WorkersCompensationUTEUnionofTaxationEmployeesSEI工人補(bǔ)償稅收員工SEI尤特聯(lián)盟課件

1、第1頁(yè)，共54頁(yè)。Workers CompensationAwareness SessionDenis St-Jean第2頁(yè)，共54頁(yè)。INTRODUCTION Workers Compensation Awareness SessionYour NameFunctionExperience, Knowledge - CompensationChallenges / Expectation?Facilitator第3頁(yè)，共54頁(yè)。第4頁(yè)，共54頁(yè)。SESSION OUTLINEIntroductionGECA Collective AgreementsTBS PoliciesHow to ge

2、t a claim approved by the Board? Roles of PartiesOther Compensation OptionsConclusion / Feedback第5頁(yè)，共54頁(yè)。INTRODUCTIONLifecyle of a claimBefore the InjuryThe InjuryCompensationShort termPermanentReturn to WorkAccommodationShort termPermanent第6頁(yè)，共54頁(yè)。GECA (1918 ; 1952)第7頁(yè)，共54頁(yè)。GECAGovernment Employee

3、Compensation Act 1918 reviewed in 1952Covers Federal Government Workers 300 000Coverage a personal injury by an accident and/or desease arising out of and in the course of employmentReferences to Provincial Workers Compensation Acts第8頁(yè)，共54頁(yè)。GECANo Fault SystemEmployer assumes financial cost while wo

4、rkers gave up their right to sueProvincial / Territorial Boards adjudicate claimsSame basic principles between Boards, but there are differences in benefits第9頁(yè)，共54頁(yè)。GECACoverage includes:Loss of earningsNon-economic lossMedical, medicationRehabilitationLMRsReturn to work provisions第10頁(yè)，共54頁(yè)。GECASumm

5、aryProvincial / Territories Compensation LegislationBenefitsAdjudication & Appeal ProcessHRSDC Labour ProgramAdministrative AgreementFunding3rd parties第11頁(yè)，共54頁(yè)。GECAChallengesDetermining extent to which GECA incorporates provincial laws lack of clarityPresumption clauses application?Rate / condition

6、s vary from Province to provinceLast review 1952 but provinces update regularly their act第12頁(yè)，共54頁(yè)。GECAChallengesPhilosophy of Compensation has evolved since GECA was reviewed, many concepts are absent, but present in Provincial acts:Presumption clausesReturn to workWorker rehabilitationTime limitsF

7、ines and penaltiesHow to train PSAC members第13頁(yè)，共54頁(yè)。COLLECTIVE AGREEMENT第14頁(yè)，共54頁(yè)。COLLECTIVE AGREEMENTInjury-On-Duty Leave37.01 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 Gover

8、nment 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 employees willful misconduct,or

9、(b) an industrial illness or a disease arising out of and in the course of the employees 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, pr

10、ovided, however, that such amount does not stem from a personal disability policy for which the employee or the employees agent has paid the premium.第15頁(yè)，共54頁(yè)。COLLECTIVE AGREEMENTAccumulation of Vacation Leave Credits34.02 For each calendar month in which an employee has earned at least ten (10) day

11、s pay the employee shall earn vacation leave credits at the rate of:第16頁(yè)，共54頁(yè)。COLLECTIVE AGREEMENTSick Leave With Pay Credits35.01(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 a

12、t least ten (10) days.第17頁(yè)，共54頁(yè)。COLLECTIVE AGREEMENT35.05 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

13、 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, f

14、or the purpose of the record of sick leave credits, that the employee was not granted sick leave with pay.第18頁(yè)，共54頁(yè)。COLLECTIVE AGREEMENTArticle 54Leave With or Without Pay for Other Reasons54.01 At its discretion, the Employer may grant:(a) leave with pay when circumstances not directly attributable

15、 to the employee prevent his or her reporting for duty; such leave shall not be unreasonably withheld;(b) leave with or without pay for purposes other than those specified in this Agreement.第19頁(yè)，共54頁(yè)。COLLECTIVE AGREEMENTOther impacts:Sick / Vacation Leave CreditsEmployment Insurance EligibilityCPP /

16、 QPP BenefitsPension PlanDisability InsuranceLife InsuranceMedical / Dental InsuranceOther benefits第20頁(yè)，共54頁(yè)。CRA POLICIES Workers Compensation第21頁(yè)，共54頁(yè)。CRA POLICIESInjury and Illness PolicyWork-Related Injury Or Illness (Appendix C1)Workers Compensation An employee injured in an accident at the work

17、place 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

18、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

19、services already available through provincial workers compensation boards.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 employer

20、s, on the interpretation and application of the legislation.第22頁(yè)，共54頁(yè)。CRA POLICIESBenefits Include:compensation for loss of earnings (if an injured employees is not entitled to injury-on-duty leave); medical, hospital, and related services; rehabilitation services; a pension, if an injury results in

21、 a permanent disability; and pensions to dependants of employees who are fatally injured in the course of their employment. 第23頁(yè)，共54頁(yè)。CRA POLICIESInjury-on-duty leaveTo avoid duplicate payment, it is extremely important that personnel officers indicate on the original injury report whether the injur

22、ed employee is entitled to injury-on-duty leave, which is provided for in the collective agreement.第24頁(yè)，共54頁(yè)。CRA POLICIESInformation 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 bookle

23、t entitled Employers Guide should be in the hands of all persons responsible for the reporting of injuries.第25頁(yè)，共54頁(yè)。CRA POLICIESEmployers Guide Disallowance of claimsThe most common reasons for disallowing a claim are the following:It is not shown clearly that the disability is the result of an acc

