The Foundations of Workers’ Compensation – Legislation and Policy

The Foundations of Workers’ Compensation – Legislation and Policy

Susan Hynes, Director, Compensation and Assessment Policy, WorkSafeBC

Mental Health Info SessionSeptember 20, 2010

Overview of Presentation

• History of workers’ compensation• Importance of legislation and policy• Major legislative changes• Major policy developments• Health care policy review

History of Workers’ Compensation

• Workers’ Compensation Act first came into effect in BC in 1917.

• The genesis of the workers’ compensation system arises from the “historic compromise”.

• Workers gave up their right to sue their employers in court in exchange for protection from income losses arising from a work injury or disease, regardless of fault.

• Employers fund the system in exchange for protection from law suit.

Importance of Legislation

• WorkSafeBC is responsible for administering the workers’ compensation system in BC.

• The Act sets out WorkSafeBC’s responsibilities with respect to such things as:• Determining compensation for workers and

dependents• Funding the system - assessment of employers• Health and safety

• The legislation is established by the Provincial Government

Importance of Policy

• Policy provides direction and guidance to WorkSafeBC decision-makers.

• The legislation sets out the powers and duties of the Board of Directors. They include:• Establish policy and regulation priorities;• Provide general direction on policy and regulatory

issues; and• Approve policy and regulations.

Policy and Research Division

• Responsible for:• Identifying policy and regulation priorities;• policy development; • and stakeholder consultation

• Assist the BOD in fulfilling its mandate by:• Providing thoroughly researched, objective policy

options and implications which incorporate the views of stakeholders

• Support and enhance achievement of the WorkSafeBC strategic objectives and initiatives

Legislative Developments

• Little change in the Act after 1917.• 2001 Core Review of workers’ compensation• 2002 – major changes to compensation and

governance legislation:• Changes to the calculation of benefits• Changes to the permanent disability award system• Creation of the Board of Directors

Policy Binding on Decision-Makers

• Prior to the 2002 changes, policy considered a guideline – not binding on staff or appeal bodies

• Bill 49 legislative change requires decision makers to apply the policy that is applicable to the case.

• Change has elevated the importance of policy in the workers’ compensation system.

• Resulted in more legal challenges to policy.

Bill 49 - Mental Stress Provision

• Expressly excludes mental stress except where:• an acute reaction to a sudden and unexpected

traumatic event arising out of and in the course of the worker’s employment,

• diagnosed by a physician or a psychologist as a mental or physical condition that is described in the most recent American Psychiatric Association’s DSM, and

• not caused by a decision of the worker’s employer relating to the worker’s employment.

• No coverage for gradual onset stress

Plesner Court of Appeal Decision

• On April 30, 2009, the BC Court of Appeal issued the Plesner decision.

• The majority determined that section 5.1(1)(a), when read with the policy, discriminates on the basis of mental disability under the Charter.

• Severed several portions of the policy which they found gave rise to the discrimination.

• Specifically deleted words such as “horrific” or “severe”, even though used in the DSM.

Mental Stress Policy Changes

• Deletion of the severed policy statements and examples.

• Inclusion of a definition of a traumatic event as “an emotionally shocking event”.

• Include statement that an acute reaction may be delayed in certain circumstances.

• Changes effective April 30, 2009.• Further challenges underway on chronic stress.

Health Care Policy Review

• Full re-write of 87 health care policies• Focus on:

• Removing outdated processes• Updating language• New policy format• Addressing issues with individual policies

• Aiming to take draft policy out for stakeholder consultation by first quarter of 2011.

Health Care Policy Review

• Out of date in terms of:• Last reviewed in the early 1990’s• Do not reflect advancements in health care.

• Number of issues, such as:• Provision of new and emerging treatments• Opioids and other potentially addictive medications • Provision of equipment such as hot tubs, ATVs,

herbal medicines, sun glasses, etc.• Benefits for the severely disabled

• Respite Care• Adequacy of Allowances

Goals of Health Care Policy Review

• Ensure that policy appropriately guide the provision of health care benefits and services.

• Resolve disputes regarding the provision of health care benefits and services which result in client dissatisfaction, reviews and appeals.

