Workplace Safety And Insurance: How to Manage Claims and Cut Costs - From Accident to Closure Under the Ontario Workplace Safety and Insurance Act

The more complex and expensive WSIB becomes, the greater your need to know how to manage claims to improve your organization's lost time record and realize potential savings. The grounding you receive in this course will immediately bolster your competence and confidence in this challenging area. 

You Will Learn How To:  

• Investigate accidents and report claims
• Deal with doctors
• Develop and implement Early and Safe Return to Work including problems with:
• Absent, ambiguous and dubious medical information
• Self imposed physical restrictions
• Refusal to work scheduled hours
• Handle permanent disability, re-employment and accommodation
• Conclude claims and manage legal hurdles to termination 

The Program Will Cover:

Investigating the Accident and Filing the Form 7 

• What to do when you discover an accident has occurred
• What information the WSIB wants to see in deciding whether or not to approve the claim
• Rules that apply to determining entitlement in the claim and the categories of a claim: Specific accident, recurrences, disablement, occupational disease
• Consequences of failing to file the Form 7 or providing misleading information  

Early and Safe Return-to-Work Plans (ESRTW Plans): How to Prepare them, What Goes In Them, How They Should be Documented 

• How to put together an ESRTW plan that complies with the employer's obligations under the WSIA and moves the claims process forward towards successful closure
• What to include in an ESTRW plan: Description of duties, time frames, signatures, and a goal.  What are each of the elements and why are they necessary?
• How the ESRTW plans should be documented, who should have input into its contents, whom should receive copies
• What to do if the employee refuses to cooperate in the formulation of the ESRTW plan/ Employer techniques for enforcing rights
• Obligations on reporting - What should be reported and when 

Typical ESRTW Plan Problems (Part I): Medical Information 

• What To Do About:
• Lack of medical information
• Vague or ambiguous medical information
• Conflicting medical information
• WSIB vs. the family doctor
• The family doctor vs. the specialist
• WSIB vs. the specialist
• Doubtful medical information, exaggerated or unrelated medical opinions 

Typical ESRTW Plan Problems (Part Ii): Worker Non-Cooperation

•  What To Do About:
• Self-imposed, self-described physical restrictions that conflict with medical information
• Arriving late/leaving early/ refusing to work the hours scheduled in the ESRTW plan
• Worker-dedicated job descriptions and worker preferences
• Failure to achieve the goals set out in the plan 

Permanency, Re-Employment, And Accommodation 

•  How long does the ESRTW plan go on?
•  How and when to move the plan from one stage to the next
•  What happens when the worker does not recover fully or is unable to achieve the goals set out in the plan?

Four Types Of Closure (Part I)

There is no need for an employer to create an unproductive job for a permanently

Disabled employee.  Every claim can be brought to closure in one of four ways: 

• The worker returns to his pre-accident job
• The worker returns to work in another productive job that already exists
• and does not need to be "created"
• The worker's employment is terminated with benefits
• The worker's employment is terminated without benefits 

How to bring each claim to closure by keeping in mind this range of objectives

Four Types Of Closure (Part II): Legal Hurdles In Termination   

• Common law rules and frustration of contract.  When does incapacity
• justify termination?
• Arbitration and incapacity:  When do labour arbitrators consider a termination justified?
• The Human Rights Code:  How does the "duty to accommodate" apply to claims management?
• Re-employment rights under the WSIA:  When they apply and how they work/ NEER and other experience rating implications