One of the ways to reduce claims costs recommended by Clear Path involves developing and actually using a “toolkit” that is ready in the event of a workplace injury. What is sometimes discounted as unimportant is the worker’s statement and other similar statements, which should be contained in an organization’s toolkit. What is often misunderstood is the value these forms play in not only the management of claims post initial entitlement, but also in the objection of a questionable claim.
The value of the worker’s report
Part of successfully managing a claim is in the submission of a Form 7, which is the employer’s chance to paint an accurate picture of the workplace injury. Many companies complete the form from only one perspective – the employer’s. This can sometimes lead to an erroneous summary of the incident and often will result in a disadvantage to the employer. In our experience, especially when dealing with doubtful claims, an organization’s own Incident Report from the worker’s perspective can often come in handy when trying to convince an Eligibility Adjudicator of the claim’s merit.
The Eligibility Adjudicator denied the claim stating she was unable to establish a workplace injury due to the Worker’s Report of Injury. It is important to note that if the Form 6 is not sent initially, then it will be sent later by WSIB to the worker or the information will be gathered by phone by the Adjudicator. By having the employee complete the report at the time of the incident and submitting it along with the Form 7, the Eligibility Adjudicator was provided with details the worker may easily have denied or later changed, ultimately saving the employer a potentially expensive claim.
Clear Path managed to have a questionable claim denied after submitting a Worker Statement along with the Form 7. The worker reported a workplace injury to his neck without providing concrete details or witnesses to the event. Upon completing the company’s Incident Report, the worker stated, in writing, that he believed the incident may have occurred because he“slept funny the previous night.” The Eligibility Adjudicator denied the claim stating she was unable to establish a workplace injury due to the details provided by in the Worker Statement.
It is important to note that a worker often does not have an opportunity to complete WSIB’s Worker’s Report of Injury (Form 6) until weeks after the commencement of a claim. Eligibility Adjudicators will send a blank form to the worker by regular mail, which sometimes does not make its way back to WSIB. Eligibility Adjudicators also attempt to obtain incident details from workers by telephone, but again, this sometimes does not take place until days or weeks after the actual event. It is easy for details to be misconstrued or forgotten, resulting in a costly claim for an employer.
By having workers complete your own custom Incident Reports or Worker Statements, and submitting it along with a Form 7, Eligibility Adjudicators are provided with details the worker may easily deny or later change.
Other forms
Witness Statements can serve the same useful purpose. As part of your investigation process after a workplace accident, it makes a lot of sense to question any workers who may have firsthand knowledge of the incident. If a worker claims that another employee witnessed the accident, that employee should be interviewed for details that either confirm or deny the claim and this information could be provided to WSIB.
The same can be said for Supervisor Reports. Since supervisors are usually the first person on scene, employers should train supervisors in their investigation processes and return to work program. This program should include the initial investigation of a workplace injury, including the information and forms that should be completed for WSIB reporting purposes.
Clear Path consultant Jennifer Wright-Tahiraj explains that the possession of more than one workplace party statement increases the likelihood of potential discrepancies. She further explains that discrepancies between statements can “assist an employer in proving a Worker Report to be false, and therefore convincing an Eligibility Adjudicator in the denial of a claim.”
The ARO decision upheld the denial of LOE by stating there were inconsistencies in the Worker’s Report compared to details provided by the supervisor. Specially, the decision stated that “…there is no evidence that the modified duties requested by the worker to the Supervisor were due to a workplace injury. There is insufficient evidence to conclude that the right thumb injury arose out of and in the course of employment as there is no compatibility between the history of the right thumb injury and worker’s job duties.”
Bringing it all together
Successful claims management begins with preparation
Prepared organizations utilize a “toolkit” which contains the documents described above, along with procedures for workplace injury investigations. Part of this investigation should include obtaining details from all those involved, most importantly, the worker! Organizations should train their workforce in this process so that employees know what is expected of them when workplace injuries may occur.
Never underestimate the value of the worker’s voice
WSIB policy is clear that when faced with a situation when each parties’ position weighs 50/50, the benefit of the doubt goes to the worker. In order to help tip the scales in the favour of the Employer, provide facts and evidence that support your concerns, such as information provided by the worker’s own hand!
Compare and point out discrepancies
If you come across discrepancies between statements, do not be afraid to discuss them with an Eligibility Adjudicator, especially if a claim is questionable. An Eligibility Adjudicator’s role is to decide the merit of a claim and investigate yellow flags. Remember that a worker is not likely to come forth with such information that may deny their claim!
- The basics of the WSIB’s NEER system - September 29, 2017
- Summarizing WSIB’s proposed Rate Framework, part 3 - August 25, 2017
- Summarizing WSIB’s proposed Rate Framework, part 2 - July 28, 2017
