|
|
WSIB fact sheets are
available in alternate formats
|
|
|
Offer your full cooperation
to the WSIB during an audit
|
|
|
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 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
|
|
|
Include any concerns
you have with a claim on the Form 7
|
|
|
Be
aware of the different kinds of claim file information you can request from
the WSIB
|
|
|
Remove the cost of a FAF that
adds no value!
|
|
|
How can I manage my worker’s claim
effectively?
|
|
|
Fax all WSIB claim-related
information to the WSIB correctly to avoid processing delays
|
|
|
Make sure the worker’s NEL award
covers only the new work-related impairment
|
|
|
A WSIB mediator and ergonomist
can help your return to work efforts
|
|
|
Use the WSIB’s Physical Demands
Information Form to help return injured workers to work
|
|
|
Some employers may be able to
defer a Workwell audit for one year by choosing to join a Safety Group
|
|
|
Gain a better understanding of
how WSIB decisions should be made by reading the WSIB’s “Adjudication
Support Documents”
|
|
|
Use the IAPA’s Small Business
Safety Calculator to find out how much workplace injuries are really
costing your company
|
|
|
Clearly communicate to doctors
that you have a modified work program in place
|
|
|
Critical Injuries
|
|
|
Segregated Payrolls
|
|
|
Call your WSIB Adjudicator to Receive
Quick Action on Your Claim
|
|
|
Always File Formal Objections in
Writing and Include Your Reasons for the Objection
|
|
|
Prepare
for the Pandemic Flu
|
|
|
Try
to avoid the need for Labour Market Re-entry
|
|
|
Looking for a Doctor?
|
|
|
Check your statements
|
|
|
Ask
the Nurse Case Manager to help you get functional abilities information
|
|
|
File all appeals on time
|
|
|
Manage
noise-induced hearing loss claims
|
|
|
Access the Operational Policy Manual online
|
|
|
Access the Employer Classification Manual online
|
|
|
Get clearance certificates every
60 days
|
|
|
Report all material changes in circumstances
|
|
|
Exclude executive officers' earnings from the
premium calculation
|
|
|
|
|
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/wsib/wsibsite.nsf/Public/FactSheetsAudio. 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.
|
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/html/audits.html,
or from the WSIB's web site at: http://www.wsib.on.ca/wsib/wsibsite.nsf/Public/EmployersEmployerAudits.
|
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.
|
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:
|
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.
|
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.
|
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.
|
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/wsib/wopm.nsf/Public/180505)
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).
|
A WSIB mediator and ergonomist can help
your return to work efforts
|
If a worker raises concerns that the modified or
alternative job you have offered is not consistent with his/her functional
abilities, you can ask either the WSIB mediator or the ergonomist to make
arrangements for both of these specialists to attend the worksite
together. They will be able to
objectively assess the proposed working conditions, determine whether they
are consistent with what the worker’s physician has indicated the worker is
physically and/or cognitively able to do, and relay this information to
both workplace parties to resolve any concerns. This can be particularly helpful in cases where the
relationship between the workplace parties has become strained, creating a
roadblock in the return to work process.
|
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/wsib/wsibsite.nsf/Public/EmployersESRW,
where you can also access examples of
how to complete Sections 2, 3 and 4 of the PDIF.
|
Some employers may be able to defer a Workwell audit for one year
by choosing to join a Safety Group
|
|
The WSIB will be
sending out letters to some employers in November 2007 to notify them that
they have been chosen for Workwell audits taking place in 2008. The WSIB uses a selection matrix to
generate this list of employers each Fall, taking into consideration: the
number, frequency and severity of Ministry of Labour workplace orders
received; injury frequency, cost and severity information (total numbers
and also as compared to other employers in the same rate group); compliance
with first aid regulations; complaints or referrals from workers or other
parties; or any information regarding deficiencies or mitigating activities
related to an employer's health and safety measures.
The passing score for the
Workwell audit is 75% or higher.
Employers that fail the initial evaluation are required to work with
a health and safety program provider and are given six months to improve
the health and safety environment in their workplaces before a second audit
takes place. If the employer
fails the second audit, it may be assessed premium increases ranging from
10% to 75% of the original premium, up to a maximum of $500,000. And that’s in addition to any other
surcharges applied to the employer's account.
Employers receiving Workwell notices in
November will have until December 31, 2007 to submit an application to the
WSIB to join a Safety Group in 2008 to try to defer the Workwell audit for
one year. The Safety Groups
program is a voluntary five-year WSIB prevention incentive program that
provides employers with a network of employers who share the common goal of
reducing injuries and illnesses.
Safety Group members pool resources, share best practices and help
each other develop and manage effective health and safety programs to
improve workplace safety, reduce WSIB premiums and potentially earn
financial rebates. Some Safety
Groups are sector specific, and others have members in a wide range of industries. It is at the discretion of the
Workwell Evaluator to decide whether the employer will be allowed to do
this. Employers who have had
fatalities do not have this option available to them.
|
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.
|
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: www.iapa.ca/sbc.
|
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/wsib/wsibsite.nsf/public/ResourcesFunctionalAbilitiesForm.
|
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:
(a) (a) places life in jeopardy
(b) (b) produces unconsciousness
(c) (c) results in substantial loss of
blood
(d) (d) involves the fracture of a leg
or arm but not a finder or toe
(e) (e) involves the amputation of a
leg, arm, hand or foot but not a finger or toe
(f) (f) consists
of burns to a major portion of the body, or
(g) (g) 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/DBLaws/Regs/English/900834_e.htm
or contact our Advice Centre
at 1-800-387-0774.
|
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/wsib/wopm.nsf/public/140103
or contact our Advice Centre at: 1-800-387-0774.
|
Call your WSIB Adjudicator to Receive Quick Action on Your Claim
|
With the goal to improve
customer service, and acknowledgement that employers and workers need to be
“kept informed,” the fastest way for employers or workers to obtain
information from an adjudicator is to telephone the adjudicator directly. If the adjudicator does not pick up
the telephone, leave a voicemail message. If your message is not returned within 24 hours, call
the adjudicator’s manager for assistance. If that manager does not return your call within 24
hours, call the Assistant Director for that group. Continue to follow the “chain of
command” until you get a response.
For written correspondence, employers and workers can expect to
receive a two-week turnaround from the Adjudicator.
|
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.
|
|
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:
www.wsib.on.ca/wsib/wsibsite.nsf/public/flu_resources
|
|
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.
|
|
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.
|
|
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.
|
|
Ask
the Nurse Case Manager 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 Case Manager is involved in
"case management" for an injured worker, the Nurse Case Manager
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 Case Manager 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:
www.wsib.on.ca/wsib/wsibsite.nsf/public/HealthProfessionals.
-
select the link for "Return to Work Message for Physicians."
|
|
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".
|
|
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.
|
|
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:
www.wsib.on.ca/wsib/wopm.nsf/home/opmhome.
|
|
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:
www.wsib.on.ca/wsib/wecm.nsf/home/ecmhome.
|
|
Get clearance certificates every 60 days
|
|
Employers should obtain a 60-day "clearance
certificate" from every contractor in order to prevent the WSIB from making
you liable for a contractor's unpaid premiums and / or injury costs. In
order to ensure continuous protection contractors should be requested to
provide a new clearance certificate one week before the current certificate
expires.
Note: A contractor can obtain a clearance certificate by calling the WSIB
at 1-800-387-8638.
|
|
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.
|
|
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.
|