• Provide appropriate benefits and services to the most seriously injured to alleviate the effects of the injury and improve their quality of life

Other Policy Projects

• Chronic pain policy review – issue currently on hold pending a Supreme Court of Canada decision.

• Review of the Permanent Disability Evaluation Schedule.• Includes the Psychological Disability Schedule which is

used to assess permanent psychological disabilities.• Incorporates aspects of the AMA Guides and DSM.• Currently underway, aiming for release for public

consultation in 2011.

Questions and Discussion

• Thank you for the opportunity to speak with you today.

• I’d be happy to answer any questions!

Your Roles and Responsibilities When Working with WorkSafeBC

Lee Grimmer, Ph.D., R. PsychSenior Psychology AdvisorPsychology Services


Thank You to Providers!

• Your attendance today & the time away from your practice

Disclosure Statement

WSBC benefits to presenter• Free float plane ride from Nanaimo (& return)• Free cookies

Outline for this session

• Psychology Advisors’ roles & responsibilities (R & R)

• Providers’ roles & responsibilities (R & R)• Role Complimentarity• Your questions• Resource List – Who are you going to call?

• FAQ handout

What do Psychology Advisors do for Providers?

• Ensure that psychological reports are accurate, and that conclusions regarding causality, limitations/restrictions, etc. are clinically justified.

• Monitor treatment to ensure that ongoing treatment is appropriate, beneficial and evidence-based.

PA Role

• Monitor risk of client self harm to ensure appropriate precautions have been put in place.

• Regularly communicate with treatment and assessment providers to ensure they understand and fulfill client & WSBC Team needs in this context

WSBC Expectations of Providers

• Critical thinking & problem solving• Familiarity with www.worksafebc.com website• For example – how to find Provider Bulletins on

the website • Screen shots to follow

http://www.worksafebc.com/

How to Find Psychology Bulletins

How to Find Psychology Bulletins

How to Find Mental Health Bulletins

Providers R & R’s

• Know how to conduct risk assessments, identify risk factors (risk of self-harm) & develop interventions

• Provide psychological limitations and restrictions in practical language (medical R & L’s are provided by physicians)

Expanded comments(I digress)

• Restrictions & Limitations• Psychological only; medical ones come from Medical Advisors or other

physicians

• Restrictions = what psychological / behavioural activities should someone avoid at risk of immediate, negative consequences for themselves / others as a result of the work injury / their psychological condition?

• Limitations = what psychological / behavioural activities a worker will have difficulty with as a result of the work injury / their psychological condition?

• Please remember to make these operational & practical for the worker, the Case Manager and the Vocational Rehabilitation Consultant. If you need help formulating these, talk to the referring PA.

• Restrictions and limitations are important clinical information to the claim.

• There are a number of Provider Bulletins that discuss psychological R & L and how to work with various disorders in a managed health care context.

Providers’ R & R’s

• Keep current by reading the Bulletins.• Time management – keep track of report due

dates and treatment end dates• Be aware of the resources in your community

that might be a source of support for your worker• Awareness that WSBC works within legislation• Help clients remain focused on Return To Work

Expanded Comments

Critical thinking and problem solving• Subjective reports and complaints• Your professional and objective commentary /

opinions• How to reconcile these two perspectives in a

sensitive and ethical manner?• What do you think of the subjective report &

why?

Expanded comments

• Risk assessments – we rely on your judgement because you see the worker directly; • Do you need help establishing a risk review checklist? • Threat reports (internal protocol) • Bulletin about working with suicidal clients.

• Identify Risk factors – demographics, chronic pain, mood disorders, substance use & past history – be prepared to comment on these when you call the PA

• Free resources for workers – free services Workers’ Advisers, FAIRPRACTICES (formerly the Ombudsman), Appellate

Bodies

Timelines

• Please keep track of treatment expiration dates and report due dates

• Some things to remember – it can take up to 72 hours from the time you fax in a report until it comes onto the PA’s electronic desk;

• Turnaround time for an extension request is about 10 working days;

• If the identification information is incomplete or inaccurate, reports are delayed in getting to the PA or may not arrive at all

Expanded comments

• WSBC works within the framework of the Workers’ Compensation Act of BC and the Policy Manuals

• You can access the Act from the website – have a look.• PA’s work to the WC Act and the Health Professions Act

