9.9 Best Practices for Active Claims Management
Goal of Program
The goal of the Return to Work (RTW) Program is the position that the injured employee will perform on a regular basis at the end of the program. The main focus will be to return the employee to their regular job. If this is not possible, then an attempt will be made to find an alternative placement, if feasible.
Hierarchy of Jobs
Utilizing the new level of capabilities outlined on the functional abilities section of the Form 8 that has been completed by the health professional who is treating the injured employee, the following hierarchy of jobs or priority placement will be used:
First, determine if the employee can perform the essential duties of their regular job, with or without accommodations (meaning, requiring modifications),
If not, then what other comparable job, with or without accommodations, is available?
If none is found, then what other suitable tasks, with or without accommodation, are available in their own work area?
Finally, if all else fails, then what other suitable tasks, with or without accommodation, are available in the entire facility?
Wages
While the employee is completely off work due to a workplace injury or illness, Workplace Safety and Insurance Board (WSIB) must cover the percentage of the employee’s lost time wages.
However, upon RTW during this program the employee will receive their regular weekly wage from [Employer/Organization Name], up to their regular number of hours per week, regardless of the hours worked. If this is a WSIB claim, then the employer will inform the WSIB Claims Adjudicator of this RTW plan and that [Employer/Organization Name] does not want to be reimbursed for any wages paid. Likewise, if the injured employee cannot continue with the program and must go off work again, then the employer will again immediately inform the WSIB Claims Adjudicator.
Time Frames
The RTW plan is for a set period of time. It can start on the same day as the injury and last from one day to a maximum of 12 weeks. Extensions are available if required. If medically possible, the employee is expected to perform tasks as outlined under the hierarchy for the length of their regular shift, However, if it is recommended by the treating health practitioner that a gradual increase in daily hours of work is required to minimize the risk of re-injury, then a schedule can be set up within the maximum time frames outlined below. Please note that this is the maximum or worst-case scenario.
Number of Weeks / Hours per Day1 / 2
2 / 3
3 / 4
4 / 4
5 / 5
6 / 6
7 / 7
8 / 8
12 weeks total program
Four weeks extension if required
Document Management
Effective Date:Revision Date: