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Access the Employer Classification Manual (ECM) online

The WSIB’s new ECM that is being used in its new North American Industry Classification System (NAICS) structure is available online. It contains the descriptions of the NAICS classification codes and additional WSIB-specific classification codes that the WSIB uses to classify the business activities of Ontario businesses for premium rate setting, and the coverage status for each code.

 

Access the Operational Policy Manual (OPM) online

The WSIB’s OPM is also available online. It contains detailed policies that the WSIB uses to make decisions on all employer and worker issues.

 

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. Failing to do so may result in a fine or imprisonment. Material changes in circumstances include any change that may affect an employer’s obligations under the Workplace Safety and Insurance Act (WSIA), i.e., changing your business name, discontinuing or changing a business activity, a change in insurable earnings, etc.

 

Costs & Audits

A clearance is mandatory if you hire a construction contractor, subcontractor or independent operator (hereafter referred to as “contractors”)

Construction contractors are required to have WSIB coverage, and to report and pay their WSIB premiums on time. Each contractor whose WSIB account remains in good standing will have one generic clearance that will be valid for all of its contracts. A principal/employer who hires a construction contractor must get a clearance before allowing them to do any work. Failure to do so is an offence, and could expose the principal to financial risk for the contractor’s non-payment/non-compliance. If a clearance expires, or is revoked, the contractor’s work must stop, and you must receive a new clearance before allowing the work to resume.

 

Get a valid clearance certificate from all non-construction contractors before allowing them to perform any work at your business premises

Employers who contract with other companies to provide non-construction services, such as janitorial or security services, will be held responsible for the injury costs of the other company’s injured workers for the duration of the contract if the other company is unregistered or in default with the WSIB. The WSIB may also hold employers responsible for any unpaid premiums owed by the contractor on wages paid to the contractor’s workers for the duration of the contract. The only way to ensure this will not occur is to require a clearance certificate from contractors, before they do any work for you. Each contractor whose WSIB account remains in good standing will have one generic clearance that will be valid for all of its contracts.

 

If you pay your WSIB premiums through your bank’s online payment system, allow three to five banking business days for the money to arrive at the WSIB to avoid late payment charges and interest, and longer if submitting payment by mail. 

Employers can pay their WSIB premiums online through their financial institution, by ePayment through a third party on the WSIB’s website, by mail, or in person at a WSIB office.

 

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. The WSIB will do this either by having an on-site field auditor going into an employer’s workplace to look at its books and accounts, or by performing a “desk audit” whereby the WSIB asks the employer to send its financial records to the WSIB. In either case, it is extremely important to organize your information to properly prepare for this assessment. The employer should make it as easy as possible for the auditor to conduct the review. The WSIB 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 audit.

An employer is required by law to comply with an audit. The WSIB is also allowed to remove any books or accounts so they can be examined, and can keep them for as long as it takes to complete the audit. An individual who obstructs or hinders an audit could 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 $500,000.

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.

 

Ask to have the cost of a functional abilities form (FAF) removed from your account if it adds no value

The WSIB encourages 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 FAF to help plan the worker’s early and safe return to work. It clearly states at the top of the FAF that it should only be completed by a health professional if asked by an employer or worker to do so. 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 Workplace Safety & Prevention Services (WSPS) Health & Safety Calculator to find out how much workplace injuries are really costing your company

The WSPS has a Health & Safety Calculator to help employers with fewer than 50 workers estimate the real out-of-pocket costs that flow from a workplace injury. It includes the costs that exceed those identified on WSIB claim cost statements, i.e., the 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.

 

Segregated Payrolls

All employers that are assigned to two or more NAICS codes are required to maintain segregated wage records and payrolls for each business activity. Please call the OEA if you have questions about this

 

The earnings of some Executive Officers may be excluded from the premium calculation

For non-construction employers, executive officers do not need to pay premiums unless you want them to be covered by the WSIB. If you are overpaying the WSIB, you may be eligible for a premium adjustment.

Executive officers in a construction business, however, are required to register with the WSIB, report their earnings, and pay WSIB premiums, with a few exceptions.

 

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 need to pay that amount back to the WSIB.

 

Accidents, Illnesses & Claims

Check Box C12 on the Form 7 if you have any concerns about a claim

Section 12 in Block C of the “Employer’s Report of Injury/Disease” Form 0007A (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 page 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. If that does not happen, you should contact the Eligibility Manager. Outlining your concerns on an attached page, or adding them in Box K on page 4 of the Form 7, is not enough to bring it to the attention of the initial entitlement staff at the WSIB. Box C12 must be checked.

