Q&A with the Saskatchewan Workers’ Compensation Board

WCB CEO Phil Germain responds to questions from SHCA members

What prompts an internal review of a file?

Phil Germain (PG): We have different ways to conduct quality assurance and quality control. We have a new risk-based quality assurance program in which we pick a data point, such as August, and look at average durations of claims based on the area of injuries, such as body type, shoulder or neck, for the prior year.

We then focus our review on the claims that are outside of the normal averages. If there’s a group of claims that are outside of the averages, we’ll look at those claims and figure out why they are taking longer than what would be considered typical. Our goal is to conduct about 20 reviews every month.

What quality checks are in place to minimize administrative errors that can not only cost employers on their account, but also where employers can incur additional costs to appeal the issue if using a third-party provider?

PG: There’s going to be some administrative costs for an employer to register with the WCB, report annual payroll, get clearances for contractors and manage injuries including disability management and return to work. We know that some employers hire third parties to help them with these activities. There’s no question that both employers and the WCB incur additional administrative costs associated with unintentional errors either by the WCB or employers. Our main objective is to understand the root cause of those errors and try to make the necessary process and/or system changes, so we can prevent these errors from happening in the first place.

“Some employers hire third parties to help them with WCB-related activities, which is an indication that our processes probably need to be adjusted and made easier for our customers.”

– Phil Germain, WCB

How does the WCB work with a company’s modified program, particularly in cases where a worker has left their employment?

PG: Our goal is to have every worker recover and return to work. Modified programs available for injured workers who left their employment would be dependent on different factors. If the worker left because they were laid off, we would continue to manage that claim until the individual had recovered to their pre-injury work condition. The claim would then be closed, other than possibly some medical costs. If they were no longer working for that employer, and they had reached their pre-injury work ability, we would help them find a new job. If the injury is so severe that they needed permanent restrictions, we would wait until the claim stabilized so we could understand the nature of the restrictions. After that, we would start to consider different vocational options for the worker.

If a worker voluntarily leaves a modified return-to-work program, or basically refuses a medically-approved modified work program, it could put their benefits in jeopardy. The only reason I’m saying “could” is because we’re assuming that individual would get their benefits cut off just by refusing to return to work. That’s not necessarily taking into account other complicating factors that can be a result of the injury, such as mental health issues. Sometimes people’s lives are turned upside down because of the impact associated with a work injury.

Many employers have good return-to-work programs that are not being utilized because case workers seem primarily focussed on the employee. What is being done to ensure physicians are aware of employer’s return-to-work programs so that they can prescribe the appropriate modified work duties and expedite a safe return to work?

PG: Ideally, we want to start with return-to-work as the end goal and work backwards to figure out how we’re going to get there. Getting the individual back to work, even in a modified work setting, is what’s best for both the worker and the employer. Our staff make every effort to ensure they keep healthcare providers aware that modified work is available and that we’re striving to get the current work restrictions from that healthcare provider. We get that information to the employer to help facilitate an early and safe return to work. Some of this is a constant back and forth between all the stakeholders and can take days to get sorted. We’re reaching out to the worker, then we’re reaching out to the doctor, which can take a few days, and then we’re reaching out to the employer. We need to confirm with the employer if they have modified work duties available and then it’s back to the healthcare provider. It’s easy for four or five days to go by as we’re trying to connect with people and get the information to make a good decision with a focus on recovery and return to work.

Now, having said all that, we know our processes are not applied consistently 100 per cent of the time, and even at that, our processes can be more efficient. We agree that with the right processes and systems in place, it is possible the decisions could take hours, not days. This is why we are embarking on a claims transformation project, to completely reimagine our claims processes. We started this journey in 2020 with a value stream mapping event that included employer and injured worker representatives.

The current system seems to favour employees’ words over those of employers. This can result in what some believe to be fraudulent claims by some employees. It also makes employers feel like our side of the story is not being heard. Are you considering a fresh approach that better balances the needs of both employees and employers?

PG: The frustrations employers feel are legitimate and there are things that need to change within our systems and processes that will better enable us to work with employers. I think we’re learning what it takes to ensure overall better return-to-work outcomes, and there is no question employers need to be deeply involved with that process from day one.

“The frustrations employers feel are legitimate and there are things that need to change within our systems and processes that will better enable us to work with employers.”

– Phil Germain, WCB

An SHCA member hired a consultant to help with an appeal. While the appeal was denied, the consultant found that the member, because of a clerical error, had been overcharged in excess of $20,000 by the WCB. The member had to pay the consultant to find a costly error that the WCB created. What systems have you implemented to prevent this from happening again?

PG: Some employers hire third parties to help them with WCB-related activities, which is an indication that our processes probably need to be adjusted and made easier for our customers. In 2019, with the help from the heavy construction association, we launched the Employer Resource Centre to serve as a single point of contact for employers. Navigating our system at times can be hard, so by creating this centre, we can help provide the answers or internal connection you need to get the right answers quickly and efficiently. Having said that, we do have different processes that are intended to catch these anomalies and correct them.

Is the WCB open to creating an industry/WCB working committee or task force of SHCA and the WCB officials to address some of the membership’s ongoing concerns?

PG: Our approach is to tap into existing structures and not create new committees or structures if they are not necessary. We find it more efficient for us and our customers if we can utilize existing structures like industry human resources committees, board meetings or conventions to dialogue with industry and understand what’s working and what’s not working. These meetings would be over and above the development of our new Voice of the Customer program that we are launching in 2021. Finally, as many in the heavy construction industry have done, we encourage employers to reach out to any of our senior leadership team if they have specific questions related to their business.