WSIB Claims Management Tips!

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High impact claims* is a term used to identify allowed lost time claims that have been shown to have significant impacts on workers and employers. The WSIB is focused on mitigating the risks for these claims to maximize return to work, recovery outcomes and to reduce costs. WSIB has implemented many initiatives to improve outcomes in these claims, including specialized case management teams, new evidence-based health services and expedited access to expert medical intervention.

We have identified three types of high impact claims, those involving the Low Back, Shoulder and Fractures. Over the past five years, these three types of claims have represented approximately 35% of all benefit payments and more than 30% of all lost time claims.

In 2012, these high impact claims represented approximately 34% of all benefit payments for allowed lost time claims.

The WSIB refers workers with certain injuries/illnesses to a variety of “Programs of Care” currently in place for upper extremity injuries, shoulder injuries, acute low back injuries, lower extremity injuries, mild traumatic brain injuries, noise induced hearing loss, occupational asthma, and occupational contact dermatitis.

These programs typically run for several weeks, and are very expensive. The costs will appear on a Schedule 1 employer’s accident cost statement and will affect experience rating. They are paid for 100% by Schedule 2 employers.

As an employer you should, by the end of each program, see a marked improvement in the worker’s ability to return to productive work. If that is not the case, contact the Case Manager to express specific concerns you have about the claim, e.g., if the program was significantly extended beyond the expected number of sessions with little benefit, and/or the worker was unable to return to productive work, and/or the treatment times/frequency make it difficult/impossible for the worker to attend at the workplace during regular business hours, making it difficult to reintegrate the worker into the workforce. If you do not feel comfortable with the Case Manager’s response, consider escalating your concerns to the appropriate WSIB Manager.

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