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Further to our October white paper, PRIVATE INVESTIGATORS - ASSISTING CORPORATE CANADA WITH FRAUDULENT WSIB CLAIMS, Investigative Research Group is providing you this valuable information with the approval of SE-GA Workplace Consulting P.C.

1. Be more concerned about a worker's (unproductive) wages than WSIB costs and do NOT allow the WSIB to pay wage top-ups when the worker is not performing modified duties for a full 8 hour work day!

Allowing the Board to pay the employees loss of earnings creates significant future projected costs boosting the total cost of the claim. The sooner an injured worker is back to earning a full day's wages with no loss time, the quicker the claim CLOSES and the faster your claim costs start to decline. You may save $10/hr but the WSIB will charge you up to five fold through your NEER costs and calculations. It's always a better option to provide modified duties and pay wage top ups!

2. Do NOT say "We can accommodate most limitations!"

This type of wording in your policy/program can create doubt in the minds of the WSIB that you are not willing to work with your injured workers and may lead to the Board siding with the worker when they are trying to resolve a dispute. Try to focus on the worker's abilities to illustrate your flexibility to the WSIB.

3. Do NOT allow a worker to perform unmonitored home study for RTW!

The work must be meaningful to the employer and employee and is generally only suitable on a short term basis of a few weeks. Accordingly this should be considered only as an alternative if there is "nothing" in the workplace.

4. NOT missing the December 15th (NEER) deadline to have all workers that received WSIB Loss of Earnings benefits during the calendar year back to work receiving full wages from the company!

If you are unable to bring your injured workers back by this date, the WSIB will keep the claim open into the next calendar year. Of relevance is to ensure that there is no wage loss and advise the Board immediately. This will dramatically increase the cost of those claims up to tenfold and could lead to a surcharge when you should have received a rebate.

5. BE AWARE of the 8 day rule (CAD-7)!

To avoid a frequency, which will increase your CAD-7 costs by a minimum of $15K a year for 2 years, ensure your worker does not miss more than 8 days of work. This includes the cumulative lost time of attending medical appointments as a result of the injury.

6. Think of the WSIB as experience rating plan and not insurance!

It's important to understand your financial responsibilities under WSIB extend beyond your premiums. Employers can face up to 4 times their expected cost under the NEER formula in additional financial penalties.

7. Understand the importance of information required on the FORM-7!

The Form-7 allows the employer to state their concerns and possible objections to pending WSIB claims. Mistakes made on the Form-7 are very difficult to correct. Also, do not include earnings information. Many companies fill out the Employer's Report of Accidental Injury report offering only the employee's account of what happened. In cases where there were no witnesses or suspicious circumstances, use phrases such as "the employee states" or "the employee claims to". In doubtful cases, attach a separate letter outlining your point of view. Collect witness statements as well as signed statements from employees who claim they did not witness the accident. Remember the Form-7 has been often described as a blank cheque for the worker.

8. Know that there is a difference between a Return to Work Policy and a Return to Work Program!

A policy is a statement, a program is the written processes and procedures that should be utilized by an organization for every WSIB case utilizing best practices.

9. Understand there is a downfall of mismanaging the HR component of WSIB such as seasonal layoffs, dismissing a worker on WSIB etc.

Knowing how to handle these situations can save of thousands of dollars to employers. Have your workers perform the majority of their pre-accident duties in order to minimize any loss of earnings.

10. Understand the true costs of your experience rating program!

Do you know your Managed Risk? What is your largest possible rebate? What is your largest possible surcharge? Knowing your financial drivers will help you make relevant decisions.

11. What to do when the Doctor says "The worker is off for 4 weeks!"

Remember, the Doctor can only list the Injured Worker's restrictions. It's up to you as the employer to accommodate your employee by offering suitable modified duties based on their abilities in order to avoid further financial costs.

12. Communicate your Return to Work program to the Doctor!

If the Doctor understands your RTW program and its process in returning their patient to full health, they are much more likely to participate. Employers should not be hesitant to talk to the treating doctor about your RTW program.

13. When your worker lives far away from your office/job site!

Consider offering meaningful work which can be performed from home and pay the worker on a short term basis, you also have the option of arranging transportation such as taxi or public transportation if the worker is unable to drive. In the long run the direct costs of managing the claim correctly far outweigh the WSIB claim costs which can accumulate tenfold.

14. Always inform your employees of their RTW obligations!

Always ensure that your employees have been made aware of their obligations in writing. If you cannot provide this type of supporting evidence to the WSIB they may side with the injured worker in the event of a dispute.

15. Maintain constant contact with your injured worker!

Maintaining continuous contact and support with a worker who has been injured on the job is critical to retaining an employee's active interest in the workplace. Engaging your employee in the process will only accelerate their rehabilitation and the protocol. Be sure to document all communication including when you are unable to reach them.

16. Consider paying for the injured worker's medical assessment!

In prolonged cases where the family doctor is evasive with return to work information, consider arranging an orthopedic assessment or a functional abilities evaluation to properly assess the worker's capabilities and prognosis. Although initially the costs for these assessments may seem high, they are negligible compared to costs resulting from an ongoing, lengthy compensation file.

17. Do not allow the WSIB to pay the worker's wages for medical appointments in subsequent years!

If the WSIB pays Loss of Earnings benefits in a subsequent year the claim gets reopened and the impact to the claim cost dollars is tremendous. Always encourage your workers to have medical appointments outside of your business hours.

