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HomeMy WebLinkAboutHUR130-021 WSIB ClaimsCity oq PICKERING CITY PROCEDURE Procedure Title: WSIB Claims Procedure Number: HUR 130-021 Reference: Occupational Health & Safety Act Workplace Safety & Insurance Act Date Originated: January 30, 2009 Date Revised: Approval: Chief Ad inistr) v Officer ��""'-� k Point of Contact: Coordinator, Health & Safety Procedure Objective To establish a procedure for all Departments and Divisions to ensure that: 1. all WSIB claims are properly documented and processed in an accurate and timely manner; 2. all claim -related absenteeism is coded appropriately and accurately for Payroll and Attendance Management purposes; 3. loss of earnings advances and sick credits are accurately recorded, implemented and/or discontinued, as warranted; 4. all WSIB claim costs are verified and forwarded to Payroll for payment; and 5. all WSIB account discrepancies are identified and reported to WSIB in a timely manner. Index 01 Definitions 02 Procedures Appendix 1 Appendix 2 Appendix 3 Appendix 4 WSIB Treatment Memorandum Form WSIB Worker's Claim/Consent Form City of Pickering Functional Abilities Form City of Pickering Incident /Accident/Near Miss Report Form 01 Definitions 01.01 Accident Report - A form specified by the Workplace Safety and Insurance Board (WSIB) for reporting work-related injury or illness resulting in health care and/or wage loss. This report is produced electronically by the Coordinator, Health & Safety and must be submitted to the WSIB within three working days of the injury or onset of illness. 01.02 Advances - The payment of regular wages by the City of Pickering to eligible employees who suffer a loss of earnings as a result of an injury or illness that is related to his or her work. Wages are paid by the City of Pickering as an "advance" of benefits owing to the worker under the Workplace Safety and Insurance Act. 01.03 Clerical Support Person - For the purposes of this procedure, the individual who is assigned responsibility for coordinating payroll submissions on behalf of his/her Department, Division or Section is designated as the Clerical Support Person. This term may refer to an Administrative Assistant, Secretary, Clerk or Coordinator. 01.04 Critical Injury - An injury of serious nature that places life in jeopardy, produces unconsciousness, results in substantial loss of blood, involves the fracture or amputation of an arm or leg (but not a fingeror toe), burns to the major part of the body or the loss of sight in an eye. 01.05 Functional Abilities Form (FAF) - A form given to an employee at the time of injury/illness, and on subsequent occasions as appropriate throughout the period of disability, to take to his or her attending health care provider for completion. This information is required to determine the employee's early and safe return to work needs, and to provide medical clearance to resume some or all of the employee's job duties. 01.06 Immediate Non -Union Supervisor - The first level of management who is not a member of a union. 01.07 Incident Report - An internal form specified by the City for the reporting of work-related near misses, first aid incidents, and injury or illness that results in health care and/or wage loss. This report is completed by the immediate Non -Union Supervisor and submitted to the Coordinator, Health .& Safety within one working day after he or she is informed of an incident or onset of illness. Procedure Title: WSIB Claims Page 2 of 9 Procedure Number: HUR 130-021 01.08 Health Care Claim - A work-related injury/illness claim where the employee has obtained medical attention, but is not absent from work due to the injury beyond the day of the accident. 01.09 Medical Attention - Health care provided by a registered health care professional (including a doctor, nurse, chiropractor, or physiotherapist) at a hospital or clinic. This does not include first aid treatment. 01.10 Recurrence - A further onset of a work-related injury/illness after initial recovery, that requires an employee to seek further health care treatment and/or lose time from work and/or require work accommodation. 01.11 Re -opened Claim - The reactivation of a prior, allowed WSIB claim, for the purpose of determining entitlement for ongoing impairment, disability and/or health care. 01.12 Sick Leave Bank - The accumulated amount of paid time available to an employee under the applicable collective agreement or contract of employment for authorized time off work relating to an illness or injury. 01.13 Supervisor - A person who has charge of a workplace or authority over a worker, as defined by the Occupational Health and Safety Act. It includes unionized supervisory staff (i.e. forepersons, lead hands and captains). 01.14 Wage Loss Claim - A work-related injury/illness claim where the employee has received treatment from a health care professional and loses scheduled time from work after the day of accident. 