider's
obligations and who have agreed to comply with the privacy
requirements in the WSIB's agreement with the LMR service provider.
Upon the
request of the worker, LMR service providers are authorized to provide the
worker with direct access to all of the information contained in the
service provider's file for the worker, including direct access to his/her
Vocational Evaluation report or Psycho-vocational Evaluation report. The
LMR service provider must then notify the WSIB that access to such
information has been provided and, if requested to do so by the WSIB,
provide the WSIB with a copy of the information.
If an LMR service provider receives a request for information concerning a
worker from an employer or any other person, such request must be
directed to the WSIB. The WSIB then discloses or withholds the information
based on who is making the request, and the purpose for which the
information is being requested.
The section regarding
disclosure to health care providers was reworded to reflect that NEL
assessment physicians and REC centres require information that enables them
to more broadly perform assessments / evaluations – with a new focus on
supporting ESRTW for the REC Centres – rather than to simply determine
entitlement / ongoing entitlement to benefits as the former policy
stated. The new section says:
Disclosure to
health care providers
Examples of appropriate disclosure to health care providers for a collection
purpose or a consistent purpose are where personal information is disclosed
to
·
a NEL assessment physician for the
purpose of allowing the physician to perform a NEL assessment, or
·
a regional evaluation centre (REC)
for the purpose of allowing the REC to perform a clinical evaluation and
to provide the WSIB with recommendations to assist it in planning
appropriate health care interventions and supporting a worker's early and
safe return to work.
In the “Note” section below
that, however, the term “regional evaluation centre” was replaced with “NEL
assessment physician” so that paragraph now reads that the latter will
receive only “relevant” portions of the worker’s health care info, rather
than all of the worker’s health
care information for consideration when doing a NEL assessment:
NOTE
How much information should be disclosed in any given case will depend
largely on who is receiving the disclosure, and the purpose for which it is
being disclosed. For example, disclosure to a treating health care provider
may include entire health care reports, while disclosure to a NEL
assessment physician would only include relevant portions of the health
care information.
Rules surrounding disclosure by
health care providers are added to the new policy (they did not exist in
the old one) and are the same as those for subcontractors (a new party
recognized in this revised policy) and secondary service providers (who
were formerly required to follow the same rules as those for LMR service
providers). The new section states:
Disclosure by secondary service providers,
subcontractors and health care providers
Secondary
service providers, subcontractors and health care providers that provide
reports to the WSIB and/or to LMR service providers are required to follow
the disclosure rules that apply to them. If a worker requests a copy of his
or her reports(s) directly from any of these persons or entities, in most
cases such disclosure rules do allow the person or entity to disclose his,
her or its report(s) to the worker, upon the worker's request.
|
17-06-03, Independent Living
Devices
|
|
The following section was removed, so severely impaired
workers are no longer entitled to reimbursement for independent living
devices if they live in an institution:
Exception – for workers
not receiving the allowance
Generally, devices provided
under this policy must cost $250 or more. This rule does not apply to
devices requested by those severely impaired workers who are not entitled
to an independent allowance because they live in an institution.
These workers may request independent living devices of any value under
this policy.
|
15-04-02, Psychotraumatic Disability
|
|
The reference to “03-03-03 dated October 30, 1990” was
added to the Document History section.
|
15-04-03, Chronic Pain
Disability
|
|
The reference to “03-03-05 dated August 22, 1990” was
added to the Document History section.
|
15-04-04, Chronic Pain
Disability Rating Schedule
|
|
The Application Dates were
changed to reflect the WSIB’s practice of not placing a limit on
entitlement for CPD. The sentences were changed from “This policy is
effective from March 27, 1986 to January 2, 1990 and applies to both
temporary and permanent disability benefits” to “This policy applies to all
accidents prior to January 2, 1990, and to entitlement periods starting
from March 27, 1986. (See Retroactivity)”
|
18-03-07, Loss of Retirement
Income Benefits (Accidents on or after January 1, 1998)
|
|
In the section pertaining to work-related deaths prior
to age 65, the reference to “see Tab 20, Survivors” was changed to “see
section “Survivors” in the Operational Policy Manual (OPM):
Death before
age 65 — work-related
If a worker who is eligible to receive an LRI benefit dies before age 65 of
a work-related injury or disease, the WSIB pays the supplementary
pre-retirement death benefit and survivor benefits, see section
"Survivors" in the Operational Policy manual (OPM), to
·
the surviving spouse, if there is one
·
dependent children, if there is no
spouse,
·
other dependants, if the worker had
neither a surviving spouse nor dependent children.
Survivors are
not entitled to receive the pre-retirement death benefit.
|
18-04-17, Loss of Retirement Income Benefits
(Accidents from January 2, 1990 to December 31, 1997)
|
|
In the section pertaining to Survivors’ benefits, the
reference to “see Tab 20, Survivors” was changed to “see section
“Survivors” in the Operational Policy Manual (OPM):
Survivors’ benefits
Anyone receiving WSIB survivor’s benefits is not eligible to receive an LRI
benefit or pre-retirement death benefit.
For more information on survivors’ benefits, see section
"Survivors" in the Operational Policy manual (OPM).
|
19-01-04, Job Search Assistance
|
|
A policy (18-03-02, Payment of LOE Benefits) that had
been incorrectly provided as a cross reference in the Benefits section was
removed:
Benefits
If workers participate in the job-search phase of a VR plan, they are
eligible to receive benefits while co-operating in all aspects of a Labour
Market Re-entry (LMR) plan. The benefits payable depend on the accident
date (see 18-06-02, Calculating Temporary Partial Disability
Benefits; 18-04-11, Supplement for Programs and LMR Plans
Before and After 24 Months; or 18-07-10, Pre-1990 Pension Supplements).
|
19-03-02, LMR Assessments
|
|
Two policies (15-06-05 and 15-06-02) provided as cross
references appeared in the wrong bullets and had to switch places to appear
correctly as:
Assessment
not provided
The WSIB does not generally provide an LMR assessment if the worker
returned to suitable employment through ESRTW but later stops working due
to
·
a labour strike or lock-out unless
the labour dispute is prolonged (see 15-06-05, Entitlement Following Work Disruptions:
Strikes and Lockouts)
·
a short-term temporary lay-off (see 15-06-02, Entitlement Following Work Disruptions:
Short-term and Long-term Layoffs), or
·
other actions or circumstances unrelated to the
work-related injury.
|
|
|
|
|
|
