The RIGHT care, at the RIGHT time, for the RIGHT outcome©.

The New WSIB – Surviving the Changes?

Unlocking the Secret to WSIB Management

Liz R. Scott, PhDPrincipal

Organizational Solutions Inc.

AGENDA

• Introduction• Information you need to know about the WSIB

“Proposed” Changes:– Summary of Changes– Examples of Cases– About NEER - Bottom Line Concerns

• WSIB Management Tips and Techniques• OSI’s Solutions for your Organizations

Introductions

• Organizational Solutions Inc – a vibrant growing Health, Disability and Workers’ Compensation Management firm

• Experienced and dedicated staff from various backgrounds - Regulated Health Care and Paralegal

• Committed to the Power of Disability Management to reduce human and financial cost through the provision of “the RIGHT care, at the RIGHT time, for the RIGHT outcome©”

Two Major Changes Proposed • Extending the NEER (experience rating)

window to four years

• Implement “work reintegration policy” – The WSIB has introduced these as interim and

for discussion purposes but in reality they are in effect.

Interim Policy

Major Changes

• Combines RTW, Reemployment and LMR• Brings LMR in house• New policy and new expectations• Significant employer non-cooperation

penalties

• NEER extending window to 4 years – intention to go to 6 years

WSIB has terminated the outside LMR Providers

Guiding Principles• Appropriate and early RTW that maintains dignity and

productivity• Where recovery and RTW barriers occur, they must be

responded to quickly through early support /intervention • A worker’s prospects for successful work reintegration (WR)

best achieved by maximizing opportunities for RTW with the injury employer, including retraining for a suitable occupation (SO)

• WSIB will play an active role• A worker should be offered programs that are high quality

and practical, and the WSIB must provide the worker with meaningful input and choice of programs

Overview of Changes

• Five interim policies and one draft NEER policy• These will replace the existing 24 policies

WSIB indicates they are to;• “produce better return to work outcomes”• “emphasis on greater accountability by

workplace parties including early involvement by WSIB” (WSIB, 2010)

WSIB Guidelines

• RTW is a process • integration of effort and co-operation of the workplace

parties, treating health professional, authorized representatives and the WSIB

• active recovery in the workplace • accessible, timely and intensive services • goal-oriented work transition(WT) plans • leveraging statutory RTW obligations (i.e., co-operation

and re-employment), and the RTW opportunities hierarchy.

WSIB Indicates RTW is a Process

• Starts as soon as the employer learns that a worker has suffered a work-related injury / disease

• Continues throughout the work-related injury / disease recovery and impairment period,

• Adapts to changes as they arise.

Hierarchy

1. Pre-injury 2. Pre-injury with accommodation3. Comparable work (earnings and nature), with

accommodation4. Alternate suitable work5. Comparable job in labour market6. Suitable work in labour market

Board Involvement

• Increased significantly

• Will meet with workplace parties within 12 weeks of an injury to ensure suitable and available work is arranged

• Proactive engagement• Dispute resolution

Responsibilities

    The WSIB is mandating co-operation of all

parties and early contact, appropriate communication, identification of return to work and elevation of relevant information disputes.

Timely Assessments

WSIB has indicated if workplace parties are unable to arrange suitable and sustainable RTW, they will provide an assessment to determine what assistance the worker may need to enable RTW with the accident employer

Experience So Far

Discussion

Suitable Work

• Safe• Productive• Consistent with functional

abilities• Restores pre-injury earnings• Available

Bundled Task

“work includes”;

• Combining tasks / duties which together constitute a temporary or permanent job

• Short term training program which leads to a job with the injury employer

Available Work

• Work that exists with the injury employer at the pre-injury worksite or comparable worksite

• Will consider • Terms of applicable collective agreement• Whether job vacancy has been posted• Evidence of hiring or transfers

Sustainable

• Does the job have reasonable prospects of being available on a long term basis

• Is it available to the general labour market

• (Applicable in cases of permanent impairment, critical but stable condition, unable to return to pre-injury job)

Suitable Decisions

• WSIB says NOT suitable;– Worker will get full LOE benefits while co-operating

• WSIB says suitable;– WSIB deems worker able to earn wages associated

with offered job– Adjust LOE benefits– Confirms in writing

Retraining

• Worker input will become a component

• Worker can choose Community College or Ministry of Training or Private School

• Work trials with new employers

• Provide educational options to young workers to increase earnings potential

Older Worker Option

Over 55 years old;

• 12 month plan to focus on self directed work reintegration

• Full LOE benefits for 12 months then benefits based on available jobs

Relocations Assistance

• WSIB will pay relocation if job opportunities do not exist in the local labour market

