The Foundations of Workers’
Compensation – Legislation and Policy
Susan Hynes, Director, Compensation and
Assessment Policy, WorkSafeBC
Mental Health Info Session
September 20, 2010
Overview of Presentation
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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:
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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. Psych
Senior Psychology Advisor
Psychology Services
Mental Health Info Session
September 20, 2010
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
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
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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
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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.
Mental Health Treatment
Contract
Sharleen Mackenzie
Senior Purchasing Officer
Corporate and Health Care Purchasing
Mental Health Info Session
September 20, 2010
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 Wadland
Manager of Client Services
Worker & Employer Services
Mental Health Info Session
September 20, 2010
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
Health Care
Providers
Injured Worker
Employer
Case 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:
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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 Primrose
Payment Services Supervisor
Payment Services
Mental Health Info Session
September 20, 2010
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
How to Check Invoice Payment Status
How to Check Invoice Payment Status
How to Check Invoice Payment Status
How to Check Invoice Payment Status
• Any questions?