(to name a few acts)• We recommend that you be familiar with WC Act as well

as your governing Acts & regulations

Expanded comments

• Return to Work focus in treatment

• Work, for most people, is a structured and positive aspect of

their lives

• Our belief is that returning to competitive employment is a

healthy step forward for the majority of our clients

• Some of our clients will not be able to return to competitive

employment due to the severity of their injuries, pre-existing

conditions or a combination of the two factors

• Some clients require ongoing long-term support after injury

Role Complimentarity

• Our role as PAs compliments yours as providers• We are here to try to help you work effectively in

a complex system• We rely on your accuracy, professional

judgement and opinions• We often have to call you for clarification

because of the interface between client and WSBC - thank you for your assistance!

Questions?

Thank you for your participation today!

My thanks also to Christine Sher, Christine Lynn, Lori Cockerill and Kim McGuire for editorial

comments and technical support for this presentation.

Sharleen MackenzieSenior Purchasing OfficerCorporate and Health Care Purchasing

Mental Health Treatment Contract


Who / what is CHCP?

Corporate and Health Care Purchasing (CHCP) is a section within WorkSafeBC’s Corporate Controllers' Department in the Finance Division.

Who is CHCP comprised of?

CHCP is comprised of Managers, Procurement Analysts, Senior Purchasing Officers (SPO’s – which I am), Purchasing Officers (PO’s), and support staff.

What’s an SPO?

Senior Purchasing Officers (SPO’s) are trained purchasing professionals who understand the procurement requirements that public agencies are bound by.

WorkSafeBC is a Public Agency

• WorkSafeBC is a public agency and as such, our procurement practices must be consistent with other public agencies.

• WorkSafeBC must also be in compliance with public procurement models such as the Agreement for Internal Trade (AIT) and the Trade, Investment and Labour Mobility Agreement (TILMA).

What is AIT?

• The Agreement for Internal Trade (AIT) is the Trade Agreement between all Provinces, Territories, and the Federal Government.

• The purpose is to eliminate barriers to interprovincial trade by publicly posting bid opportunities.

What is TILMA?

• The Trade, Investment and Labour Mobility Agreement (TILMA) builds upon the goals of the AIT and further breaks down trade barriers between Alberta and BC using national bulletin bidding boards such as BC Bid.

• TILMA’s designed to help reduce costs to government and increase investment and labour mobility by increasing competition.

What is BC Bid?

BC Bid is a website (www.bcbid.gov.bc.ca) which offers:

1.a process for suppliers interested in receiving automated e-mail notification of matched tenders

2.the creation of a personalized commodity profile and

3.the ability to submit bids electronically to posted opportunities.

How does BC Bid work?

Mental Health Treatment Services

• If you’re interested in becoming a Mental Health Treatment Provider, you need to respond, and be evaluated successfully, to RFQ #H005-2005.

• The RFQ, and it’s subsequent addenda, are posted on the WorkSafeBC and BC Bid websites.

• They define our service needs and your response requirements.

What’s a RFQ?

RFQ (in the public procurement model) stands for Request for Qualification.

• It’s used to qualify, short-list and/or select providers and/or contractors.

• It’s a legal, competitive process by which all rules must be followed to ensure consistency and fairness.

Where is the RFQ on your website?

Then what?

Ok, I did that, now what?

RFQ

WorkSafeBC is committed to maintaining a fair, open, competitive supply environment, while obtaining the best value in the interests of our organization, injured workers, and employers.

RFQ Response Requirements

• Respondents are required to provide the information detailed in Section III. Response Requirements.

• It’s in your best interest to respond with as much detail as possible to all questions, because the information you submit is evaluated and scored according to the evaluation criteria.

RFQ Questions

• If you’re trying to fill out the RFQ but you have some questions, you may contact me and I’ll do my best to clarify.

• The bid opportunity section (or subsequent addenda) of the RFQ details the name, phone number, and e-mail address of the CHCP personnel that you may direct your question.

RFQ

I’ve noticed that the sections which seem to cause the most confusion, and the ones I’m receiving the majority of the questions, are around the:

1.WorkSafeBC Assessment Registration Number

2.Proof of Personal Optional Protection (POP)

3.Protection of Information and Personal Privacy

Assessment Registration Number

An Assessment Registration Number is the number you receive when you apply for, are deemed eligible and subsequently pay for WorkSafeBC insurance coverage.

