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We would like to know the industry standard for lost time frequency with respect to denied WCB claims. i.e should a denied claim be included? Historically the organization has included them but stopped the Lost Time Day count on the date the WCB decision is rendered. In other words, we historically have not changed the injury classification in the record based on the WCB’s decision.
Thanks
Great question. The standard might not be the same in all parts of the country. What jurisdiction are you in with regard to workers’ comp? I will be out tomorrow but will try to get you an answer by the end of the day Monday. Is that acceptable? If not, call me at 203 984-9433 and I’ll try to patch something together. Glenn Demby
We operate in all provincial jurisdictions in Canada.
Thanks
That’s a tricky question that will require some research. I’ll do the research and get back to you in the next couple of days. For now, what I CAN tell you is that:
1. Whether a denied claim counts toward lost time frequency is dictated not by industry standard but the requirements of the workers’ comp laws themselves, specifically, the definition of “lost time.” That’s what I need to research.
2. My theory is that the rules governing what you include in your lost time injury frequency rate is based on whether a worker actually misses time rather than whether the WCB accepted the claim. But I need to do the research to see if that theory holds water.
3. FWIW, I believe that most WCBs in Canada count only accepted claims when calculating their own provincial lost-time injury rates, injury totals and fatality totals.
. . . to be continued. Glenn Demby, OHS Insider, Editor in Chief
I researched Alberta, BC and Ontario:
Alberta: In calculating an employer’s experience rating for the year, the WCB considers BOTH the number of claims AND total claim costs, among other factors. https://www.wcb.ab.ca/assets/pdfs/public/policy/manual/printable_pdfs/0702_1.pdf
BC: “POLICY As a general rule, all acceptable claims coded to a particular firm are counted for experience rating purposes. Whether the firm was at fault is not considered.” ASSESSMENT MANUAL, Experience Rating Cost ITEM: AP5-247-2 Inclusions/Exclusions
The notion that only accepted claims count toward ER is reinforced by the ASSESSMENT MANUAL policy on the Experience Rating plan which notes that ER adjustments are based solely on claims costs and that the Board’s admin costs don’t get counted in ER calculations. In addition, the claims costs that are included are subject to caps of 100% of the first $70,000; 50% of the next $50,000; and 10% of all costs above $120,000.
ONTARIO: Like BC, Ontario counts just accepted claims. Here’s a cite from the WSIB NEER Policy: “The premium rate calculation methodology considers all of an employer’s insurable earnings, claim count and the associated claim costs over the six year period before the year premium rates are set. . . . THE CLAIM COUNT REFERS TO ALLOWED CLAIMS with an accident date within the review period. The claim costs refer to the actual costs that are paid in respect of claims with an accident date falling within the review period. (emphasis added) https://www.wsib.ca/en/operational-policy-manual/employer-level-premium-rate-setting
I didn’t research any of the other provinces but will if there’s a specific province you want me to look in. But at the end of the day, counting just accepted claims makes sense because it’s in line with the overall workers’ comp policy of allocating premiums to employers based on how much they cost the workers’ comp system; moreover, employers are still required to report all time loss injuries to the WCB regardless of whether the claim is compensable.
Hope this helps. Loop back with me if you have any further questions or want me to follow up. Glenn D
Hi
Thanks for the information. I am not so interested in the experience rating calculations, but rather on using injury frequency for OHS measurement. Historically we have included all lost time incidents when calculating frequency irrespective of the claim status. From our perspective an incident has happened and the employee has lost time from work.
I was just curious if other companies remove denied claims from their stats.
Thanks
Fair question. It occurred to me that experience rating wasn’t what you were after. I did look into this but couldn’t find anything addressing the denied claims issue other than in the premiums setting sections of the respective WCB Policy Manuals. Two suggestions:
1. Call the WCB of your jurisdiction and ask them directly.
2. Email my colleague Haley O’Halloran–haleyo@bongarde.com–about setting up an OHSI members survey so we can convass our member base. Tell her I recommended you if you want to pursue that route.I’ll keep my eyes open in the meantime.
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