WSIB claims reporting 101 video: Text transcript with description of visuals

Dana is in the top right-hand corner of the screen and is speaking. Slide titled “Agenda,” appears. Content on screen:

Introduction
Claims registration and online services
Payment tips
Eligibility and late reporting
 

Okay. So, let’s start with what your reporting obligations are. When an injury happens at work, you report it, and we like to say here, ‘when in doubt, fill it out.’ Businesses must report a work-related injury to the WSIB if they learned that an employee requires health care or is absent from regular work, earns less than regular pay for regular work – an example is they're working five hours instead of eight – requires modified work at less than regular pay, or requires modified work at regular pay for more than seven calendar days following the date of injury. Must report even if it's unknown whether or not the injury was caused by work. The WSIB has an exclusive jurisdiction to determine work relatedness and will consider the individual facts and circumstances of each injury or illness reported. You should report an injury when an employee reports they believe they've been injured, at work or that their injury is work-related, regardless of if you agree or not, and the employee is unsure of the injury is work related. So this would be –like a common example would be that they're complaining of pain over their shift. Usually, it's low back pain or shoulder pain throughout their shift. It may have been going on for a while, but you're just hearing about it now. You'll want to fill that out – fill out the Form 7. The WSIB must receive the complete accident report within three business days after the business learns of the reporting obligation. It doesn't include statutory holidays. You must make every reasonable effort to obtain the information requested on the Form 7 and complete and submit it within the three business days. If you can't complete the information within the allotted time period, then submit the Form 7, along with the explanation of what's missing and what's being done to obtain it. You can also attach supporting documents, if needed. You should also provide a copy of the completed form to the employee and ask them to keep it for their records. You must report the injury or illness to meet your reporting obligation, even if an employee indicates they don't want to claim. Otherwise, you may be fined, even if the WSIB determines that the injury or illness wasn't work-related. You can share any concerns you have about the injury or illness and challenge the WSIB’s decision through the appeals process. 

So, things that hold up a claim, or things that could be considered as an incomplete Form 7 is not filling out the worker’s birth date or not having the correct birth date. The accurate date of injury or illness. Now, with that one, if it’s something – if it’s an injury or illness that’s happened over time and you don’t have a specific date, in the box, you can just put the date that it was reported. But in the box at the end of the form, you can go into details about whether or not the worker or the injured person might have said, you know, ‘I’ve been having this pain over the last few weeks but now it’s getting worse and I wanted to tell you about it.’ You can put those details there. The complete details of the injury – that’s really important because that’s also where we find or where your adjudicator will determine if it’s work-related. The accident location details – so it might have been in your parking lot, or it might have been on the way to work – this will all make a difference when the adjudicator is adjudicating the file. The date of medical care – the date of medical care is an important one because the other piece to this is if an injured person has gone to the hospital and reported to their doctor that it was an injury that occurred at work, the doctor will fill out a Form 8, and a Form 8 is a form that allows a claim to be opened. So, it's important that you educate your employees to say, you know, if you do go to the hospital and report an injury, we need to know immediately. But, also they should – the WSIB will call you if we receive a form 8. Again, really important that you get that Form 7 and immediately – even if you don’t have the details of it, you can in the medical section, you can just say ‘We’re unsure of what day they received medical, but it was reported that they did see a doctor.’ 

Health care can look a few different ways for us. So, what we consider health care and who can fill out that Form 8 – obviously, the hospitals and health care facilities, walk-in clinics, any kind of doctor, a nurse, a dentist, a chiropractor, and a physiotherapist. Even if the worker gets hurt at work and they only seek first aid, and that might be first aid you have on site or you may have a designated person that completes those incident reports. We consider first aid as any kind of minor cuts or scrapes, treating a minor burn, applying a cold compress, applying a splint, changing bandages or dressings after a follow-up visit. You don’t need to complete this report for first aid only if it’s handled in-house. However, you must record all of the details, because if they end up seeing a doctor, that’s going to be required.

