TABLE OF CONTENTS
STRATEGIC CLAIMS MANAGEMENT PROGRAM
Page#
1.INTRODUCTION...... 1
1.1Program Objectives...... 1
1.2Program Structure...... 1
1.3Supporting Information...... 1
2. BASIC PRINCIPLES OF WORKPLACE SAFETY & INSURANCE ACT.....2
2.1Overview:...... 2
3.GOVERNING LEGISLATION...... 3-9
3.1Bill 162...... 3
3.2Dual Award System...... 3 3.3 Non-economic loss (NEL) Award 3 3.4 Future-economic loss FEL Award 4
3.5Maintenance of benefits...... 6
3.6Vocational rehabilitation ...... 6
3.7Reinstatement/Accommodation...... 8
3.8Reclassification Schedule 1 Employers:...... 9
3.9Reporting Assessable Payroll...... 10.
3.10Calculation Annual Assessments...... 10
3.11WSIB Audits...... 10
3.12Checklist Prior to WSIB Audit:...... 11
3.13Optional Coverage...... 11
3.14Contracting Companies...... 11
3.15Funding...... 11
4.0 WORKERS’ COMPENSATION REFORM - BILL 99...... 12-16
5.0 NEER (NEW EXPERIMENTAL EXPERIENCE RATING PROGRAM).....17-25
5.1Overview...... 17
5.2Neer Assessments...... 17
5.3Insurance Factors...... 18
5.4Neer Statements...... 18
5.5The Neer Cover Sheet...... 19
5.6Interpreting The Neer Statement...... 21
5.7NEER Calculations...... 23
5.8Company’s NEER Performance ...... 23
5.9Factors Affecting NEER Costs...... 24
5.10Projected Future Costs...... 25
5.11NEER Strategies...... 25
5.12Changes to Experience Rating ...... 26
5.BCAD 7 (Construction Experience Rating Program)...... 27
5B1Overview...... 28
5B2Calculations...... 29
5B3Definitions used for Calculations...... 30
5B4Abbreviations/Components...... 31
6.0 WORKWELL...... 27
7.0 WSIB SERVICES...... 28
7.1 Specialized Services...... 28
7.2 Additional Services...... 28
7.3 Translation Services...... 29
8.0 RIGHTS AND RESPONSIBILITIES...... 30-34
8.1 Employer’s Responsibilities...... 30
8.2 Supervisor and Manager Responsibilities...... 32
8.3 Employer’s Rights...... 32
8.4 Employees' Responsibilities...... 33
8.5 Employees' Rights...... 34
9.0 FIRST AID REQUIREMENTS ...... 35
10.0 ACCIDENT PREVENTION STRATEGIES ...... 38
10.1 Establish Cost Accountability / Location...... 38
10.2 Pre-employment / Pre-placement Screening...... 38
10.3 Accident Trend Analysis...... 39
10.4 Physical Demands Analysis Job Classifications...... 39
10.5 Enforcement Protective Equipment...... 39
10.6 Training...... 39
10.7 Health & Safety Committee Meetings...... 39
11.0 DEALING WITH ACCIDENTS...... 40-43
11.1 Accident Reporting ...... 40
11.2 Accident Investigation ...... 40
11.3 Accident definition...... 41
11.4 Specific accident...... 41
11.5 Disablement...... 42
11.6 Industrial disease...... 42
11.7 Types of Accidents...... 43
12.0 THE CLAIMS PROCESS...... 44-48
12.1 Overview...... 44
121.2 Form 6: ...... 44
12.3 Form 7: ...... 44
12.4 Form Re07:...... 45
12.5 Form 8:...... 45
12.6 Form 26: ...... 45
12.7 Form 9:...... 45
12.8 Completion Of Form #7’s...... 46
12.9 Reporting Aggravation Of Pre-Existing Conditions...... 47
12.10 Reporting Recurrences...... 47
13.0 CLAIMS MONITORING & CONTROL...... 49
13.1 Follow-Up With Worker...... 49
13.2 Contact With The Worker's Physician...... 49
13.3 Follow-Up With WSIB...... 50
13.4 Treatment Monitoring...... 50
13.5 Record Keeping...... 51
14.0 RETURN TO WORK PROGRAM
INTRODUCTION
14.1 Program Objectives
14.2Governing Legislation On Return To Work (Bill 99)
14.3Employer’s New Responsibilities
14.4Worker’s New Responsibilities
14.5WSIB’s New Responsibilities
14.6Health Professional’s New Responsibilities
14.7Steps For Promoting Program
14.8Worker Obligations
14.9When To Contact WSIB For Rehabilitation Assistance
14.10WSIB Responsibilties Labour Market Re-Entry Process
14.11Employer’s Key Objectives On Return To Work In Priority
14.12How To Choose A Rehabilitation Provider
14,13Rehabilitation Services
14,14 Cost Benefit Analysis Appropriate Rehabilitation:
15.0 THE APPEAL PROCESS...... 62-65
15.1 Reasons To Appeal...... 65
16.0 SIEF REQUESTS...... 66
16.1 When To Apply For SIEF...... 66
16.2 Appeal Guidelines - SIEF...... 67
16.3 Defining Accident Severity...... 67
16.4 Defining Pre-Existing Conditions...... 68
17.0 FILING & RECORD KEEPING...... 69-71
17.1 Tickler System for Active NEER Cases:...... 69
17.2 Individual Medical Files:...... 70
17.3 Monthly Cost Statements ...... 70
17.4 NEER Statements:...... 71
18.0 STATISTICAL REPORTING AND TRACKING SYSTEM 72
APPENDICES
Appendix
Accident Investigation Form...... A
Accident Investigation Policy...... B
Health & Safety Policy Committment...... C
Health & Safety Policy...... D
Modified Duty Forms...... E
New FAE Form......
Normal Healing Times...... F
WSIB Forms...... G
-Form 6
-Form 8
-WSIB FAE form
Company’s NEER Statement & Reserve Factors...... H
Statistical Report...... I