24、ident, or occupational disease. The injury or occupational disease reported did not arise out of and in the course of employment. 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.第26頁(yè)，共54頁(yè)。CRA POLICIESInju

25、ry-on-Duty LeaveEmployees 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 employment.第27頁(yè)，共54頁(yè)。CRA POLICIESInju

26、ry-on-Duty LeaveRight to Choose DoctorAn 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 Quebe

27、c where there is no such restriction.第28頁(yè)，共54頁(yè)。CRA POLICIESVerification of disability periodWhile 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 empl

28、oyee 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

29、 of sick leave involved.第29頁(yè)，共54頁(yè)。CRA POLICIESTermination of injury-on-duty leave 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. 第30頁(yè)，共54頁(yè)。CRA POLICIESTermination of injur

30、y-on-duty leave Normally, after 130 (working) days, all employees will be paid directly by the provincial workers compensation board.The level of payment will be based on the provincial regulations. 第31頁(yè)，共54頁(yè)。CRA POLICIESTermination of injury-on-duty leaveProvincial wage compensation benefits for to

31、tally disabled employees are generally75% of earnings, based on a maximum annual earnings ceiling.第32頁(yè)，共54頁(yè)。CRA POLICIESDuty to Accommodate Persons with Disabilities A request for accommodation need not be in writing, but should be communicated as clearly and specifically as possible. The person to

32、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 accommod

33、ation. This could include the persons own physician, psychologist or centres of expertise within the Public Service Commission or the accommodating department.Provide the accommodation based on the request of the person being accommodated, or, if necessary, on the advice of experts.第33頁(yè)，共54頁(yè)。CRA POL

34、ICIESDuty to AccommodatePersons 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 stric

35、tly 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. 第34頁(yè)，共54頁(yè)。CRA POLICIESDuty to AccommodateCRA should develop their own i

36、nternal 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

37、Canadian Human Rights Commission.第35頁(yè)，共54頁(yè)。How to get a claim approved by the Board?第36頁(yè)，共54頁(yè)。How to get a claim approved by the Board?Claiming Workers CompensationWhen?How?What should I say / not say?What if I need accommodation?Where can I get help?第37頁(yè)，共54頁(yè)。How to get a claim approved by the Boar

38、d?Definition of Acccident includes:A chance event occasioned by a physical or natural cause; orThe biggest reason for the denial of these claims is a lack of proof that an injury happenedA disablement arising out of and in the course of employmentThe major reason for the denial of these claims is la

39、ck of prrof that the work caused the injury第38頁(yè)，共54頁(yè)。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:Exemple:Do not say: I fell and hurt myself.Say: I was walking through the office in the scanning division. I step

40、ped 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.第39頁(yè)，共54頁(yè)。How to get a claim approved

41、by the Board?Reconsiderations and AppealsOntario:A notice of Objection must be in writing6 month time limit to appeal Except for RTW / LMR: 30 daysTwo (2) levels of appealsARO / TribunalQubecA written letter to the CSST30 days to appeal intial decisionA form must be completed to the CLP45 days to ap

42、peal第40頁(yè)，共54頁(yè)。ROLES OF PARTIES第41頁(yè)，共54頁(yè)。ROLES OF PARTIESMaking a Case Plan:Open a file for each workerKeep copies of all informationRecord all activitiesPhone callsInterviewsLettersConfirm with the worker what issues will be addressedPriorize issues and actionNote the date and level of decision by t

43、he Board relating to each issueNote any issues that arise in qualifying for benefitsDetermine what information is requiredWitnessesMedical informationPhysical demandsExposuresAnalyze each problem and outline action plan第42頁(yè)，共54頁(yè)。ROLES OF PARTIESWorkerIt is better to talk in person rather than over t

44、he phoneAdvise the worker to bring copies of all correspondence & information receivedEncourage the worker to explain the problemReview any document the worker has received from the Board or doctors for a history of the claimPre-accident job historyDescription of job at the time of accidentDescripti

45、on of the accidentEvents since the accidentsReview the relevant facts to make sure you understand correctly 第43頁(yè)，共54頁(yè)。ROLES OF PARTIESBoardComplete and send Authorization form to the BoardInclude workers name and claim numberExplain reasons why you are writing and the actions you wish the Board to T

46、ake careExplain any new information, indicate why they are importantExplain your argumentsMake sure the decision maker understands the issueKeep a record of all calls第44頁(yè)，共54頁(yè)。ROLES OF PARTIESDoctorIntroduction of yourself and your relationship to the workerReasons why you are writingBrief statement

47、 of issueRelevant brief background and historyRequest the doctors medical opinion regarding the issue under appealRequest that the opinion be evidence-based第45頁(yè)，共54頁(yè)。ROLES OF PARTIESLocal / ComponentIdentify local representative, involve this person in the representation processIdentify Service Offi

48、cer 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 ke

49、y information on accident causation which will often help the injured worker in making a demonstration that the workers 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 m

50、ember 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第46頁(yè)，共54頁(yè)。ROLES OF PARTIESLocal / Component TOOLOpen fileAttach summaryName of workerMember numberComponentLocalEmployer data

51、WSIB File NumberInjury/disease typeDate of accidentName of treating doctorDecision under appeal datetimelines for appealDocument all telephone conversation, interviews and lettersProtect appeal deadline with sample letter (template to be provided) stipulating that you are protecting the appeal deadl

52、ine, you want a complete copy of the file, you will analyze the file and further advise the Board whether you will pursue the representationEnsure that the worker and its Local/Component representatives understand that they are custodians of their claims第47頁(yè)，共54頁(yè)。ROLES OF PARTIESLocal / ComponentIt

53、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 employe