Even if you are aware that a worker has a pre-existing condition, you must file a Form 7 with the WSIB if the worker reports an injury to the employer.

 

Report all work-related accidents/injuries/illnesses to the WSIB, even if you think the claim may be “fraudulent”

Employers must report accidents and/or occupational diseases to the WSIB by completing the Form 7 when an injury or disease causes a worker to,

  • obtain health care
  • be absent from his/her regular work beyond the date of accident
  • require modified duties at less than regular pay
  • earn less than regular pay at regular work
  • require modified work at regular pay for more than seven calendar days.

The employer must complete a Form 7 within three calendar days of learning of the accident, and the WSIB must receive it within seven business days from when the employer learns about the accident. Even if the employer believes the accident/injury/disease is not work-related, or is “fraudulent,” he/she must still complete and send a Form 7 to the WSIB within the prescribed time limits in order to avoid potential penalties.

 

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. Inform the MLTSD of any critical injuries. (See the section on Critical Injuries, below.)

 

Ensure workers are cooperating in appropriate health care

Section 34 of the 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.

 

Consider whether hiring an ergonomist may be helpful when dealing with potentially costly claims, or those that may be appealed to the WSIAT

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. You may wish to contact the Association of Canadian Ergonomists for more information.

 

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.

Unless you are filing documents with the WSIB electronically, fax all WSIB claim-related information to the WSIB correctly to avoid processing delays

If faxing information to the WSIB, 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,
  • check the fax confirmation sheet to make sure all of the pages were sent successfully, and
  • keep the fax confirmation sheet in the worker’s file

Critical Injuries

In addition to completing a Form 7 for the WSIB, critical injuries must also be reported immediately to the Ministry of Labour, Training and Skills Development (MLTSD). 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 MLTSD’s website, or contact the OEA.

 

Work Reintegration (WR) and Work Transition (WT)

Let the WSIB know if a Program of Care is not helpful in returning the worker to productive work

The WSIB refers workers with certain injuries/illnesses to a variety of “Programs of Care” that are in place for musculoskeletal injuries, shoulder injuries, acute low back injuries, mild traumatic brain injuries, and noise induced hearing loss.

These programs run for several weeks, and are very expensive.  The costs will appear on a Schedule 1 employer’s accident cost statement and will affect experience rating.  They are paid for 100% by Schedule 2 employers.

As an employer you should, by the end of each program, see a marked improvement in the worker’s ability to return to productive work.  If that’s not the case, contact the Case Manager to express specific concerns you have about the claim, i.e., if the program was significantly extended beyond the expected number of sessions with little benefit, and/or the worker was unable to return to productive work, and/or the treatment times/frequency make it difficult/impossible for the worker to attend at the workplace during regular business hours, making it difficult to reintegrate the worker into the workforce.  If you don’t feel comfortable with the Case Manager’s response, consider escalating your concerns to the appropriate WSIB Manager.

If you have any questions about any of these programs, you can contact the OEA and speak with one of our Intake Advisers who can advise you on the best course of action to take.

 

Make sure your offer of modified work is in writing

When attempting to return a worker to work, you must ensure that the work you have offered the worker is in writing, and kept on file for future reference if necessary. Make sure the work you are offering is safe, productive, consistent with the worker’s functional abilities, and restores the worker’s pre-injury earnings where possible. It’s important to speak with the injured worker when preparing an offer of suitable work to match the worker’s functional abilities to duties that are available in your workplace. You should document all of the options you have considered. If, after having considered all of the options, you are unable to offer the worker suitable work, you must notify the WSIB decision-maker immediately.

 

Meet your WR and re-employment obligations

Employers who are found in breach of their WR and/or re-employment obligations are subject to financial penalties under OPM Doc. No. 19-02-02, “Responsibilities of the Workplace Parties in Work Reintegration.” You must understand what your co-operation and re-employment obligations are in order to avoid incurring these additional costs. You should carefully review the WSIB policy, and call the OEA if you have any concerns. Return to work obligations can continue even after re-employment obligations cease. In some circumstances, the policy requires the employer to continue to co-operate in return to work even after the worker has been terminated.

