Discussion and analysis
The WSIB is one of the most comprehensive workplace injury and illness 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 2017, we served more than 5.4 million people and over 300,000 employers, registered 239,000 claims, and issued $2,672.7 million in benefit payments. The WSIB is committed to ensuring a sustainable insurance system for employers and employees, and improving outcomes for those with workplace injuries or illnesses.
The Accounts and Claims Enterprise System (ACES), the WSIB’s case and account management solution, revealed that some limited-entitlement claims were inaccurately coded as lost-time claims.
Limited-entitlement claims are claims where:
health care benefits are granted, and
loss-of-earning benefits are not granted because appropriate modified work is available.
This is a reporting issue only. It does not affect how claims are managed or the WSIB’s financial liabilities.
We are correcting our claims coding for 2017 to ensure clarity and accuracy in future reporting. The WSIB strongly believes that ensuring people receive the benefits that they are entitled to is important to the integrity of the workplace safety and insurance system. We will therefore continue to track limited-entitlement claims and assess their impact on employees’ benefits.
Summary of performance for Schedule 1
The WSIB’s integrated recovery and return-to-work approach continues to result in positive outcomes. Over the past 10 years, the workforce covered by the WSIB has grown by 15 per cent, while the number of registered claims has decreased by 25 per cent. The 2017 lost-time injury rate was 0.95 and continues to be the lowest amongst all jurisdictions in Canada.
Workplaces, people, and claims
Since 2008, 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 2008 and all 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 recovery and return-to-work time. These claims involve injuries related to the lower back, shoulders, and fractures. They typically have higher treatment costs and longer recovery times. Over the past five years, high-impact claims represented 42 per cent of all lost-time benefit payments, and 30 per cent of all lost-time claims.
Access to timely, quality health care is an important factor in supporting recovery and return to work after an injury or illness. That is why we continue to enhance the network of specialized assessment and treatment services across the province for lower 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 workplace injury or illness has remained relatively stable in recent years. Compared to 2016, the percentage of people receiving loss-of-earning benefits at three months after an injury or illness increased to 13 per cent in 2017 and the percentage receiving loss-of-earning benefits at six months increased to eight per cent for 2017.
Benefit payments increased slightly in 2017, breaking the decreasing trend since 2013. Changes to the service delivery model, specialized and timely health care and positive improvements to the return-to-work program have resulted in a six per cent decrease in Schedule 1 total benefit payments from $2,518.4 million in 2013 to $2,359.8 million in 2017. At the same time, after adjusting for inflation, the amount of loss-of-earning benefits paid for a single day off work has remained relatively stable.
The WSIB continues to emphasis 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 88 per cent of people returned to work upon completion of their work transition plan in 2017, as compared to 84 per cent in 2016.
In 2017, the WSIB’s return-to-work staff made over 22,000 visits to Schedule 1 & 2 employers to build case-specific plans for people and their employers early in the claim and to demonstrate an increased focus on return-to-work in case management. In addition, approximately 89 per cent of Schedule 1 and 2 people with injuries were off full loss-of-earnings benefits within a month of a Return-to-Work Specialist's visit. We have more than 200 professionally designated work transition specialists who provide additional return-to-work support in circumstances where the person requires a longer plan. Our vision is to support people 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 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 all those we serve.