Workers Compensation

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					Workers Compensation
       Awareness Session
         Denis St-Jean
Compensation Awareness
 Your Name

 Function

 Experience, Knowledge -
 Challenges / Expectation?

 Facilitator
   Introduction
   GECA
   Collective Agreements
   TBS Policies
   How to get a claim
    approved by the Board?
   Roles of Parties
   Other Compensation
   Conclusion / Feedback
   Lifecyle of a claim
      Before the Injury
      The Injury
      Compensation
         Short term
         Permanent
      Return to Work
         Accommodation
            Short term
            Permanent
GECA (1918 ; 1952)
   Government Employee
    Compensation Act – 1918 reviewed
    in 1952
     Covers Federal Government
      Workers – 300 000
     Coverage a personal injury by an
      accident and/or desease arising out
      of and in the course of employment
     References to Provincial Workers
      Compensation Acts

   No Fault System
   Employer assumes financial
    cost while workers gave up their
    right to sue
   Provincial / Territorial Boards
    adjudicate claims
   Same basic principles between
    Boards, but there are
    differences in benefits

   Coverage includes:
     Loss of earnings
     Non-economic loss

     Medical, medication

     Rehabilitation

     LMRs

     Return to work provisions

   Summary
       Provincial / Territories
        Compensation Legislation
          Benefits
          Adjudication & Appeal Process

       HRSDC – Labour Program
          Administrative Agreement
          Funding

          3rd parties

   Challenges
     Determining extent to which
      GECA incorporates provincial
      laws – lack of clarity
     Presumption clauses application?

     Rate / conditions vary from
      Province to province
     Last review 1952 – but provinces
      update regularly their act
   Challenges
       Philosophy of Compensation has
        evolved since GECA was reviewed,
        many concepts are absent, but
        present in Provincial acts:
         Presumption clauses
         Return to work

         Worker rehabilitation

         Time limits

         Fines and penalties

       How to train PSAC members
Injury-On-Duty Leave
 37.01 An employee shall be granted injury-on-duty leave
    with pay for such period as may be reasonably determined
    by the Employer when a claim has been made pursuant to
    the Government Employees Compensation Act and a
    Workers' Compensation authority has notified the Employer
    that it has certified that the employee is unable to work
    because of:

(a) personal injury accidentally received in the performance of
    his or her duties and not caused by the employee's willful
(b) an industrial illness or a disease arising out of and in the
    course of the employee's employment,

if the employee agrees to remit to the Receiver General for
     Canada any amount received by him or her in
     compensation for loss of pay resulting from or in respect of
     such injury, illness or disease, provided, however, that such
     amount does not stem from a personal disability policy for
     which the employee or the employee's agent has paid the

     Accumulation of Vacation
          Leave Credits

   34.02 For each calendar month
    in which an employee has
    earned at least ten (10) days’
    pay the employee shall earn
    vacation leave credits at the rate
Sick Leave With Pay Credits
 35.01

(a) An employee shall earn sick
  leave credits at the rate of nine
  decimal three seven five (9.375)
  hours for each calendar month
  for which the employee receives
  pay for at least ten (10) days.
   35.05 When an employee has insufficient or no
    credits to cover the granting of sick leave with
    pay under the provisions of clause 35.03, sick
    leave with pay may, at the discretion of the
    Employer, be granted to an employee for a
    period of up to one hundred and eighty-seven
    decimal five (187.5) hours, subject to the
    deduction of such advanced leave from any sick
    leave credits subsequently earned.

   35.06 When an employee is granted sick leave
    with pay and injury-on-duty leave is
    subsequently approved for the same period, it
    shall be considered, for the purpose of the
    record of sick leave credits, that the employee
    was not granted sick leave with pay.
Article 54
Leave With or Without Pay for Other
54.01 At its discretion, the Employer may
 (a) leave with pay when circumstances
  not directly attributable to the employee
  prevent his or her reporting for duty;
  such leave shall not be unreasonably
 (b) leave with or without pay for
  purposes other than those specified in
  this Agreement.

   Other impacts:
     Sick / Vacation Leave Credits
     Employment Insurance Eligibility
     CPP / QPP Benefits
     Pension Plan
     Disability Insurance
     Life Insurance
     Medical / Dental Insurance
     Other benefits
Workers’ Compensation
Injury and Illness Policy
Work-Related Injury Or Illness (Appendix C1)
Workers' Compensation
   An employee injured in an accident at the workplace or
    disabled by reason of an illness due to the nature of his
    or her employment, is entitled to receive compensation
    for loss of earnings, medical care and other benefits.
    These benefits are similar to those received by private
    industry employees through workers’ compensation in
    the province in which they work.
   The government provides these benefits to employees
    under the Government Employees' Compensation Act
    (GECA) administered by The Department of Human
    Resources and Skills Development (HRSDC). Instead of
    establishing its own system for compensation and
    treatment, the government uses the services already
    available through provincial workers’ compensation
   The regional offices of Labour Canada are responsible for
    receiving and processing claims through to the appropriate
    provincial authority. They provide a general advisory service to
    employees and unions, as well as to employers, on the
    interpretation and application of the legislation.
 compensation for loss of earnings (if
  an injured employees is not entitled
  to injury-on-duty leave);
 medical, hospital, and related
 rehabilitation services;
 a pension, if an injury results in a
  permanent disability; and
 pensions to dependants of
  employees who are fatally injured in
  the course of their employment.
Injury-on-duty leave

