Case Management WSIB


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Case Management WSIB

  1. 1. CASE MANAGEMENT<br />Return to Work & WSIB<br />Injury Management Solutions<br />
  2. 2. Components of Case Management<br />Understanding the employee’s needs (why he or she is unable to work).<br />Assessment of return to work obstacles (both physical and psycho-social).<br />Development of the return to work plan.<br />Negotiating, implementing and coordinating internal and external resources.<br />Monitoring the program.<br />Documenting and evaluating the process and outcomes.<br />Injury Management Solutions<br />
  3. 3. WSIB Service Delivery (2010)<br /> You also have to understand the WSIB process. <br /> The WSIB implemented a new Service Delivery Model in 2008 and completed the transition of their Service Delivery Teams during 2009. <br /> <br />Injury Management Solutions<br />
  4. 4. Form 7 must be received within 7 business days<br />Eligibility Adjudicator <br />(7 – 14 Days)<br />WSIB CENTRAL CLAIMS PROCESSING Codes & assigns claim number<br />Employer completesWSIB Form 7<br />Accident/ illness Reported<br />Assigned in order of available Adjudicator – NO DEDICATED ADJUDICATOR TO EMPLOYER<br />Short-term Case Manager(26 weeks))<br />Long-term Case Manager<br />(+ 6 months until claim closure)<br />Injury Management Solutions<br />
  5. 5. WSIB ROLES<br />Eligibility Adjudicator determines eligibility upon receiving a claim for benefits; <br />Case Manager concentrates on the opportunities and obstacles to return to work, determines ongoing benefits to be paid to the worker, and arranges and monitors Labour Market Re-entry services wherever and whenever needed; <br />Return to Work Specialist facilitates return to work and case resolution at the workplace.<br />Injury Management Solutions<br />
  6. 6. OBJECTIVES<br />Return to regular job.<br />Comparable job (pre-injury wages, similar skills/ responsibilities, physically appropriate).<br />Suitable job (may be wage loss, fewer skills/ responsibilities, physically appropriate).<br />Injury Management Solutions<br />
  7. 7. PROGRAM<br />Document your program and process in Policy (Human Resources and/ or Health & Safety).<br />Obtain commitment from stakeholders: management, employees, union.<br />Ensure everyone in the organization is knowledgeable and aware of their roles.<br />Know all the jobs in your organization; be aware of the tasks in each job and the risks associated with them; document the physical demands of each job.<br />Have plan of action in the event of an accident/ injury: Include roles and responsibilities for supervisors, managers and employees; job offer – regular or modifies; Functional Ability Form for worker ( if appropriate; follow-up plan – communication; documentation – Form 7, Accident Investigation, return to work plan.<br />Evaluation.<br />Injury Management Solutions<br />
  8. 8. PROCESS<br />A) When a workplace accident occurs resulting in injury or illness<br />1. Provide First Aid <br />Provide first aid according to standard first aid practices, and make an accurate record of the incident and first aid given.<br />2. Arrange Transport to Medical Treatment (as necessary) and Pay for It <br />If more serious treatment than first aid is required, transport the worker to the appropriate medical facility. You may need to assign someone to accompany the worker, or call an ambulance. <br /> <br />Provide your employee with a letter offering suitable employment immediately, regardless of injury or illness, documenting your willingness and ability to provide physically suitable work.<br />Injury Management Solutions<br />
  9. 9. PROCESS (cont’d)<br />3.Pay your Employee a Full Day’s Wages<br />You must pay your employee a full day’s wages on the day of the incident. WSIB loss of earnings (LOE) benefits start the working day after the incident occurs. <br />4. Investigate the Incident<br />Identify the cause of the accident or illness and keep a record of steps taken to correct the problem.<br /> <br />5. Complete Form 7 if your employee requires health care and/or:<br />is absent from regular work<br />earns less than regular pay for regular work (e.g., part-time hours)<br />requires modified work at less than regular pay<br />requires modified work at regular pay for more than seven calendar days following the date of accident.<br />The completed Form 7 must be received by the WSIB within 7 business days of the injury/ illness.<br />Injury Management Solutions<br />
  10. 10. B) Return to Work Meeting<br />Review medical and work information.<br />Discuss all barriers/ issues to a return to the pre-injury job.<br />Discuss work hours.<br />Set the return to work objective (see hierarchy).<br />Complete the return to work plan.<br />Review and have all stakeholders sign the plan – include the treating practitioner.<br />Set a follow-up date.<br />Submit return to work plan to WSIB, where applicable.<br />Injury Management Solutions<br />
  11. 11. C) Implement return to work plan<br />This requires consistent follow-up, regular communications and cooperation. Always maintain focus on objective and address issues and barriers immediately.<br />Injury Management Solutions<br />
  12. 12. D) Evaluation<br />At the completion of the plan evaluate and document all findings. <br />Injury Management Solutions<br />