Northern Exposure

Overcoming the hurdles in managing workers’ compensation claims

by David Marchione, OHS Consultant/Paralegal

Many employers struggle to efficiently manage workers’ compensation claims. Most provincial experience rating programs established by workers’ compensation boards are based on two things: claim costs and claim duration. Thus, a failure by an employer to efficiently manage a claim can result in increased costs and increased duration of the claim, thus leading to a negative impact on the employer’s experience rating. The situation is further complicated by the fact that managing a worker’s return to work often becomes more difficult as time passes.

One of the most common challenges for employers dealing with complex workers’ compensation claims involves gathering updated and timely information regarding the worker’s current functional abilities. This difficulty may be caused by uncooperative workers, delayed communications from the compensation board or conflicting information received from the compensation board, and the worker’s physician as to the worker’s progress.

However, there are a number of things that employers can do to more effectively manage this process. First, employers should gather as much information as possible about the worker’s injury at the outset of the claim, including the area of injury and the mechanism that caused it. This information will help identify the activities the worker should avoid during the acute phase of the worker’s recovery and will help narrow the forms of possible accommodation required for the work-related condition.

Employers should also ensure that they maintain regular communication with the injured worker throughout the worker’s recovery period in order to facilitate a return to work as quickly and safely as possible. Employers should ask workers about the type of treatment they are receiving and how often. This information is critical in cases where a worker has not yet returned to work after an injury.

Employers are not precluded from assisting workers with finding appropriate treatment, such as physiotherapy, which might expedite the worker’s recovery. Furthermore, it is perfectly appropriate for an employer to ask workers how they are progressing with treatment—e.g., are they attending the treatment and is it helping them? If not, an employer can recommend that a worker follow up with his or her physician to determine if a different treatment may be in order.

In addition, employers should explore all options for gathering information about a worker’s functional abilities. While many employers rely on a worker’s family physician for this information, there may be other treating medical practitioners who are better placed to provide the information. For example, physiotherapists, chiropractors, and other specific practitioners can be an excellent source of functional abilities information, particularly in situations where these practitioners are seeing the worker often and taking the lead in providing treatment to the worker. As such, their input may be more useful than the input of the worker’s family physician when an employer is evaluating the return-to-work process.

Likewise, it is also very important that the worker’s treating medical practitioner be made aware that the employer offers modified or accommodated work, that such work is available, and the specific details of such work.

In more complex cases, employers may wish to consider sending a worker for an independent medical examination paid for by the employer. As these examinations can be costly, they should be used only in circumstances such as where the employer is faced with incomplete, inconsistent, or contradictory medical information. Often, these examinations can be helpful in clarifying a worker’s functional abilities and assessing whether the worker is capable of performing specific duties or tasks.

Each compensation board may have different policies surrounding independent medical examinations, so it is important for an employer to consult with the case manager involved if it is considering asking for one. In addition, any independent medical examination should be undertaken in accordance with any governing collective agreement and/or employer policies addressing the issue.

In conclusion, it is not uncommon for employers dealing with workers’ compensation claims to have difficulty gathering information about a worker’s current functional abilities. However, rather than simply letting a claim run its course—while the costs of that claim escalate—employers should instead work to be as proactive as possible in managing the claim, both for their own benefit and that of the worker.