And I think we see a hand up here. Is that Amanda? Amanda, go ahead.

Dana is in the top right-hand corner of the screen and is speaking. Slide titled “Reporting injuries and/or illnesses,” appears. Content on screen:

Reporting injuries and/or illnesses
It’s important to include the following information when reporting injuries/and or illnesses:

• Correct date of birth for employee
• Accurate date of injury or illness
• Complete injury or illness details
• Accident location details
• Date of medical care
• Detailed employer objection or concerns
• Lost time details
  • modified work
  • return to work
• Prior similar condition

Okay, thank you. Yeah, it does. It’s pretty much how we’ve been dealing with it. It’s just basically preventative for the worker and as you said, it covers our bases and the workers bases if something does happen two days down the line with an infection.

And I don’t want to give any gruesome examples here, but I will say that we do get some of – some of these claims do take a turn. And the fact that it was registered with us will at least mitigate any penalties or anything like that.

Okay, the next one that’s important to fill out is whether or not you’re objecting or you have some concerns. This box is important because you might not feel that the accident happened at work. And I’ll give you an example of something we see often. An injured person was out on a baseball team or hockey team, got hurt, came in to work the next day still feeling the pain, reports it to you, and then you hear that well, you know, they came into work limping today and so now you have a concern about the claim. Did it happen at work or not? You fill out the Form 7 and you put the details of your objection. And ideally, any type of witness statement that you have to support that. This will remove – if you fill out this box, this will remove it from our eAdjudication process, and it will be seen by a live adjudicator who will likely call you and want to gather information. And just to speak on that eAdjudication piece, if there’s no objections or there’s no concerns with the Form 7 and everything’s pretty straightforward, it goes through eAdjudication and, as you’re probably aware, eAdjudication spits out a decision letter automatically that gets sent to you. And we’ve heard from employers that that decision letter is very vague, and they want more detail, and that’s something that we’re currently working on. And I know there’s been a draft going around, but I’m not part of that team. But, we are working on getting out a more detailed decision letter from the eAdjudication piece. When it goes to an adjudicator, you’ll get a fulsome decision letter about the decision and what information was weighed to come to that decision.

Lost time details. So, on the date of the accident, you’re reporting the injury, you may have offered that injured person modified work the day of, and it would be a conversation to the effect of, ‘Okay, I see that you broke your finger. If you’d like to come in tomorrow, we can definitely accommodate you with work that does not involve that hand.’ If possible – and I know it really depends on the structure of your business – but, if possible, you’ll have something in writing that that injured person would agree to. Because that does change our decision on whether or not we’re going to pay a loss-of-earnings. So, for example, on the Form 7, if you click off that box that says ‘offered modified work, yes,’ and then, ‘Did the injured person accept or decline?’ and you say ‘decline,’ that will also go to an adjudicator to review. Because if it's determined that that modified work was suitable – which is why you would hopefully have something in writing that you would have given them – then there’s a chance that we wouldn’t be paying loss-of-earnings benefits because they turned down modified work. And a tip here about that modified work is we really want to look at that suitability piece. Tou may not have the restrictions because they’re just going to the doctor or they haven’t had the FAF form filled out, but those, you know – if you know that they’ve hurt their left hand, you just want to make sure that you’re offering work that doesn’t involve the left hand. If you just give a slew of different types of jobs and it’s not really explained, the adjudicator might find that the offer wasn’t presented properly or the offer wasn’t suitable. So, you really want to make sure that you’re documenting that you had that discussion. Now, if the injured person only had one day off because they went to the doctor the next day, and then they come back, we need to know that as well. Because if it goes – again, if it goes through eAdjudication it just gets marked up for a few weeks and it requires a live person to pull that payment back for just the date that was missed.

And then the last one is the prior or similar condition. So, if you’re aware that this person has had claims in the past for this area of injury, or you’re just aware of a condition, or maybe they were on modified work when they got hurt but they were on modified work for a non-occupational condition and got hurt, we would need to know that.

