Thank you, Mr. Chair, and members of the standing committee.
Thank you very much for giving me the opportunity to speak to you here today. It's something I don't often get to do in my normal duties.
As you said, my name is John Genise. I'm an executive director on case management at the Workplace Safety and Insurance Board and I also reside in Ottawa.
I'll give you a little bit about the WSIB. We're one of the largest organizations of its kind in North America. We provide workplace insurance for more than five million workers and over 300,000 employers across Ontario. Each year we receive an average of 230,000 claims. We collect over $4.5 billion in employer premiums to fund the system and no tax dollars are involved. Relevant to this committee, we registered approximately 3,800 traumatic mental stress claims in 2016 and we are actively managing about 1,300 of those.
In terms of the criteria for entrance into our policies, there are a few. If a designated worker, who is typically a first responder, is diagnosed with post-traumatic stress disorder and meets specific employment criteria, it is presumed to have arisen out of and in the course of their employment, unless the contrary is shown. So we have a presumption clause.
All other workers are entitled to benefits for traumatic mental stress when they experience an acute reaction to a sudden or unexpected traumatic event arising in the course of their employment. A traumatic event may be the result of a criminal act, harassment, or a horrific accident. In all cases, the event must be clearly and precisely identifiable, objectively traumatic, and unexpected in the normal or daily course of the worker's employment or the work environment. The policy considers acute reaction, cumulative effects, and harassment as three types. Now, I'll tell you a little bit about us.
In terms of this committee's areas of interest, I'll speak a little bit about compensation for pain and suffering. The WSIB insurance replaces lost wages, covers health care costs, and helps workers get back to the job safely. We do not financially compensate for pain and suffering. We do have a non-economic loss award, or benefit, for a functional abnormality or loss which results from the injury. It's expressed as a “whole person impairment” as a percentage using a prescribed rating schedule—we use the AMA guide. In 2017, that prescribed amount, the “whole person” base amount, was approximately $59,000. The base amount is then adjusted at the time of the injury, based on the workers age. There's an added adjustment factor for every year that the worker is under the age of 45 and on the other side, we subtract the same adjustment factor for every year that they are over the age of 45.
In terms of short and long-term income replacement, the WSIB pays for loss of earnings, both full or partial, starting with the first day after a work-related injury. Benefits are calculated depending on the date of injury, based on annual wage ceiling. We pay 85% of net average earnings. Loss of earnings benefits continue until the person is no longer impaired by the injury, there's no longer a loss of earnings—perhaps they're back to work—or until age 65, whichever comes first. After 72 months, those benefits are made permanent to age 65. Payments are issued every two weeks and adjusted for inflation annually.
In terms of supplementary support for severely injured veterans—one of your interest areas—our approach is recovery first, access to quality medical care, layered with support for a return to work when appropriate. Workers must have a DSM diagnosis to qualify and we often fund this assessment, even prior to accepting a claim. Often workers don't have the means to get assessed in order to reach the entrance criteria, so we'll pay for that, even if we don't have an allowable claim. Our approach to managing these files is that we have a multidisciplinary team. We have dedicated case managers for these cases, as well as dedicated nurses. We also have dedicated work reintegration specialists and they are in the worker's own community. We also have contracted medical services. We have a dedicated roster of psychiatrists and psychologists across the province in order to expedite care for these clients. We also use the Centre for Addiction and Mental Health, CAMH, for assessment and treatment.
In terms of transition and rehabilitation services, I said earlier that a provider network has been established to assist and provide clinical expert assessment and recommendations to workers in communities across Ontario. This means that we move quickly to get workers treated when needed. For us, return to work is our primary focus. We want to make sure that we restore workers' abilities before we can move forward on these cases.
Work transition specialists are involved early in post-traumatic stress claims, even before the worker is ready to work. We use a collaborative approach in return to work planning, by involving the client, the employer, and the treating physician together to come up with a plan. When workers are able to go back to the workforce, we continue to support them while they are working, and help them to work through their challenges and some of their barriers.
That primarily is my presentation on the four areas that you wanted us to focus on.
I'd be happy to take any of your questions.