A Cost Free Way to WCB Savings: Historical Claim Review

Posted in: Claims Costs,WCB Premium Reduction | Posted by Rebecca Ingram on October 26, 2016

During November and December every year, most Workers’ Compensation Boards (WCB) across the country send out the annual Experience Rating statements to employers. These statements include figures used in the calculations to establish their WCB premium rates for following year. Provided, on the statement, is a list of all the claims and associated costs that are used to determine any discount or surcharge being applied to the premium rate. Seeing your WCB claims history laid out along with the financial impact associated with those claims, can be a jolt to the system!

As an employer, have you ever wondered if all the costs on your WCB claims are your responsibility? Are the costs on a claim relative to the work-related injury? Have you ever felt that something was not quite right with a claim but couldn’t put your finger on it? Or have you wondered whether there were special circumstances that would result in cost relief but not sure what WCB policy or section of the Worker’s Compensation Act applied?

There is an easy and cost free way to try to lower your WCB premiums and ensure that you are paying the lowest possible premium rate. A historical claims review is a simple and effective way to take a second look at any WCB claims and confirm that all the costs associated with those claim are related to the injury or illness sustained.

As much as the WCB mandates fair and equitable decisions for injured workers and employers, every claim is unique and the system is not perfect. WCB decision makers often work in high stress environments with large caseloads and complex situations. Their primary focus is on the injured worker, not necessarily the employer’s premium rates; after all, it is “Worker’s” compensation, not “Employer’s” compensation. As such, there are aspects of a claim that get can be overlooked, forgotten or not followed through on. In many cases, even though an employer is entitled to a cost saving benefit, it may not be applied or applied appropriately.

Some of the most common areas that can affect costs are:

  1. Pre-existing Conditions – if an injured worker has a medical condition that pre-dates the date of accident and that condition affects the worker’s recovery from the work-related incident, certain costs may be removed from the claim.
  2. Concurrent Conditions – if an injured worker has a medical condition that is unrelated to their specific injury and that condition is impacting their recovery, costs may increase.
  3. Cost Relief (C/R) Policy – the WCB C/R policy and guidelines can be difficult to understand and determine if it may be applicable. Even when the application seems straight-forward, sometimes C/R is overlooked and not implemented before the claim file is closed.
  4. Payment of Time Loss(T/L) Benefits –  there are instances where a worker has been deemed fit for work but does not go back to work immediately. Without appropriate documentation to support T/L from work, a worker is not entitled to benefits that are issued.
  5. Fitness for Work – sometimes a worker is deemed fit for modified work and even though modified duties are offered/documented and available, the worker decides not return to the workplace. In this case, the worker would not be entitled to benefits.
  6. F/U on 3rd Party Action – there are claims where 3rd party action may be possible, such as motor vehicle accidents. Although 3rd party action on a claim doesn’t always result in successful cost recovery, it is important to ensure any recoveries are applied appropriately.
  7. Transfer of Costs Claims or Sec 95(2) – sometimes a work-related incident is the fault, or partially the fault of another employer’s negligence. The Worker’s Compensation Act has provisions which may result in some or all of the costs of a claim being transferred to that other employer.
  8. Erroneous billings – occasionally a medical invoice or receipt for reimbursement is billed to the wrong claim. If these billings are not identified and removed, they will remain part of the claim costs and be incorporated into the premium rate setting calculation.

As much as reviewing claims in their entirety can help identify areas of cost savings, many employers do not have the time, resources or experience to take this on.

A Historical Claims Review can be an invaluable service to any size organization, often resulting in WCB savings. Using an experienced employer representative allows quick and easy identification of claims that have the potential for cost recovery.

The faster costs are removed from a claim, the sooner an employer will see a positive impact to their WCB account. Additionally, there are limits that can determine whether an issue or request for cost removal will be considered, so time is of the essence.

BCL Consulting Group Inc. has been representing employers with all matters pertaining to workers’ compensation for almost 30 years. With a firm grasp of how the WCB operates internally, a comprehensive understanding of WCB policies and procedures, an extensive knowledge of medical terminology, injuries, recovery and rehabilitation combined with an objective perspective, we are leaders in the field.

Our services include a comprehensive Historical Cost Recovery Review program which is provided on a contingency basis, meaning absolutely no cost to the employer unless and until premium savings are achieved. 

For further information on employer representation or historical claims review and cost recovery, reach us via email at [email protected], [email protected], or contact us directly, during business hours, using our chat feature or by phone, at 1-844-377-9545 and you can always connect with us on Facebook ,Twitter , or LinkedIn.

Historical WCB Cost Recovery Review