 

Meet your accommodation obligations

The WSIB expects you to accommodate an injured worker if that will provide the worker with suitable work. Since the WSIB applies the Ontario Human Rights Commission’s (OHRC) “Policy on ableism and discrimination based on disability” in its decision-making process, you should be familiar with that document. It’s available on the OHRC’s website.

Suitable work must be available, safe and within the worker’s functional abilities. You are not required to create a job that doesn’t exist. If safe work is available and needs to be accommodated, the WSIB expects you to accommodate the worker to the point of undue hardship. This employer obligation exists under the WSIA if you have a re-employment obligation to your injured worker, or independently under human rights legislation. If you refuse to accommodate the worker, the WSIB may impose a re-employment penalty or a non-cooperation penalty, depending on the particular circumstances.

Good communication and cooperation between the workplace parties is essential. When necessary, modify the work and/or the workplace to provide work that is consistent with the worker’s functional abilities, and that accommodates the work or workplace. That may include reduced hours, reduced productivity requirements, assistive devices, and so on. Adjust your return to work plan as needed. Return the worker to the pre-injury job if he/she is ready to return to regular duties sooner than expected. If the worker finds the work too challenging, you may need to remove certain duties or prolong the duration of the modified job. Establish new target dates if the change in job duties is extended. Document all discussions with the worker and the WSIB, and all job offers to the worker, in writing. Keep copies of all documentation on file.

 

Use the WSIB’s Physical Demands Information Form (PDIF) to help return injured workers to work

The WSIB’s 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. It can also help you to modify the job to reduce risk factors and/or to accommodate an injured worker’s restrictions so they can return to work, 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’s 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. An English version of the PDIF, including instructions, is available on the WSIB’s website.

 

Tell the worker’s doctors that you have a modified work program in place

If a workplace injury occurs, print a copy of the “Functional Abilities Form for Planning Early and Safe Return to Work” (Form 2647A) from the WSIB’s web site and give it to the worker to take to his/her doctor for completion. Some employers add 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. They do this 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’s hoped this will further encourage dialogue between all parties involved in the return to work process.

 

Try to avoid the need for WT services

Employers should try to avoid the need for workers to obtain WT services by providing suitable or comparable work that restores the worker’s pre-injury earnings. If WT services are provided, inform the WSIB, in writing, that you intend to participate in the WT process to ensure the WT plan offered is both appropriate and cost effective. If you disagree with a proposed WT plan, file an appeal within 30 days from the date of the WT plan letter. Let the WSIB know if suitable work becomes available while the worker is participating in the WT plan.

 

Appeals

If you are appealing a decision to the WSIB’s Appeals Branch, provide the names of any potential witnesses when completing the Appeal Readiness Form / Respondent Form

If you are completing an Appeal Readiness Form (because you are appealing a WSIB decision) or a Respondent Form (because you are objecting to an appeal filed by the worker), you must provide the names and titles of all witnesses, as well as a brief explanation about how their participation is relevant to the issue(s) under appeal.  This is referred to as a “will say” statement.  If the name of a witness does not appear on these forms, the WSIB Appeals Branch will not allow you to add that person to the proceedings later.  This information is provided in the WSIB’s Appeals Services Division Practice & Procedures guide which is available on the WSIB’s website.

 

Always file formal objections in writing and include your reasons for the objection

To appeal a WSIB decision regarding a worker’s benefits, WR, SIEF or WT, complete an “Intent to Object Form” 2397A (ITO Form) which is available in the Employer Forms section of the WSIB’s website. This form is to be used for claims-related matters only. The ITO Form has extensive directions on it which must be followed. Once you submit the ITO Form, the time limit to appeal stops running. You may then take as much time as you need to submit an Appeal Readiness Form (ARF) to the WSIB.

To appeal a WSIB decision regarding classification or other revenue-related issues, write a letter to the decision-maker indicating your disagreement with his/her decision. The WSIB will not automatically send you a copy of your firm file for employer account appeals. You will need to contact the Firm File Access area and ask for your firm file to be sent to you. For more information about accessing employer-specific information, refer to OPM Doc. No. 21-01-01 “Access to Employer Information,” on the WSIB’s website.

 

File all appeals on time

The WSIB strictly enforces the statutory time limits for objecting to a WSIB decision.  Objections to return to work and work transition decisions must be received by the WSIB within 30 days of the decision letter date, and all other issues must be received within 6 months.  All objections to a claim decision must be made using the WSIB’s new Intent to Object form.

Final WSIB decisions made by AROs must be appealed within six months of the decision date to the WSIAT.