‹‹ Archives December 2009 - Issue 200
Employer must review 2009 NEER for SIEF Adjustment

 

As part of the New Service Delivery Model the WSIB developed dedicated teams to adjudicate recurrence entitlement and employers’ application for cost relief under the Second Injury & Enhancement Fund (SIEF) policy.

With the introduction of the SIEF dedicated team, it became evident in the claims we were managing that:

  • Decisions pertaining to cost relief were prolonged;
  • Requests for cost relief seemed to be denied at a greater rate than we have noted in the past; and
  • When applied, it is more often that 50% of relief is granted even when we believe that the evidence supports relief greater than 50%.

While the Appeal mechanism can be used to remedy the latter two issues, delays in rendering SIEF decisions have been a significant concern, especially since the WSIB has long held the position that SIEF does not form a basis for retroactive NEER adjustment under WSIB Operational Policy 13-02-07. Under these circumstances, an organization entitled to SIEF, but the application was not granted until after September 30, 2009, could:

  1. Completely lose the financial benefit of the SIEF application on 2006 claims (as September 30, 2009 is the last NEER review for 2006 Accident-Year); and/or
  2. Realize a larger surcharge (or smaller rebate) than would have been the case had the SIEF been applied prior to September 30th.

In recognition of this challenge, the WSIB has decided to undertake a case-by-case review of SIEF granted after September 30, 2009. In this regard, the WSIB will review employer accounts and where SIEF was granted after September 30, 2009, but it can be demonstrated that the application for cost relief was received by the WSIB prior to September 30, 2009 the Board will manually adjust the employer’s 2009 NEER Rebate/Surcharge position to reflect the application of the SIEF granted.

Given the above, consideration should be given to the following:

  1. Review all SIEF decision rendered prior to September 30, 2009, to ensure that it is appropriately reflected on the September 30, 2009 NEER statement.  If the cost relief is not applied to the statement, you need to contact the WSIB to ensure that an amendment occurs.
  2. Where the decision to grant SIEF was made after September 30, 2009, but the application for cost relief was sent to and received by the WSIB before September 30, 2009, an adjustment to your account should also be made to reflect the SIEF granted. In this case you should contact the WSIB Experience Rating branch or your Account Manager to ensure that a manual adjustment will be made to your firm’s Statement of Accounts.

As noted earlier, the 2006 accident-year exits the ‘NEER window’ as of September 30, 2009; no further adjustments will be made to this NEER-review.  As such, while it is important that all claims be reviewed with respect to the application of SIEF cost relief, it is critical that 2006 claims be reviewed in this regard to ensure that any SIEF entitlement is reflected on the WSIB Statement of Accounts.

 

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