WSIB Claims Cost Control!

What happens if an employee becomes injured at the workplace and if that worker has an underlying or pre-existing condition that either caused the injury or prolongs their recovery?

The WSIB offers cost relief to employers where a workplace injury aggravates a pre-existing condition, causes the injury or prolongs the period of recovery. The rationale behind this is that the pre-existing conditions are non-compensable and should not form part of the overall claim costs. Removing some or all of the costs benefits the employer by decreasing the overall impact of the claim on their experience rating.

In many cases, the pre-existing condition may be underlying and the worker may not have any symptoms. For example, in the case of degenerative disc disease, a worker may not have any pain or symptoms prior to an injury. However, an injury to the back may be enhanced because of the underlying condition, and the period of recovery may be longer than for a worker without the degenerative disc disease.

The WSIB applies the cost relief directly to the costs of the claim. The net result for the employer is a decrease in claim costs and a positive effect on their experience rating. However, the claims cost relief to the employer does not impact the amount a worker receives. It is recommended that employers request cost relief on applicable claims by June of each year, that way the claim cost relief amount will impact the annual September statement which will display whether the employer will be in a surcharge or rebate position. 

As an employer, you may be aware of information that may provide evidence of a pre-existing condition, such as a prior claim to the same area of the body, prior complaints by the worker, or knowledge of prior medical attention, treatment or surgery to the affected area of the body. This information may be important to the compensation board when assessing whether cost relief is in order, and the amount that will be applied. Since claim cost and claim duration are often two of the most important factors used to calculate an employer’s experience rating, minimizing claim costs just makes sense.

Workplace Law Consulting offers claims cost relief review services and WSIB claims management workshops out of our Vaughan training centre.