   To avoid duplicate payment, it is
    extremely important that
    personnel officers indicate on
    the original injury report whether
    the injured employee is entitled
    to injury-on-duty leave, which is
    provided for in the collective

Information booklets
 There are two information booklets
  available from Labour Canada. A
  handbook entitled "If You Have an
  Accident" should be provided to all
  employees, and a booklet entitled
  "Employer's Guide" should be in the
  hands of all persons responsible for
  the reporting of injuries.
           Employers' Guide
Disallowance of claims

The most common reasons for disallowing a
  claim are the following:

   It is not shown clearly that the disability is
    the result of an accident, or occupational
   The injury or occupational disease reported
    did not arise out of and in the course of
   A description of an accident is given, but
    the disability is not the result of it.
   The injury reported is not substantiated by
    medical evidence.
         Injury-on-Duty Leave
   Employees of the CRA are
    eligible for benefits provided by
    the Government Employees’
    Compensation Act for personal
    injury resulting from an accident
    in the course of and arising out
    of their employment or an illness
    that was a consequence of their
        Injury-on-Duty Leave
Right to Choose Doctor
 An injured or ill employee has the
  right to choose a doctor for the
  required treatment, but once the
  choice is made it must be
  adhered to. Permission to
  change doctors must be obtained
  in writing from the provincial
  workers’ compensation authority
  except in Quebec where there is
  no such restriction.
Verification of disability period
 While CRA is awaiting the receipt of
  certification required for the granting of injury-
  on-duty leave, the disabled employee may be
  granted sick leave to the extent of his or her
  sick leave credits.

   If the employee has insufficient sick leave
    credits, he or she may be advanced additional
    sick leave in accordance with the terms of the
    collective agreement. When sick leave is
    granted and injury-on-duty leave is
    subsequently approved for the same period,
    the employee is to be credited with the number
    of days of sick leave involved.

Termination of injury-on-duty
 Injury-on-duty leave should not
  be granted beyond the date
  certified through Labour Canada
  that the employee is fit for work,
  including "light duty" work,
  where it is available.

Termination of injury-on-duty leave
 Normally, after 130 (working) days,
  all employees will be paid directly by
  the provincial workers’ compensation
 The level of payment will be based
  on the provincial regulations.
Termination of injury-on-
 duty leave

   Provincial wage
    compensation benefits for
    totally disabled employees
    are generally 75% of
    earnings, based on a
    maximum annual earnings
      Duty to Accommodate Persons with
    A request for accommodation need not be in writing,
    but should be communicated as clearly and
    specifically as possible. The person to whom the
    request has been directed should do the following:

   Determine the type of accommodation required, based
    on information provided by the employee.
   If the candidate or employee does not know what type
    of accommodation is required, consult experts in the
    field to determine the appropriate accommodation.
    This could include the person's own physician,
    psychologist or centres of expertise within the Public
    Service Commission or the accommodating
   Provide the accommodation based on the request of
    the person being accommodated, or, if necessary, on
    the advice of experts.
             Duty to Accommodate

   Persons requesting accommodation may be
    asked to provide documentation from a
    qualified health care professional to clarify
    the limitations caused by the disability
    and/or the type of accommodation that
    would be most effective.

   Any medical records provided should be
    kept strictly confidential and separate from
    personnel files. Requests for this type of
    information should come from personnel
    designated to deal with accommodation
    requests and trained to handle potentially
    sensitive medical information.
          Duty to Accommodate

   CRA should develop their own internal
    procedures for dealing with
    accommodation requests, including
    mechanisms for resolving situations
    where accommodation is denied. All
    candidates and employees should be
    advised of such procedures.
   Persons who are denied
    accommodation may also wish to use
    the recourse mechanisms set out in
    the Canadian Human Rights
How to get a claim approved
by the Board?
How to get a claim approved
by the Board?
   Claiming Workers
     When?
     How?

     What should I say / not say?

     What if I need accommodation?

     Where can I get help?
    How to get a claim approved by
    the Board?
    Definition of Acccident includes:
       A chance event
        occasioned by a physical
        or natural cause; or
           The biggest reason for
             the denial of these
             claims is a lack of proof
             that an injury happened
       A disablement arising out
        of and in the course of
           The major reason for the
             denial of these claims is
             lack of prrof that the
             work caused the injury
How to get a claim approved
by the Board?
    Personal injury by an accident
    and/or desease arising out of and in
    the course of employment:
  Do not say: I fell and hurt myself.

