Top 10 tips for better claims managementWritten by Doug Rourke, EMC Canada 18 May 2010
Workplace Safety and Insurance Board (WSIB) in Ontario —now have increased focus on claims management for work-related injuries, as well as early and safe return to work (ESRTW). This has resulted in health and safety and human resource professionals being given additional duties, often very complicated. If mismanaged, these added responsibilities can cost companies money, time, respect and integrity.
Excellence in Manufacturing Consortium (EMC) — Canada’s largest manufacturing consortium and a leading sponsor of WSIB’s Safety Groups program — and our manufacturers across the province have been quick to recognize the need for greater awareness, understanding and best practices for improving claims management.
As EMC’s manager of environmental health & safety and safety groups, I have been working extensively with members and all manufacturing employers, to help develop strong claims management teams and industry-leading best practice solutions. This powerful peer-to-peer networking approach has allowed us to drill down to the core issues and engage manufacturing-driven solutions.
Here are 10 tips to help employers better manage their claims and as a result, control their costs and improve employee relations:
1. Understand the roles and responsibilities of all parties involved
All parties involved, including supervisors to the union steward, to the physician and treating therapists, the WSIB claims manager, the joint health and safety committee, and even other uninjured employees have critical involvement in managing claims. Clearly defined roles and responsibilities is an employer resource, allowing them to intervene if someone is not doing their job.
Action: Develop a program that clearly defines the roles and responsibilities of all parties.
2. Make sure everyone understands their roles and responsibilities
As an employer, you must ensure you have trained your employees on their roles and responsibilities under your RTW Program. Medical professionals need to be informed of your program and their roles; this is often done via letter attached to the functional ability form. WSIB must be aware of your program and that you are actively monitoring all parties.
Action: Communicate to and train all applicable parties on their roles and responsibilities. This is a significant step towards good claims management.
3. Document all injuries
The legislation clearly defines what an injury is and what your reporting responsibilities are as an employer. There are situations where an injury is so minor that it does not require the filing of a Form 7, but employers must keep a record of the minor incidents and ensure that the employees recover fully.
Action: Ensure your documentation is in compliance with legislated standards.
4. Report everything
Sometimes an employee will indicate that they do not want to file a claim or an employer does not feel that the injury warrants a claim. These are not your decisions to make. File all claims and allow WSIB to decide what claims are allowed. Failing to report injuries will result in greater long-term loss than any perceived short-term gain.
Action: Report all claims to WSIB regardless of your opinion on the claim.
5. Do not coach employees on filing claims
Whether an employee chooses (or not) to file a Form 6, follow up with a physician or attend an appointment, it is their decision. This decision should not involve or be influenced by the employer. As an employer, you need to encourage the employee to follow the appropriate steps when reporting and recovering from an injury.
Action: Encourage employees to follow appropriate steps, but do not influence/interfere in their decisions.
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