Non-Cooperation Penalties

• Where either employer or employee refuses to co-operate

• Worker - Reduce of suspend benefits (reduces by 50% for 14 days then suspends)

• Employer – fine the costs of providing benefits to the worker (50% of LOE benefits for 14 days then full) PLUS 100% of any costs of any WT services to the worker

Re-employment Rights

• If worker is;

– Unable to work due to work related injury– Employed with accident employer at least one

year pre-accident

• More than 20 workers in workplace

Re-employment Obligation

• Fit for essential duties• Fit for alternate suitable duties• Duty to Accommodate

• Obligation last until second anniversary of the date of injury or one year after worker is medically able to perform essential duties or age 65

• Must be kept for 6 months

Actual Case• Contacted by a Work Transitional Specialist (WTS) in January 2011 regarding a

claim with the date of injury from 2003. • To add another layer to the situation, this worker resigned from his position with

the company in 2008 for unrelated reasons and did not leave on good terms. • The WTS requested a workplace meeting to see if there could be a permanent

modified job available. • Obviously, the employer did not want this worker back for reasons noted above.

We convinced the employer to have the work place meeting due to the previously mentioned penalties associated with non-cooperation. The meeting was held, it was determined that currently there is no suitable work for this worker. This worker will go for re-training / re-skilling and then the employer will probably be contacted again by a WTS for another work place meeting. The WSIB will keep going back to the injury employer.

• It does not matter how old the claim is. If someone in the company is off work and collecting full LOE benefits, chances are a WTS will be contacting the company.

NEER Changes

• Extends the window to 4 years (from 3)

• Starting with the 2008 year!!!!!

• No impact on CAD-7, MAP (small business)

HOW TO BE PREPARED

Important to be ready for the changes

Return to Work Program

KEY ELEMENTS

The Impact of Process 

Claim Initiation

• Appropriate paperwork

• Appropriate treatment

• Focus on RTW / capability

What is key?

• Appropriate treatment to resolve the injury

• The work community is an important element for all of us

• Set clear expectations – NO LOST TIME

• Make sure (s)he progresses to regular duties

Influencing Factors

Evidence based guidelines are not being followed

Only 1 in 16…. or 6 in 100 good care rate 

Over 40% of all Dr. notes are inappropriate

* Coyne, 1995, Katon, 1995, Kessler, JAMA, April 2003

Treatment Problem

Disability Is a Question of Function Not Diagnosis

• Collect the right information – customize the FAF

• Communicate - correct information flow• Monitor capability not disability• Targeted therapeutic interventions• One objective measure is worth a thousand

opinions

Some “Red Flags”

• Unclear or no RTW date• Repeated deferrals of RTW• “Stress” / work conflict issues• Frequent Users / unsuccessful RTWs• No medical restrictions on form• Back Pain RTW 2-4 weeks• Multiple Diagnosis• Changing physicians “Doctor shopping”

Lost Time Management

REMEMBER:

The injury applies only to the affected area; not the whole person

Full recovery is not a prerequisite of return to

work

Return to Work

• A return to work program is designed to achieve fair and consistent treatment of employees that have been off work with an illness or injury

• A early and safe return to work is the best approach for both the employee and the organization

• The employee benefits from having meaningful employment, gradual work conditioning and support associated with returning to work

Return to Work

The key variables in the return to work process include:

 • Understanding of the capabilities given the specific impairment

• Impact the impairment may have on the employee’s ability to perform the essential duties of the job

• Services or treatments to be provided

• Barriers to full return to work

• Alternatives to return to work if the employee does not have the capabilities to return to this worksite

• Evaluation of the cost benefit of return to work interventions

Step by Step Process

Minimize WSIB’s involvement

Return to Work ProgramRTW Process Overview

• Intake/initial assessment• RTW Plan• Implement• Post-plan Evaluation

…human oriented process of minimizing the impact of illness or injury

When to Rehabilitate

• In some circumstances transition back to the pre-injury job is not possible.

• In these situations it is important to ensure the employee becomes involved in appropriate rehabilitation

• This may only apply to a small portion - however it is important to understand the strategies

Does Return to Work Make a Difference – YES!

• Decreased costs by 100% first year, additional 50% by the second year

• Employees felt supported in disability and return to work process

• Co-workers felt the program was fair and consistently applied

Real Results

Next Steps – Analysis

• Complimentary Analysis of your NEER, CAD-7, or MAP Experience Rating Statement

• We will determine if there is an opportunity to intervene / reduce cost

EVERYONE HAS A WSIB STORY We look forward to hearing

yours!

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Liz R. ScottPrincipal / CEOOrganizational Solutions Inc. Please feel free to use and benefit from any of the materials provided. If you do reproduce please give appropriate credit / reference to the originating source / forum. Thanks.