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Proposal for a mill: Workers’ compensation case management Framework for a Cost-Effective Program


November 1, 2007
By Pulp & Paper Canada

Risk Financing:

Risk Financing:

01. Workmens’ Compensation Premium after adjustment for performance: rebate for good performance or penalty for poor performance.

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02. Retained losses or those losses that the employer assumes out of operating earnings and that are not insured.

Risk Control:

03. Risk Control Costs or the costs of all workplace injury/illness prevention efforts and activities, programs, including total cost of man hours dedicated by management and the workforce to loss prevention.

04. Administration costs related to managing the entire OHS effort.

Cost Containment

A Workmens’ Compensation Case Management (WCCM) program falls into the category of cost containment. It takes square aim at items 01 and 02, the reduction of medical expense and workers’ compensation disability costs (item 01) which reduce WCB premiums, and by reducing absenteeism due to workplace injuries and illnesses which reduces all the various injured/ill employee replacement related costs (overtime, training, retraining, supervision, lower productivity).

The program is designed to help managers and supervisors minimize the cost of workplace injuries/illnesses resulting from actual medical expense and workers’ compensation disability costs by:

01. Providing approaches, or more importantly, a clear, step by step process to manage the situation, to contain costs and to return injured employees to work as quickly as possible. It illustrates to managers and supervisors the skills and information they need to play their part in that process;

02. Controlling the Exit from Work immediately following an injury/illness and stressing early return to work, either to regular or alternate productive work activities; and

03. Recommending early evaluation of possible long-term disability cases for the best approach to case management: early job placement, counseling, rehabilitation and/or retraining.

WCCM Model

The model proposed in this document is based on establishing a universal approach to handling claims that can be adapted to each provincial WCB legislation and customized for each department within each mill if necessary.

The manual is intended as a step-by-step guide to the timely and effective management of WC claims which arise out of workplace/work related injury or illness incidents. The manual combines a comprehensive claims management flowchart that provides an easy to understand overview of the entire claims process from injury to recovery and return to work.

For each step in the flow chart, the manual describes what action must be taken, who is responsible for taking the action, when the action must take place and how to do it.

Important: Positive approaches and coaching techniques by management and supervisors are very important to make this approach work.

The basic flowchart critical path is composed of only about 15 steps, with alternate paths covering the other three subjects addressed which are the Claims Challenge Process, Modified Duties/Restricted Work Procedures and Rehabilitation Procedures. The total number of steps is about 50. The manual can be made compact for portability and convenience, complete with the fold out flow chart. The manual covers the roles of all parties from injured/ill employee, supervisor, management, union representatives, first aiders, treating physicians, personal physicians, corporate physicians, OHS nurses, OHS medical specialists, WCB personnel, and so on.

The typical basic 15 steps in the process are:

01. Employee reports injury;

02. First Aid (if available/applicable);

03. Immediate incident investigation (if possible), but defer to step 04;

04. Immediate Medical Treatment at nearest hospital, clinic, or doctor (competent, neutral, objective, unbiased). Review possibility of modified duties with treating physician (and probably pay the physician for his time to do the paperwork);

05. Joint management/Union investigation (as applicable);

06. Complete mill incident report within 24 hours of incident;

07. Complete Provincial/Federal WC report with signature within 24 hours of incident;

08. Review by next level of mill management — decision to challenge claim or not;

09. If no challenge advise payroll (send forms), send form to Provincial WC;

10. WC decision received and reviewed;

11. Monitor medical recovery progress (mill OHS dept) with employee and WC;

12. Medical Review (if unfit, decision to recommend Modified Duties or Rehabilition Procedures);

13. Doctor declares employee fully fit to return to former job;

14. Supervisor reports employee back to work during first shift back;

15. Claim closed, WC notified (file with mill MIS system).

John E. Little, B.Eng/CRM, is a risk management consultant and can be reached at: jelittle@videotron.ca


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