Tips for Managing WSIB Claims

( Disponible en anglais seulement )

février 9, 2015 | Evan Campbell

Dealing with the Workplace Safety & Insurance Board (“WSIB”) can be a challenging and expensive process for any employer. Each claim commenced in relation to a work-related injury can have a significant financial impact on an organization. Schedule 2 employers (as defined by the Workplace Safety and Insurance Act) are required to pay the full cost of accident claims filed by their workers plus an administration fee. For Schedule 1 employers, a claim can impact the applicable experience rating affecting the size of the rebate or surcharge they will receive. As such, properly managing WSIB claims is critical in keeping costs at a minimum.

The best way to reduce the cost of claims is the prevention of workplace injuries. However, when a work-related injury occurs, here are 5 tips to assist employers to better manage claims:

1. Have an Accident Reporting Policy

All employers should have a policy regarding accident reporting and investigation. A policy should cover such issues as what constitutes an accident, the roles and responsibilities of all involved, the accident investigation procedure along with the accident investigation documentation to be completed. Having a clear understanding of the accident and resulting injury is critical if an employer wants to challenge a claim at a later date.

2. Stay Actively Involved in the Process

Once a claim has been made, employers often believe that they are simply bystanders in the process. However, employers must stay informed about the status of the claim, requesting updates from the WSIB case manager if needed. Given the financial consequences of claims, an employer should assess whether decisions by WSIB should be appealed and should consider being involved in any challenges advanced by the employee.

3. Documentation is Critical

It cannot be overstated how important accurate records are in any WSIB claim. Employers should keep minutes of meetings and telephone conversations with related parties, records of missed meetings and phone messages, and information regarding return to work activities. Accurate documentation is critical in an appeal and allows the employer to know what has been done on a claim and what steps have been taken to assist the employee.

4. Red Flags

As a component of tip 2 (staying actively involved in the process), an employer should assess whether the claims advanced by an employee are legitimate. Some issues that an employer should consider when assessing a claim include prior occupational claims and absences, prior related medical issues, prior employment history, known hobbies and activities, timing of the accident, and any inconsistencies in reporting.

5. Facilitate the Employee’s Return to Work

The cost of a claim increases the longer an employee is off work. As such, an employer should facilitate a worker’s safe return to work. Employers should maintain regular contact with the injured worker to determine the status of any injures, find out how he/she is recovering and determine when the worker is capable of returning to regular or modified duties. However, employers must ensure they follow the guidelines outlined in the WSIB Work Reintegration policies during the return to work process.

The proper management of WSIB claims can significantly reduce costs for employers.  Employers should develop a comprehensive claims management plan with the above noted tips in mind.

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