Okay, so you can go to the next slide, Amanda.

This is the Form 7. I’m sure you’re all very familiar with it. I do think that it’s worth – as a business, I think it is worth having these conversations with whichever department it is that is filling out the Form 7 for you, or if it’s you, yourself, just to have people understand why it’s such an important form. Now that it’s actually on our website and you can do it through the website, it should be much easier. But, the accuracy of information is important, and the person that you want us to contact to discuss the claim is important. It’s terrible when we, you know – sometimes we have employers just fill out their CEO’s name on the bottom and then signed for or signed on behalf. We need to know who to call. And if there’s – if you’re with a bigger company and you have a person just designated to handle the disability department, then we would probably want to speak to them, because we want to have those in-depth conversations about what kind of work they would normally do and what that modified work would look like and if it’s something that can be accommodated.

Amanda, you can go to the next.

So, as you’re aware, you now have a portal that this is – we’re very excited about this here because, as you know, we don’t correspond via email. So, the portal has been a really big deal for us. But you can go into your claims portal –you can do that through the website – and in this portal, you can view all the registered claims that you have and the information about the benefits and health care benefits. Submitting documents, you can do that through the portal.

So, a good example is the payee information, especially if they’re on modified work and we’re doing a graduated plan. You can view the claim information, obviously. The next – the secure message is as close as we’ve gotten to email so far. But you can send a message through the claim portal, and that will get reviewed by one of the customer service agents. They’ll get an alert and they’ll set an activity that the case manager has to respond to in two business days.

So, that’s been really good. It was a slow uptake, for sure. We’re really noticing that it’s starting to become more popular, definitely in the last three months. So, that’s available to you now. 
Obviously, the report – the reporting is up there, but you can also review your statement summary and insights into your claim costs and rates. 

Dana is in the top right-hand corner of the screen and is speaking. Slide titled “Managing claims through online services,” appears. Content on screen:

Through our online services, you can:

• view registered claim information such as status, information about benefit payments and health-care benefits
• submit documents for employees’ claims
• view claim information
• send us a secure message about your employee’s claim
• report injuries and illnesses
• view your statement summary report and insights into your claims, costs and rates

Dana is in the top right-hand corner of the screen and is speaking. The website loads to a new page that has a timeline bar at the top, with three steps:

1. Start Report
2. Report Details
3. Submit Report

The circle around Step 1 is blue, while the other steps are grey.

Below this is the question, “Who experienced the workplace injury, illness or exposure incident?” The user has the option to pick one of four answers:

• Me
• My employee
• My patient
• Someone I am representing

There are two buttons beneath the question: “Next” and “Reset”. 

Dana is in the top right-hand corner of the screen and is speaking. The website reloads and shows the timeline bar at the top with the circle around step 1 in black, the circle around step 2 in blue and the circle around step 3 in grey.

Below this is the question, “Are you reporting:” The user has the option to pick one of three answers:

• An injury or illness?
• An exposure incident (e.g., exposure to COVID-19 or a chemical, physical or biological hazard)
• A fatality? 

There are three buttons beneath the question: “Back,” “Next” and “Reset”.

And then it'll take you to your login. So now, as soon as you put in your login details, the Form 7 boxes will highlight for you and you can fill it out, and then just press submit and it gets uploaded right away, and we get – and it’s time stamped so we know when you reported it.

Thanks, Amanda. You can go to the next slide.

Dana is in the top right-hand corner of the screen and is speaking. The website reloads and shows the timeline bar at the top with the circles around step 1 and 2 are in black, while the circle around step 3 is in blue.

Below this is a button that says “Log in.” Underneath this it says, “For fatalities and catastrophic injury claims, please report as soon as possible."

There are two buttons beneath this: “Back” and “Reset”.

So, section G is the area that is the payment area on the Form 7. We need to know what the employment pattern is, whether it’s seasonal or not or if it’s contract. If it’s contract, please include the end date of the contract, the position the injured person is in and was hired for, rate of pay, of course, hourly rate. If it’s a salary, you just fill out that first box. It’s very frustrating when we don’t have the basics of the information because, again, this will get flagged and get sent to an adjudicator later and not go through the eAdjudication, which, again, can hold things up.

