Skip to content

Claims management should not end when retraining starts

In past articles, I have discussed the factors that impact the experience rating costs of a worker’s compensation claim — claim costs, and duration of the claim. Duration of the claim directly impacts the costs. Because of this, employers should do everything they can to accommodate a worker’s functional abilities with suitable work, ideally at no wage loss.

The goal is to assist a worker in returning to a pre-injury job with the pre-injury employer. If she can no longer do the pre-injury job, then the employer should try to help her return to other suitable employment within the organization. All of these activities are beneficial to both the worker — helping her return to regular activities and a sense of normalcy following an injury — and to the employer — maintaining a productive employee and helping to minimize the costs of the claim.

But what happens when a worker is unable to return to work with the pre-injury employer? What happens if the pre-injury employer cannot accommodate the worker’s permanent restrictions and cannot provide suitable work on a permanent basis? In those cases, injured workers are generally entitled to additional benefits and perhaps vocational rehabilitation (VR) services to assist with returning to the workforce. Such benefits may include retraining, job search assistance or job placement services, including payment of related expenses.

VR services are generally aimed at assisting the worker with returning to comparable employment and minimizing or eliminating any residual wage loss. VR services are based on a worker’s personal and vocational characteristics, including prior training, education and skills.

Many employers tend to back off from active case management when a claim reaches this point, especially if the worker will not be returning to work with the pre-injury employer. Depending on the age of the claim, and whether or not it continues to impact an employer financially, this is not the best approach, as VR services — and the ongoing payment of wage-loss benefits while the worker participates in them — can be extremely expensive and have a significant impact on an employer’s experience rating.

Employers should continue to participate in the claim by doing ?the following:

• ?Suggest a potential vocational goal for the worker that may result in her being able to re-enter the workforce in a direct-entry occupation, without the requirement for any training. This will help to minimize VR costs. Provide additional information to the workers’ compensation board about the worker’s prior training, past work experience and transferable skills in order to assist with defining an appropriate VR goal.

• ?Monitor the claim for decisions about the vocational goal chosen by or for the worker and consider appealing decisions about VR services. Sometimes the compensation board agrees to VR programs that are inconsistent with the worker’s personal and vocational abilities, and are therefore unlikely to be successful. This may happen because the worker requests specific training (such as a university program).

• ?Monitor the proposed wages for the VR goal. The purpose of a VR program is to minimize residual wage loss. Therefore, any program should be focused on doing as much as possible to that end. Consider appealing any adverse decisions surrounding residual wage loss as this may have an impact on your experience rating.

• ?When appealing any adverse decisions, ensure you observe applicable time limits. Some jurisdictions have different appeal time limits for VR issues. For example, in Ontario, the time limit is 30 days, rather than six months for other claim issues.

If a worker is unable to return to his pre-injury job or other suitable employment with the pre-injury employer, VR services can assist him in re-entering the workforce and minimizing the long-term financial impacts of a claim. Employers should be mindful of the costs of those services and the impact that they may have on the employer’s experience rating. Employers should continue to monitor the claim to ensure decisions are being made that will have the best outcome for all parties involved.

David Marchione

David Marchione is an occupational health and safety consultant and paralegal at Fasken Martineau DuMoulin in Toronto. He can be reached at (416) 868-3468 or dmarchione@fasken.com, or visit www.ehslaw.ca for more information.
CLICK TO COMMENT ON THIS BLOG POST
(Required)
(Required, will not be published)
(Required)
All comments are moderated and usually appear within 24 hours of posting. Email address will not be published.