Workers’ Compensation – The Small Picture: what’s your claims nightmare?

This is the second in a three-part blog series on the relationship between workplace culture and the costs associated with occupational injury and illness.

If you have been involved in workers’ compensation claims with your organization, I am pretty sure you have at least one horror story. Unfortunately it isn’t the just the horror story that needs attention.  A couple of years ago I was working with a medium-sized Ontario manufacturer and was reviewing their Workplace Safety and Insurance Board (WSIB) New Experimental Experience Rating (NEER) quarterly statements and was asking questions regarding all their lost-time claims. Few were outstanding in terms of costs or duration but as I went through them, one stood out as we discussed the circumstances.

The employee was a long-term worker with over seventeen years of uninterrupted service and an excellent work record. She had a couple of health care-only claims but this one was a three-week lost-time claim. The story was she had come in to work as normal on the Monday morning but as she was leaving at 3 p.m. she told her supervisor she had ‘hurt her back’ at 9:30 in the morning. The following day she called in and told the employer her doctor had ordered her off work for two weeks. She also brought in a doctor’s note. The company diligently completed and submitted the Form 7 (Ontario WSIB Report of Injury) as well as conducted an accident investigation. They also offered ‘modified’ duties which the employee’s doctor felt was ‘too soon.’ After the second week a second note authorizing a further week off was presented and the employer contacted the WSIB to facilitate a return to work. By the end of the week the employee returned to the modified work with doctor’s permission.

Now while the costs and duration of this claim were not significant, the story itself is. First of all the Monday that the incident occurred happened to be the first day of March Break and all the schools were closed for that week. When we checked, we found the employee had five school-age children. While her mother normally took care of them, when we spoke to her supervisor, he recalled a discussion wherein she told him that her mother and father had taken a two week trip to Portugal starting the week of March Break. 

While the employee may not have intentionally faked the injury to look after her family, when the opportunity to be off and take care of her children, there was little direct intervention to offer alternatives. Of course her responsibility was to communicate appropriately but the level of engagement and commitment was less than desired despite a seventeen-year good-work record.

What’s your lost-time or workers’ compensation nightmare? Tell us in the comments section below.

Robert Smith is an injury management, human resource and disability management expert with decades of experience in the field, including years within Ontario’s WSIB.

One thought on “Workers’ Compensation – The Small Picture: what’s your claims nightmare?

  1. Nice information! From my point of view benefit is based on your average weekly wage for the 52 weeks prior to the date of injury. Worker’s compensation pays 66⅔ percent of your average weekly wage, up to a maximum of $650 per week.

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