Handling Disability Management Cases - Return-to-Work Process Map

In this process, the employer is used to refer to the delegated authority within departments and agencies. In most cases, the delegated authority is the employee's immediate supervisor.

The first claim process is when an employee is on an approved Workers' Compensation Benefit claim:within 130 days of the onset of injury/illness, the employee will be absent from work on injury-on-duty leave (IODL) and receiving his or her base salary plus rehabilitative and other medical services from the workers' compensation board (WCB).

Otherwise, the employee will be on sick leave without pay (SLWOP) for medical reasons and be receiving income replacement benefits as well as services from the WCB and may be receiving additional income replacement benefits from Disability Insurance (DI) or the Public Service Management Insurance Plan—Long-Term Disability (PSMIP-LTD).

The WCB then evaluates the potential of the employee returning to work that can result in three paths:

1. The employee may be on temporary disability and able to work. The employee, the WCB, union representative (if applicable) and employer then develop a return-to-work (RTW) plan and identify any necessary accommodations.
2. The employee may have a permanent, partial disability and be able to work. The employee, the WCB, union representative (if applicable) and employer develop a graduated RTW plan and identify necessary accommodations. The WCB may allow a permanent partial disability award, either as a lump sum or a monthly payment.

   In these first two cases, an RTW plan is executed; the manager implements necessary accommodations, and the employee returns on a full or gradual basis to regular duty or to an alternate position. IODL or WCB services and benefits may continue, with income replacement benefits reduced according to employment income earned. (Where applicable, a permanent partial disability award is not affected.)

3. In the last case, the employee may have a permanent disability and not be able to work. The WCB allows a permanent disability award, either as a lump sum or a monthly payment. The employee, if he or she has not already done so, applies for DI or PSMIP-LTD to cover the shortfall between the WCB and the disability plan threshold.

   In this case, there is a termination of the employment relationship, and the employee has several options, each with different financial implications. Human Resources and Compensation and Benefits help the employee make an informed decision. Options include the following:

   • Retirement on medical grounds;
   • Retirement; and
   • Resignation.

An employer may also seek to terminate the employment relationship due to medical incapacity. In all cases, the employee should apply for the Canada Pension Plan or the Quebec Pension Plan (CPP/QPP) disability pension. The employee may also be eligible to receive DI or PSMIP income replacement benefits to age 65, minus any other disability-related income received (e.g., the CPP/QPP, the WCB and the Public Service Pension Plan).

The second claims process is when an employee is on sick leave without pay (SLWOP) in the first 24 months of a DI or PSMIP-LTD claim, under the employee's “own” occupation definition of disability: the employee is receiving income replacement benefits equal to 70 per cent of his or her base salary and may be receiving rehabilitative services from the insurer (Health Management Consultant).

The employer maintains regular contact with employee, insurer and treating physician. The treating physician provides information on prognosis and any limitations. This may result in three paths:

1. The employee may have a permanent disability and not able to work: the treating physician and insurer agree there is no prospect for RTW in the foreseeable future. In this case, there is a termination of the employment relationship. The employee has several options, each with different financial implications. Human Resources and Compensation and Benefits help employee make an informed decision. Options include:
   • Retirement on medical grounds;
   • Retirement; and
   • Resignation.

   An employer may also seek to terminate the employment relationship due to medical incapacity. In all cases, the employee should apply for the CPP/QPP disability pension. The employee may also be eligible to receive DI or PSMIP income replacement benefits to age 65, minus any other disability-related income received (e.g., CPP/QPP, the WCB and the Public Service Pension Plan).

2. The employee may have a permanent partial/temporary disability and an RTW is uncertain. The employer maintains regular contact with the employee, seeking clarification upon granting extensions to sick leave without pay (SLWOP) on the expected RTW date, and information on necessary accommodation, including from insurers' Health Management Consultant if applicable. There may be two results from this:
   • The employee is found totally disabled under the “any commensurate occupation” definition of disability. In this case, there is a termination of the employment relationship: the employee has several options, each with different financial implications. Human Resources and Compensation and Benefits help the employee make an informed decision. Options include:
     • Retirement on medical grounds;
     • Retirement; and
     • Resignation.

   An employer may also seek to terminate the employment relationship due to medical incapacity. In all cases, the employee should apply for the CPP/QPP disability pension. The employee may also be eligible to receive DI or PSMIP income replacement benefits to age 65, minus any other disability-related income received (e.g., CPP/QPP, the WCB and the Public Service Pension Plan).

   • The employee is found able to work under the “any commensurate occupation” definition of disability.
     • In this case, the employee may return to work or may appeal the insurer's decision. If unsuccessful, the employee may return to work. However, as sick leave without pay (SLWOP) has extended beyond one year, the employee's position may have been filled. The employer either finds an alternative position, provides accommodation if required or, if applicable, places the employee on priority status.
3. The employee has permanent partial or temporary disability and is able to work. The employer works with the employee, the treating physician and the insurer to create an RTW plan, and obtains information on the employee's limitations with which to determine any necessary accommodations.

   An RTW is put in place. If the duration of sick leave without pay (SLWOP) is no longer than 12 months, the employee returns to his or her substantive position and the manager implements any necessary accommodation. If sick leave without pay (SLWOP) extends beyond one year, the employee's position may be back-filled. The employer either finds an alternative position, provides accommodation if required, or places the employee on priority status. Income replacement benefits under DI or PSMIP-LTD will usually cease at 24 months. DI and PSMIP benefits may be extended beyond 24 months in exceptional cases.