Personal Optional Protection (POP)

• Personal Optional Protection (POP) is optional workplace disability insurance for individuals not automatically covered under the Workers Compensation Act.

• POP will cover your lost salary and medical expenses if you’re injured on the job.

Where are these questions in the RFQ?

WorkSafeBC Insurance Coverage

• The WorkSafeBC Assessment Registration department would determine whether you need to register for full coverage or are eligible for POP.

• They are also the department that you would contact with questions about your requirements for insurance coverage.

WorkSafeBC website

Status Letter

• If the WorkSafeBC Assessment Registration department advises that you do not need to register for coverage and/or are not eligible for POP, you will need to request a Status Letter from them.

• For your convenience, you may contact them at 604-244-6182 or at www.worksafebc.com

Protection of Information and Personal Privacy

The second set of questions around the Protection of Information and Personal Privacy is also causing some confusion for respondents.

Where is that in the RFQ?

But I don’t subcontract

Again, you need to respond to this section, whether you’re subcontracting or not.

RFQ Submissions

• Once you’ve completed the RFQ you need to submit the document as defined in the individual Submission, Closing, and Delivery clauses.

• These clauses are normally found in Section 1 – Instructions to Respondents.

How should I deliver my response?

RFQ Evaluation Process

• The length of time it takes to evaluate your response is dependent on the complexity of the bid opportunity, and includes factors like the number and location of respondents.

• All respondents will be formally notified of their outcome by a letter or the award of a contract from WorkSafeBC.

Existing Payee Numbers

• All Mental Health Treatment Service Providers will be required to have a formal contract with WorkSafeBC to provide these Services.

• Please note that if you already possess a payee number, that does not imply that you have a formal contract with WorkSafeBC. It may have been provided for payment purposes only.

WorkSafeBC Business Opportunities

You may sign up for automatic notification emails of future business and bid opportunities on both the WorkSafeBC and BC Bid websites.

Where is this on your website?

Where do I go from there?

Then what do I do?

Contract award

• If your response has been evaluated successfully, you will be awarded a contract.

• As with any contract, it would be prudent for you to peruse it before signing.

• Once the contract has been executed (signed), it’s your responsibility to ensure compliance to all the agreed upon terms and conditions.

Any questions?

Case Management Perspective

Rick WadlandManager of Client ServicesWorker & Employer Services


WHAT DOES A CASE MANAGER DO?

• Here is a copy of the Case Manager job description:

I. FUNCTION The Case Manager is responsible for directing, integrating, implementing and evaluating case management claim files, with a primary focus on an early and safe return to work for the injured worker; coordinating the efforts of the employer and service providers in the return to work plan; maintaining a comprehensive knowledge of claims adjudication procedures, policies and directives; overseeing the management of all assigned active cases; performing a variety of functions required in the adjudication of wage-loss claims including verifying and authorizing cost allocation and calculation of benefits; reviewing decisions on the basis of new information and altering decisions where appropriate; assuming responsibility for all team decisions regarding the disposition of a case and performing other related duties as assigned.

Role of Case Managers

• Project Manager

Guidelines

• Workers Compensation Act• Rehabilitation Services and Claims Manual

Role of Mental Health Providers in the Claims Management Process

• Need your support and expertise• To work with the Case Manager in supporting

workers’ recovery

What do we need from you?

• Plan on how to get workers back to pre-injury job or to alternate work.

• Need to know the following:• What are their main barriers to a full return to work?• How do we remove these barriers?• What are the workers’ limitations & restrictions?• What is the prognosis?• How long will they require treatment?

Communication

• The better the communication, the better the results• Consultations (in person or by telephone) on clinical

matters are billable• Call your Case Manager with concerns or questions

• Team work is invaluable

Any Questions?

How to Bill WorkSafeBC

George PrimrosePayment Services SupervisorPayment Services


Invoice for Psychology Services

Where to Find Forms

Website:www.worksafebc.com

Forms

Click on the Health Care

Providers tab

Scroll down to the Mental Health Treatment & Assessment Section

How to Check Invoice Payment Status





• Any questions?

Documents

The Foundations of Workers’ Compensation – Legislation and Policy