01.15 Workplace Safety & Insurance Board (WSIB) - A corporation created by the Ontario Workplace Safety & Insurance Act. The WSIB is responsible for the administration of the workers' compensation scheme in Ontario, including the adjudication of claims for benefits relating to workplace injuries and illnesses. 01.16 WSIB Employer's Report of Accidental Injury/Illness - The proper form name of the official reporting form required by the WSIB, also commonly referred to as the "Form 7". See also Accident Report, section 01.01. 01.17 WSIB Treatment Memorandum - The form given to the injured/ill employee by the immediate supervisor, to take to his/her health Procedure Title: WSIB Claims Page 3 of 9 Procedure Number: HUR 130-021 care provider to inform the provider of the work-related nature of the injury/illness. 01.18 WSIB Worker's Claim/Consent - The form signed by the injured person to claim compensation and to authorize the release of medical information to the WSIB. 02 Procedures 02.01 General Procedures applicable to all WSIB Claims 02.02 Reporting the Injury or Illness Every worker must report any work-related injury or illness to his or her Supervisor immediately on the day of injury/illness. 02.03 First Aid and Medical Treatment for Worker The supervisor's first responsibility is to ensure that the employee receives first aid treatment as required, and is provided an opportunity for further medical assistance as soon as possible. If necessary, the supervisor should ensure that the employee has immediate transportation to a hospital, health care provider's office, or home, as required. 02.04 Treatment Memorandum, Claim/Consent Form, and Functional Abilities Form During the initial interview of the worker following the accident, the supervisor must provide the employee with the following documents: a) WSIB Treatment Memorandum (Appendix 1); b) WSIB Worker's Claim/Consent Form (Appendix 2); and c) City of Pickering Functional Abilities Form (Appendix 3). The Employee should complete and sign the WSIB Worker's Claim/Consent Form before leaving the workplace for medical treatment, and distribute the: a) white copy to his or her health care provider; b) yellow copy to his or her supervisor; and Procedure Title: WSIB Claims Page 4 of 9 Procedure Number: HUR 130-021 c) keep the pink copy for his or her own records. The employee takes the WSIB Treatment Memorandum, the white copy of the signed Claim/Consent form, and a FAF to his/her health care provider upon the initial visit, and ensures the FAF is completed by the health care provider and returned to the employee's supervisor by a due date specified by the supervisor. The immediate non-union supervisor receives the completed FAF from the employee and reviews the form for a return to work date, the estimated recovery time, and the employee's functional ability to perform suitable work. The immediate non-union supervisor forwards a copy of the completed FAF to the Coordinator, Health & Safety within one business day of receipt. 02.05 Accident/Incident Report The supervisor must complete an Accident/Incident Report (Appendix 4) as. soon as he or she has taken care of the employee's immediate needs, and must forward the Report and the yellow copy of the signed Worker's Claim/Consent form, to the immediate non-union supervisor and Department/Division Head the same day. The immediate non-union Supervisor and Department/Division Head must review, sign and forward the Accident/Incident Report and the yellow copy of the signed Worker's Claim/Consent form, to the Coordinator, Health & Safety within one business day of notification of the occurrence. The Coordinator, Health & Safety is responsible to complete and submit the WSIB Accident/Incident Report form and the yellow copy of the signed Worker's Claim/Consent form to the WSIB within 3 business days of the occurrence. 02.06 Timesheet and pay for day of accident The immediate non-union supervisor ensures that the employee's full scheduled hours of work for the day of the accident, including scheduled overtime, are recorded on the timesheet. Procedure Title: WSIB Claims Page 5 of 9 Procedure Number: HUR 130-021 The Supervisor, Payroll Services pays the employee the full scheduled hours of work, at the applicable rate of pay, for the day of accident. 