Discussion and Analysis
The WSIB is one of the most comprehensive workers’ compensation benefit systems in North America. Between Schedule 1 and Schedule 2 employers, we cover 16 industries and employers that are self-insured within the province of Ontario. In 2016, we served more than 5.3 million workers and over 300,000 employers, registered 230,000 claims, and issued $2,521.4 million in benefit payments. The WSIB is committed to ensuring a sustainable insurance system for employers and workers, and improving outcomes for injured workers.
On December 6, 2016, the WSIB’s Accounts and Claims Enterprise System (ACES) was fully implemented. ACES is our modernized, integrated solution for administering employer accounts and managing worker claims. The implementation of our new system is improving our ability to respond to customers’ needs. In addition, our eAdjudication processes are facilitating faster eligibility decisions and earlier interventions for recovery and return to work. We discovered that some limited-entitlement cases which should have been coded as no lost time claims have, in fact, been coded as lost time through the adjudication process. Limited-entitlement claims are claims where health care benefits are granted but loss of earnings benefits are not because appropriate modified work was available. To ensure clarity and accuracy in future reporting, we have corrected our claims coding for 2017. In 2016, however, a small number of metrics included in By The Numbers were affected. Most observable for 2016 is an increase in the lost time injury rate and allowed lost time injuries, but a decrease in the no lost time injury rate and no lost time injuries. These nuances should be taken into consideration when using the By The Numbers report and data this year.
Summary of Performance for Schedule 1
The WSIB’s integrated recovery and return to work approach continues to result in positive outcomes for both workers and employers. Over the past 10 years, the workforce covered by the WSIB has grown by 11 per cent, while the number of registered claims has decreased by 31 per cent. The 2016 lost time injury rate was 0.94 and continues to be the lowest amongst all jurisdictions in Canada. These sustained trends seem to demonstrate that the workplaces of Ontario are becoming safer work environments.
Workplaces, Workers, and Claims
Since 2007, the services, health care, manufacturing, transportation, and construction sectors accounted for over 80 per cent of both WSIB covered employment and allowed lost time claims. These five industry sectors experienced an overall decrease in allowed lost time claims since 2007 and all but manufacturing have experienced an increase in covered employment over the same time period.
Continued Focus on High Impact Claims
High impact claims are a subset of allowed lost time claims that have significant impacts on workers and employers in recovery and return to work time. These claims involve injuries related to the low back, shoulders, and fractures. They typically have higher treatment costs and longer recovery times. Over the past five years, high impact claims represented more than 40 per cent of all lost time benefit payments, and between 32 per cent and 34 per cent of all lost time claims.
Access to timely, quality health care is an important factor in supporting recovery and return to work for injured workers and employers. That is why we continue to enhance the network of specialized assessment and treatment services across the province for low back and shoulder injuries. These improvements in health care approaches have improved our overall case management of high impact claims. In addition, high impact claims as a percentage of all Schedule 1 claims have been declining over the past five years.
Recovery and Return to Work Outcomes
The average number of days lost within one month post injury or illness has remained relatively stable in recent years. Compared to 2015, the percentage of workers receiving loss of earning benefits at three months from injury or illness held steady at 11 per cent in 2016 and the percentage receiving loss of earning benefits at six months also remained steady at six per cent for 2016.
Benefit payments have continued their decreasing trend since 2012. Changes to the service delivery model, specialized and timely health care for injured workers, and positive improvements to the return to work program have resulted in a 16 per cent decrease in Schedule 1 total benefit payments from $2,664.3M in 2012 to $2,252.3M in 2016. At the same time, after adjusting for inflation, the amount of loss of earning benefits paid to an injured worker for a single day off work has remained relatively stable.
Contributing to improved return to work outcomes is the WSIB’s ongoing emphasis on an integrated approach to recovery and return to work, including specialized medical assessment and treatment services. Our work transition program also continues to result in positive outcomes. Approximately 84 per cent of injured and ill workers returned to work upon completion of their work transition plan in 2016, as compared to 79 per cent in 2015.
In 2016, the WSIB’s Return to Work staff made approximately 25,000 visits to Schedule 1 & 2 employers to build case-specific plans for workers and employers early in the claim. This is almost 20 per cent more visits than in 2015, the result of an increased focus on return to work in case management. In addition, improved return to work outcomes by Return to Work Specialists have meant fewer cases have required a referral to Work Transition Services. In 2016, approximately 89 per cent of Schedule 1 and 2 injured workers were off full loss of earnings benefits within a month of a Return to Work Specialists visit. As well, we have more than 200 professionally designated Work Transition Specialists who provide additional return to work support in circumstances where the worker requires a longer plan. Our vision is to support injured and ill workers to return to productive and safe employment. For employers, our approach ensures minimal disruption to their workforce as they continue to have an experienced and productive employee stay with their company. The WSIB is proud of the improvements we’ve achieved in improved return to work and recovery outcomes.
The WSIB continues to make investments in service quality and timeliness. We have an ongoing commitment to improving our systems and making a more sustainable and transparent compensation board that provides effective and efficient service to workers and employers.