Provincial Human Rights and Equity Teleconnect RTW. Provincial Human Rights and Equity Teleconnect. Ontario Nurses

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1 Provincial Human Rights and Equity Teleconnect RTW

2 WORKSHOP LEARNING OBJECTIVES 1 Overview of Experience Rating (NEER) How the system is funded How NEER works 2 How does NEER influence RTW practices? Employer avoidance of WSIB costs Aggressive RTW practices

3 FUNDING THE SYSTEM Coverage is compulsory for any business named in Schedule 1 Schedule 1 employers must contribute to the insurance fund The insurance fund is made up of annual premiums paid by Schedule 1 employers The amount of premium is based on the WSIB's classification of the employer's business activity and the employer's total insurable payroll 3

4 SETTING PREMIUMS 4

5 WSIB Premium Base Rate Rate Group 853 (Hospitals)

6 EXPERIENCE RATING? Recognition of a company s accident performance A financial incentive to promote workplace health & safety Provides a more fair distribution of premiums within a rate group Incentive is either retrospective (rebate/ surcharge) or prospective (premium adjustment) 6

7 WHAT IS NEER? NEER stands for New Experimental Experience Rating Only Schedule 1 employers NEER mandatory for all Schedule 1 employers as of

8 NEER EXPLAINED It s pretty simple really The WSIB sets a formulated monetary target for each accident year. If you come under the target you get a rebate Go over the target you get a surcharge Its easy to go over the target with only a few bad claims. 8

9 BASIC FEATURES OF NEER Four year review. Claim costs charged to accident year. Compares expected costs to NEER costs. Considers actual, future and overhead costs. Built-in insurance features. Refunds / surcharges issued annually. 9

10 NEER Claim Cost Statement ACME LTD 666 Avenue Street Sometown, Ontario L2J 2H0 Account No Firm No Rate 123 Past Awards to: Sept 30, 2009 Accident Year Claim Cost Limit 373, , , , Overhead Factor (%) Claim Past Awards Discounted Projected Limited Accident Claim Age Non- Past Future Over- Claim Claim # Worker's Name Date Type Month Pension ($) Pension ($) Awards ($) ($) head ($) ($) 1234 Cruise, Edgar 05Jan , , , , ,500.00* 2345 Missy, Ann 04Apr Reno, Ray 15Jun , Mann, Hector 02Jul , , , , , Chester, Mary 02Jul , , , , , Peach, Judy 22Dec , , , , , Totals 117, , , , , *subject to claim cost limit Expected ($) $500,000 Surcharge $110,

11 NEER Claim Cost Statement ACME LTD 666 Avenue Street Sometown, Ontario L2J 2H0 Account No Firm No Rate 123 Past Awards to: Sept 30, 2009 Accident Year Claim Cost Limit 373, , , , Overhead Factor (%) Claim Past Awards Discounted Projected Limited Accident Claim Age Non- Past Future Over- Claim Claim # Worker's Name Date Type Month Pension ($) Pension ($) Awards ($) ($) head ($) ($) 1234 Cruise, Edgar 05Jan Missy, Ann 04Apr Reno, Ray 15Jun , Mann, Hector 02Jul , , , , , Chester, Mary 02Jul , , , , , Peach, Judy 22Dec , , , , , Totals 117, , , , , *subject to claim cost limit Expected ($) $500,000 Rebate $255,

12 REFUNDS / SURCHARGES ACCIDENT YEAR PREMIUMS ($) EXPECTED COST FACTOR (%) EXPECTED COSTS ($) NEER COSTS ($) RATING FACTOR (%) PERFORMANCE INDEX ,000, ,750,000 2,500, % 1.43 Refund/Surcharge Formula (NEER -Expected ) X Rating Factor (%). Example - Accident Year Adjustment =($2,500,000 - $1,750,000) X 100%. =$750,000 X 100%. =$750, Surcharge. 12

13 REFUNDS / SURCHARGES ACCIDENT YEAR PREMIUMS ($) EXPECTED COST FACTOR (%) EXPECTED COSTS ($) NEER COSTS ($) RATING FACTOR (%) PERFORMANCE INDEX ,000, ,750, , % 0.29 Refund/Surcharge Formula (NEER -Expected ) X Rating Factor (%). Example - Accident Year Adjustment =($500,000 - $1,750,000) X 100%. =$1,250,000 X 100%. =$1,250, Refund. 13

14 RTW EXAMPLES 1 day lost time = $100 + $100 HC =$200 Claim Type Claim Age Non Pension Pension Discounted Past Awards Future Weekly LOE: $500 Overhead Factor: 50% Rating Factor: 100% Overhead Limited days lost time = $500 + $100 HC =$600 Claim Type Claim Age Non Pension Pension Discounted Past Awards Future Overhead Limited days lost time = $600 + $100 HC =$700 (Reserve Factor = 5.00%) Claim Type Claim Age Non Pension Pension Discounted Past Awards Future Overhead Limited

15 3 Years Later Weekly LOE: $500 Overhead Factor: 50% Rating Factor: 100% 6 days lost time = $600 + $100 HC =$700 (Reserve Factor = 1.40%) Claim Type Claim Age Non Pension Pension Discounted Past Awards Future Overhead Limited day recurrence 7 days lost time = $700 + $200 HC =$900 (Reserve Factor = 3.00%) Claim Type Claim Age Non Pension Pension Discounted Past Awards Future Overhead Limited

16 AVOIDANCE OF WSIB COSTS Intimidating/threatening a worker to not put in a claim Disputing any entitlement with insurance or workers' compensation provider Delaying in sending in proper forms for prompt payment of claims Paying a worker to simply sit in a lunch room, or somewhere out of the way Hiring investigators, medical and claim consultants to dispute genuineness of claims Using safety award programs to create co-worker animosity 16

17 AGGRESSIVE EMPLOYER RTW PRACTICES Offering to provide modified work immediately after the injury Not recognizing time to heal Offering modified work that is designed to embarrass, or ostracize, the worker Offering modified work for a short period, and then arbitrarily communicating an ultimatum to resume their normal job, or go off on benefits Not interested in proper accommodation of job Transfer into another bargaining unit Not caring about non-occupational injuries/illnesses 17

18 MAXIMIZING DISABILITY COSTS The choice is aggressive claims management or an effective and sustainable H&S and RTW Program that is applied fairly and consistently and that produces favourable and measurable outcomes 18

19 $1.67M Over 4 Years 19

20 $2.5M Over 3 Years 20

21 Over 3 years - total variance of $6,485,

22

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