Canadian Occupational Safety (COS) magazine is the premier workplace health and safety publication in Canada. We cover a wide range of topics ranging from office to heavy industry, and from general safety management to specific workplace hazards.
Issue link: https://digital.carswellmedia.com/i/351674
May 2014 11 the employer, it is important to ensure benefi ts are only paid when they should be paid. Employers need to remain dili- gent in managing compensation claims from the outset to conclu- sion; whatever that conclusion may be. Sometimes it means the worker returns to his full pre-injury duties, sometimes he returns to permanently accommodated work and sometimes he seeks work elsewhere. However, employers must always manage the claim to ensure workers only receive benefi ts to which they are entitled C laims management is an endeavour that should be undertaken for the life of a claim. Many articles have been written, and much advice given, about how to manage the front end or early stages of a claim — meaning identification of any issues in dis- pute with initial entitlement to benefi ts and to ensuring suit- able work is offered as early as possible. How- ever, long-duration claims sometimes fall by the wayside, despite ongoing claim costs. Employers tend to spend a lot of time in the early stages of a claim trying to help a worker get back to work. But what happens when a claim becomes prolonged? What happens when a worker needs an initial or sub- sequent surgical procedure some time down the road? What happens when the worker's doctor states he is incapa- ble of performing suitable work or any work at all? Or when a worker advises the employer she can no longer work because her condition has worsened? Should employers take that informa- tion at face value or do additional questions need to be asked? I am a fi rm believer in ongoing investigation to confirm the true nature of a condition and the real reason why workers say what they say. Perhaps there are other factors at play that may result in the worker not being entitled to further benefi ts. Workers are generally entitled to health care and wage loss benefi ts that relate to the work-related injury. How- ever, sometimes there are other factors involved that may be keeping a worker from being able to work. Perhaps these are family situations or worsening of a non-compensable pre-existing condi- tion. Perhaps the worker has decided he no longer wishes to work with the injury employer and voluntarily leaves his job, or decides to move out of province for personal reasons. These are all factors that may limit a worker's entitlement to benefi ts. I worked on one particular claim where the employer was having dif- fi culty in getting a worker to return to suitable duties. The worker would not return phone calls, and when he did, he left messages late at night. The worker e v e n t u a l l y told the e m p l o y e r that he could not return to work as he was taking parental leave with his new baby. The employer advised the compen- sation board, which determined that the worker's wage loss was due to a per- sonal situation and not due to the work-related injury. It determined the date he began receiving wage loss benefi ts from the government due to the parental leave and suspended his benefi ts as of that date. His entitlement to further ben- efi ts would be reviewed once he had completed his parental leave. Workers are required to report "material changes" to the compensa- tion board as such changes may affect their entitlement to benefi ts. How- ever, they do not always do so. As an employer, it is important to continue to gather information from workers throughout the period of recovery, and to make sure the compensation board is informed of any material change. If a worker is suddenly unable to keep working, ask questions to try to deter- mine why. Information may also be provided directly by the worker or by other sources, including co-workers, who may have some insight into a worker's situation. For example, it may be the worker is not able to work because she requires treatment for a non-work-related condition. In other situations, the worker may need to take time away from work to care for a family member who needs treatment. While these are legitimate scenarios, they may negate the worker's ability to claim for payments from the com- pensation board. When such information does become available, be sure to report it to the compensation board, so it can make a determination about whether the worker should be entitled to fur- ther benefi ts while he is off work. If the compensation board determines fur- ther benefi ts are in order, this may be an appealable issue for the employer. As ongoing benefi t payments may have substantial fi nancial implications for Managing the material changes in individual circumstances Conduct ongoing investigation throughout the duration of the claim under the workers' compensation legislation. The compensation system exists to assist workers with losses due to work-related injuries and illnesses. Because employers bear the costs of that system, they need to keep an eye on the benefi ts being paid out of it. David Marchione is an occupational health and safety and workers' compensation specialist with Compclaim, a consulting practice of Mathews, Dinsdale & Clark LLP in Toronto. He can be contacted at dmarchione@compclaim.com. DAVID MARCHIONE WORKERS' COMPENSATION DAVID MARCHIONE COMPENSATION The nationwide search for the most outstanding safety professional is on! Canadian Occupational Safety is now accepting nominations for the 2014 Safety Leader of the Year. If you know an OHS professional who deserves to be recognized for exceptional leadership, we would like to hear from you. 2013 SAFETY LEADER OF THE YEAR David Johnston Director EHS Toronto Hydro NOMINATIONS CLOSE JULY 4, 2014 CALL FOR NOMINATIONS Visit cos-mag.com/safety-leader.html for nomination details. 2014 SAFETY LEADER OF THE YEAR IS SPONSORED BY COS0996-2014_SafetyLeaderNomination_4.25x7.25.indd 1 2014-04-03 4:20 PM laims management is an endeavour that should be undertaken for the life of a claim. Many articles have been written, and much advice given, about how to manage the front end or early stages of a claim — meaning identification of any issues in dis- pute with initial entitlement to benefi ts and to ensuring suit- able work is offered as early as possible. How- ever, long-duration claims sometimes fall by the wayside, despite ongoing did, he left messages late at night. The worker e v e n t u a l l y told the e m p l o y e r that he could not return to work as he was taking parental leave with his new baby. The employer advised the compen- sation board, which determined that the worker's wage loss was due to a per- sonal situation and not due to the work-related injury. It determined the date he began receiving wage loss benefi ts from the Conduct ongoing investigation throughout the duration of the claim