18. Consider the opportunity to pursue third party costs transfers (MVA/outside contractors)!

In most jurisdictions, if one of your workers is injured because another company has breached OH&S legislation, the other company can be liable for the compensation costs. Also, most jurisdictions allow for cost relief in cases where a pre-existing or underlying condition has prolonged a normal recovery period.

19. Understand the new criteria for obtaining cost relief!

Unless employers can prove that SIEF applies due to the circumstances of the claim by providing extensive medical evidence as well as providing precedence that policy applies and that SIEF has been granted in previous circumstances the probability of gaining SIEF is very low. The WSIB keeps evolving; unless you keep up you will be left behind.

20. Let employees know what compensation is costing the company!

If workers/supervisors know what claims are costing their employers, they may understand as to why modified work is being offered. Many are still under the impression that workers' compensation benefits are government funded.

21. Always bookmark your appeals!

If you receive a decision and have any doubt regarding the merits of that decision endeavor to bookmark the appeal by sending the WSIB a response indicating you wish to appeal at a later date since the legislation has very specific time lines regarding the appeals process. If circumstances change and you discover new information at a later date, this can allow the WSIB to change their initial decision.

22. Never say "We can't offer modified work; our workplace is unique!"

Failure to contain your WSIB costs will lead directly to WSIB surcharges: THERE ARE NO EXCEPTIONS regardless of your work environment. You should also have pre-set PDA's for your most common jobs so that the doctor can quickly understand the tasks in which your i/w can accomplish based on his current abilities.

23. Consider Private Investigation when you have a runaway claim!

For a detailed explanation, visit our blog page at

24. Understand that you can appeal the decision of the adjudicator!

Some employers believe that the operating level decisions are final however any and all decisions are appealable. It is important to know your financial drivers and the relevant policy but also case law on specific matters which may come back to "impact" the organization down the road.

25. Don't always assume that the cost relief awarded by the WSIB has been applied correctly!

Nobody is perfect but the WSIB does make errors and SE-GA's cost recovery process can quickly identify these mistakes as well as improve upon the results. In most cases we can review back to when you were first registered with the WSIB, in many cases the financial results can be quite substantial.

26. Review your experience rating statements for incorrect claim types and other errors!

Review your experience rating statements and question everything you don't understand. The WSIB will not identify these for you. Remember, WSIB policy dictates that the employer must identify the mistake and contact the right department to be corrected accordingly.

27. Be careful of LOE awards to Apprentice at Journeyman rates!

In Ontario an apprentice will be paid at the journeyman rate in the event of Loss of Earnings. Ensure that your Return to Work program includes readily available modified duties for your apprentices to avoid the financial impact against your CAD-7 costs and calculations.

28. Monitor the year to year changes in experience rating performance!

NEER costs change on a year-to-year basis based upon the activity of the claims. Do not give back Rebate Dollars unnecessarily.

29. Recognize a recurrence and do not allow the WSIB to create a new claim!

Understand Board polices regarding1-866-973-SEGA (7342) aggravation basis or recurrence. These types of "accidents" can minimize the benefits allowed but more so your NEER position.

30. Track injuries and near misses!

This practice of tracking trailing indicators refines your health and safety program since it can identify areas of concern which allows shortfalls to be addressed accordingly.

31. Make Sure the Doctor clearly understands the types of work available!

Doctors are now required to fill out a Functional Abilities form and they cannot accurately do this without knowing the physical demands of the regular job and/or the modified work you plan to offer the injured worker. Therefore, you should ensure that the family doctor is aware of the job requirements prior to completing the form. Encourage your doctor to contact your organization if there is any hesitation regarding the modified work duties.

32. Implement a Modified Work Program!

The sooner a worker returns to work, the less likely he or she will become an expensive long-term claim. Most studies indicate the longer a person is off work, the more difficult it becomes to return them as a productive worker. Always make the modified work offer in writing. Consider reduced hours, graduated hours, alternate days, and/or combining half days of regular work with modified work.

33. Make sure your employees know the rules!

Provide injured workers with information about accident reporting: where, when and to whom. They should have information about what to expect and their right to have first aid administered or attend formal medical care. This should be part of their initial job orientation and should be documented.

34. Know the Rules!

In addition to the Act, get a copy of your province's workers' compensation policy manual and understand your financial drivers. Making WSIB decisions requires knowledge of your legal financial and moral obligations.

35. Understand your financial obligations under the experience rating program for workers over the age of 65!

Wage loss benefits for workers over the age of 65 may still be paid for up to two years after the injury. Accordingly, know how this can impact your experience rating position if transitional work is not offered.

36. Consider the opportunity into having multiple rate groups!

There may be opportunities to have your operations split into separate rate groups in order to reduce your premiums.

37. Monitor the WCB websites. "Why didn't the Board tell me this? Why didn't the Board do that for me?"

Remember, it's your responsibility to stay abreast of all changes by reviewing your mailings and monitoring the WCB websites for changes, not knowing is not an excuse.

38. Put everything in writing!

Verbal communication is never enough, it's very important to maintain policy of having everything in writing, signed and dated. In the event of a misunderstanding, appeal or disputes, being able to provide copies of written records can be invaluable.

39. Understand when a claim has gone off the rails and it's time to outsource to a knowledgeable WSIB/WCB consulting firm!

Workers' Compensation in itself is a full-time job, and yet many employers have added this responsibility to a manager who is already involved in another area of work. If you do not have the time to properly devote to your workers' compensation claims, health and safety or revenue management, consider outsourcing to the experts. Understanding the costs of not receiving sound advice at an early stage, even isolated issues can cost employers significant financial hardship and frustration. Lastly, if all you have exhausted all your options from the attached tips, it's time to call for help.