Next slide. 

Dana is in the top right-hand corner of the screen and is speaking. Slide titled “Form 7 – section G,” appears. Content on the screen:
1. Employment pattern

• helps determine how we potentially calculate this person’s rate
• should be based on the position for which the person is hired

2. Rate of pay

• hourly rate at the time of the injury/illness

There is a screen shot of section G of Form 7 at the bottom of the slide.

Okay, all of these boxes – so I’m going to go through them because we do get a lot of inconsistency here. So, number one, the net claim codes – that’s the rates that are used for taxes that you’re deducing from the workers pay. The vacation pay box – we need to know if it’s accumulated or if it’s paid out. We use four per cent over two weeks. The date and hour last worked – so, this is important because it determines, especially if someone’s on a night shift, what we’re considering as the date of injury. So, that’s really important in general, but especially for anyone, any companies that have the 12 a.m. shift. The normal hours of the last day that the injured person worked. The actual earnings – so, were they paid full for their last day? This can potentially change how we would pay as well. So, for example, if a person worked half a day the next day of the injury, we would pay half a day for that day. It’s a little bit confusing, but – and this can always be weeded out with that extra information that you give – but just remember that if an injured person is hurt at work on April 29, they should be paid for the full day or their full shift, and if an ambulance was called, it’s the responsibility of the employer for that ambulance cost. So, that’s why that’s an important piece.

Number six, normal earnings for their last day. Again, this is how we confirm the hourly rate. Advances – so, this helps to determine who we should be paying for lost time. If regular schedule and covering full hours, that would be yes to a full advance. So, if you are paying that person while they are off and we are reimbursing you, that’s what an advance is. And you would want to indicate ‘Yes,’ for their regular pay and then any other earnings. So, this would be the section for earnings that are earned other than hours worked. These are premiums. So, anyone in health care, we had that three-dollar premium, there’s overtime premiums, cost of living premium. We also want to catch anything like if people are receiving tips or bonuses or a percentage of their sales like a commission – we need to know all of that because that gets factored in. And I think that’s it for other earnings. Okay, you can go to the next one.

Dana is in the top right-hand corner of the screen and is speaking. Slide titled “Form 7 – section H,” appears. On the left side of the slide, it says:

1. Net claim codes
2. Vacation pay
3. Date and hour last worked
4. Normal hours on last day
5. Actual earnings for last day
6. Normal earnings last day
7. Advances
8. Other earnings

On the right side of the slide is a screenshot of section H of Form 7. 

Okay, and the work schedule. So, there’s three areas here. Part A is the typical one that we would use, right? So, Part A is, you know this person works eight hours a day, five days a week. So, you would just fill that out exactly like the example.

Rotational shifts. Obviously, we see this a lot in health care, manufacturing. We need to know their days on and off, and that cycle, because when the payment specialist receives that pay, we use – they have a formula to sort that piece out. The case managers don’t do that. They only provide the information to the payment specialist. It’s the payment specialist that goes into those details. And if it’s irregular work – we see this a lot in construction, right? Or landscaping. Very dependent on the weather. So, we want to kind of get an average over that four-week period. And then that is what the short-term rate would be determined on, that prior four weeks.

When you’re submitting the information for this – so, you would have the hourly rate filled out and then you fill out section C. I would also say that we have made a little bit of an improvement here, in the sense that we’re accepting now the last two pay stubs prior to the injury to calculate this. Whereas before, we needed the last word, pay statements. This does help us set that short-term rate. And, again, if you’re unfamiliar with it, the short-term rate is paid up to 12 weeks. That 12 weeks – a few weeks before it hits 12 weeks, you’ll receive a letter from payment saying that a long-term rate needs to be calculated and further information is going to be required. And then it’s that long-term rate that would continue on from 12 weeks, ongoing, if the claim went on for more than 12 weeks. So, all of this on the Form 7 is to determine that short-term rate.

