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
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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.
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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
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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.
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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
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