  Say: I was walking through the office in
    the scanning division. I stepped on a
    marker that was on the floor. My right
    leg went forward and I lost my balance.
    I fell backwards. I hit my shoulder on
    the fax machine. I hurt my right
    shoulder on the machine. When I
    landed on the floor, I hurt my right
    wrist, my neck, and my right hip.
How to get a claim approved by
the Board?
Reconsiderations and Appeals

  Ontario:                Québec
   A notice of
                             A written letter
    Objection must
    be in writing
                              to the CSST
                                 30 days to
   6 month time
    limit to appeal               appeal intial
    Except for RTW
    / LMR: 30 days           A form must be
   Two (2) levels            completed to
    of appeals                the CLP
        ARO / Tribunal          45 days to
Making a Case Plan:
 Open a file for each worker
 Keep copies of all information
 Record all activities
    Phone calls
    Interviews
    Letters
 Confirm with the worker what issues will be
 Priorize issues and action
 Note the date and level of decision by the Board
  relating to each issue
 Note any issues that arise in qualifying for benefits
 Determine what information is required
    Witnesses
    Medical information
    Physical demands
    Exposures
 Analyze each problem and outline action plan
      It is better to talk in person rather than over
       the phone
      Advise the worker to bring copies of all
       correspondence & information received
      Encourage the worker to explain the problem
      Review any document the worker has
       received from the Board or doctors for a
       history of the claim
           Pre-accident job history
           Description of job at the time of accident
           Description of the accident
           Events since the accidents
      Review the relevant facts to make sure you
       understand correctly
       Complete and send Authorization form
        to the Board
       Include worker’s name and claim
       Explain reasons why you are writing
        and the actions you wish the Board to
        Take care
       Explain any new information, indicate
        why they are important
       Explain your arguments
       Make sure the decision maker
        understands the issue
       Keep a record of all calls
  Introduction of yourself and your
   relationship to the worker
  Reasons why you are writing
  Brief statement of issue
  Relevant brief background and
  Request the doctor’s medical
   opinion regarding the issue under
  Request that the opinion be
Local / Component
     Identify local representative, involve this person
      in the representation process
     Identify Service Officer and communicate with
      him/her to assistance and follow-up on accident
      investigation and corrective/prevention
      measures as well as leave advance if required,
      and eventually return to work strategy.
         participation by a worker representative on the
          accident investigation team, will permit to obtain
          key information on accident causation which will
          often help the injured worker in making a
          demonstration that the worker’s injury was caused
          –by an accident arising out of and in the course of
          his employment or is disabled by reason of an
          industrial disease due to the nature of the
          employment -.
     Assist member when a grievance may be
      required following being advised by the
      employer that the employee will be
      terminated if they choose to resign or to
      apply for medical retirement
 Local / Component
    TOOL
Open file
 Attach summary
    Name of worker
    Member number
    Component
    Local
    Employer data
    WSIB File Number
    Injury/disease type
    Date of accident
    Name of treating doctor
    Decision under appeal – date
    timelines for appeal
 Document all telephone conversation, interviews and letters
 Protect appeal deadline with sample letter (template to be
  provided) stipulating that you are protecting the appeal deadline,
  you want a complete copy of the file, you will analyze the file and
  further advise the Board whether you will pursue the
 Ensure that the worker and its Local/Component representatives
  understand that they are custodians of their claims
Local / Component
   It is recommend that each local has at least
    one person that has basic understanding of
    the WCB process who can assist the worker
    in writing the initial claim to ensure key
    elements of the description of event are
    included and to work with the worker to
    obtain sick leave credit advances from the
    employer and/or apply for other benefits
    while the Board analyzes the eligibility of the
    claim. A local representative should also
    work with the worker and the employer to
    ensure that accommodations are put in
    place when a worker has functional
    limitations requiring it.
Regional Office
 Work with member in need of Representation
  for Workers Compensation appeal
 Work with Component and Locals for:
       Initial claim
       Process explanation
       Appeal preparation
       Explain Workers Compensation decisions and
        impacts for member and workplace
   Provide training for interested Local officers in
    Rights and Obligations under Workers
    Compensation applicable Legislation
   Lobbies Provincial Federations of Labour for
    legislation amendments
   Work with Office of the Workers Advisors in
    those Provinces and Territories where they
    represent unionized workers

National – Program Section
 Represent Labour to Regulatory
  Review Working Groups
 Lobbies Government for GECA
  legislative amendments
   What if the Board takes a long time to decide on my claim
    or if the Board rejects my claim?
        Sick leave credits
        Sick leave advances
        Employment Insurance sick leave benefits (first 15 weeks) –
         max. 42 300$ / 55% (23 265$ annual)
        Disability Insurance (after 13 weeks) 70% / 66% / top up
        Canada Pension Plan Total Disability Benefits
        Public Service Superannuation Act
             (2% X # years)
        Welfare

   WSIB: max. 75 100$ annual / 85%
   CSST: max. 62 000$ annual / 90%

   I you apply for these benefits you must let them know that
    you are also applying for WCB benefits. They will ask you
    to sign a form which is a promise to pay back the money
    you may receive from WCB.
   Lifecyle of a claim
      Before the Injury
      The Injury
      Compensation
         Short term
         Permanent
      Return to Work
         Accommodation
            Short term
            Permanent
Denis St-Jean
National Health and Safety Officer
Public Service Alliance of Canada