And then you can go to the next slide.

Dana is in the top right-hand corner of the screen and is speaking. Slide titled “Form 7 – section I,” appears. On the left side of the slide, it says:

Work schedule

• part A: provide the person’s schedule and hours worked each day if it’s regular
• part B: enter the person’s rotational schedule as best you can
  • can use section K if the schedule doesn’t fit
• part C: if hours vary from week to week, enter hours based on the closest four weeks of pay to the date of injury

On the right side of the slide is a screenshot of section I of Form 7.

Okay, section K. We love section K because this is where you can fill out and put the details of pay in as much detail as you possibly can. And, again, you can also attach some of the pay stubs and stuff like that to help.

But if, for example – and a good one is contracts with, let's say, City of Toronto – when someone's on a contract, if they're hurt two weeks before that contract is over and you've paid out or you're paying out that contract every two weeks, we will need to know those details.
So, you would put that in this section K because the adjudicator is going to need to determine, are we paying beyond that contract date. And things that we would consider are if the injured person needs to be accommodated, they would not be able to find work or would not be able to work beyond that contract because of the injury. Potentially, we would continue paying until their functional abilities improve.

Another example of this would be if they would roll into another contract. –and we see that a lot with the city where you know, they'll be in one contract in the summer for Parks and Rec and then the winter comes and they're doing snow removal and that's their pattern. If there's a pattern, we want to know about that, because that could determine whether or not we're paying. And I think that's it. Do we have any questions?

Dana is in the top right-hand corner of the screen and is speaking. Slide titled “Form 7 – section K,” appears. On the left side, it says:

We recommend filling out section K with as much detail as you can about your pay structure. You can also include additional information about the person’s work schedule.

On the right side of the slide is a screenshot of section K of Form 7.

I will just point out a couple of things that came up in the same webinar we had – I think we did this last year. One of the questions we had was about if the company’s unionized, how that impacts the claim. On the Form 7, there's a box that you would need to fill out to let us know that they are unionized and often the union acts as a rep. The reason this is important is because sometimes the agreement is very clear about what kind of modified work a person can or can't do. And, you know, when it starts to encroach into another job and, hopefully not, but in cases where a worker needs to be retrained and they go through RTW services, it's important for the union to be involved because there's only so many jobs that that person may be able to go into. So, we need to take that into account when we're trying to find a suitable occupation.

Another question – we had a lot of questions about the email. We are working on it. But right now please use the message function.

Yeah, we still accept faxes, for sure. But, we are trying to weed that out as we're going more online. We're just hitting, like, faster targets at this point. Sometimes the fax, you know, as you're aware, it can not go through  or it goes into the pile of faxes that we get every day, and it needs to be sorted through. So, sometimes it can hold things up. But absolutely, if you can't, we can always take it by fax.

The other thing you can do is actually call in to our customer service line, and they can fill out the Form 7 with you, which is also very helpful if it's your first time and you'd like some guidance.

If you walk away from here today and you forget everything I said, there are these resources on our website. So, the Employer’s Report of Injury Reference Guide. This is a really helpful guide, it goes step by step explaining what you need to report and what those boxes are and how to fill them out. And then there's also a self-evaluator. So, if you're really unsure and you don't know if something needs to be reported or not, you can answer the questions through the self-evaluator and it will most likely tell you to report it, but it will give you that information.

But, other than that, I just want to thank you all for coming and learning about the importance of the claims registration piece. Quick and accurate reporting of your employee's workplace injury or illness leads to faster claim decisions, better return to work and recovery outcomes, and always helps you avoid costly late filing penalties.

Dana is still in the top right-hand corner of the screen and is speaking. Slide titled “Resources,” appears on the slide with the following bullet points:

• Employer’s report of injury/disease (Form 7): Reference guide for businesses | WSIB
• Initial injury or illness self-evaluator for businesses | WSIB