02.07 Medical Attention for Needle Sticks, Contact with Body Fluids or Exposure to Communicable Diseases The immediate non-union supervisor must send an employee for immediate medical attention in all cases where the employee has received a needle stick puncture wound, been in direct contact with body fluids or been exposed to a communicable disease such as tuberculosis, meningitis, SARS, rabies, measles, etc. 02.08 Scheduling Health Care Appointments The immediate non-union supervisor and the employee should work together to schedule health care appointments and treatments outside of regular working hours, in accordance with the Attendance Management Policy HUR 030-001, (Sections 06.01 and 06.02). If health care treatments cannot be scheduled outside of working hours, the immediate non-union supervisor must ensure that the appropriate absence code is recorded on the employee's timesheet. If health care treatments require leave from work, and a treatment schedule is known, the immediate non-union supervisor must provide this information in writing to the Coordinator, Health & Safety. The clerical support person must ensure that absences are accurately recorded in the Attendance Management System. 02.09 Critical/Fatal Accidents All City personnel must comply with the procedure set out in City Procedure Critical and Fatal Incident Response HUR 130-004. 02.10 Recurrences The employee must inform his or her immediate non-union supervisor that a recurrence of his or her previously approved WSIB health care or lost time claim has occurred. The employee advises the immediate non-union supervisor of the WSIB claim number for the original injury or illness. Procedure Title: WSIB Claims Page 6 of 9 Procedure Number: HUR 130-021 The immediate non-union supervisor and the Coordinator, Health & Safety follow general procedures for health care or lost time claims. 02.11 Modified Work — Reduced Hours, Shifts or Wages The Immediate Non -Union Supervisor must ensure that the Employee's absences are coded on the time sheet, as follows: a) P is used for hours worked; and b) W, WP or WU are used for hours not worked. When using the codes W and WP, indicate the number of hours missed. The clerical support person must ensure that absences are accurately recorded in the attendance management system. The Supervisor, Payroll Services must ensure that the employee is paid the applicable rate for: a) hours worked during the modified work program; and b) advances for the hours not worked for absences coded W or WP. The clerical support person must notify the Coordinator, Health & Safety in writing, of the employee's actual modified work hours, on a bi-weekly basis, for the duration of the modified work program. The Coordinator, Health & Safety must advise the WSIB of the employee's modified work hours and earnings, on a bi-weekly basis, for the duration of the modified work program. The immediate non-union supervisor must notify the Coordinator, Health & Safety in writing when the employee has returned to regular duties and hours. The Coordinator, Health & Safety must notify the WSIB in writing when the employee has returned to regular duties and hours. Procedure Title: WSIB Claims Page 7 of 9 Procedure Number: HUR 130-021 02.12 WSIB Advances for CUPE and Non -Union Employees The City pays WSIB advances for full and part-time employees within the CUPE and Non -Union categories as outlined below: a) the employee must have sufficient sick entitlements to cover advances for an approved lost time claim. Partial sick credits are deducted to cover the top -up between WSIB benefit level and the employee's full salary. b) the employee must have sufficient sick entitlements to cover advances for a pending lost time claim. While the claim is pending, full sick credits are deducted for WSIB absences. Once the WSIB claim has been approved, the employee's sick entitlements are adjusted to reflect that only partial sick credits are deducted for all WSIB approved absences. Partial sick credits are then deducted to cover the top -up between WSIB benefit levels and the employee's full salary. The Coordinator, Health & Safety must notify the WSIB in writing at the time of reporting lost time as to whether the City will be paying advances to the employee during the period of absence. The clerical support person must immediately notify the Coordinator, Health & Safety, and Payroll Services in writing if the employee receiving advances falls below the following number of hours in sick entitlement: a) 25 hours or less in sick entitlement for an approved WSIB claim; or b) 100 hours or less in sick entitlement for a pending WSIB claim. The Coordinator, Health & Safety will instruct the immediate non- union supervisor to notify the employee in writing that his or her sick entitlements are being depleted and to identify the date that advances from the City will cease and WSIB direct payments will commence. The Coordinator, Health & Safety must advise the WSIB of the date to pay WSIB loss of earnings benefits directly to the employee. Procedure Title: WSIB Claims Page 8 of 9 Procedure Number: HUR 130-021 The Supervisor, Payroll Services continues to pay full advances to employee with a pending WSIB claim until: a) WSIB has made a decision in the claim; b) employee has returned to work; or c) employee's personal and Sick Leave Bank entitlements have been depleted. Procedure Title: WSIB Claims Procedure Number: HUR 130-021 Page 9 of 9