September 2016

6.5 Workplace Accident Insurance Coverage

Legislative Authority

Not applicable

Summary of Directive

To outline coverage available for work-related injury or illness and to identify actions to be taken when a client has a work-related injury or illness while participating in an ODSP employment supports workplace training placement.

Intent of Policy

To ensure clients and the employers who provide workplace training are protected in the event of a workplace accident or illness and to outline the responsibility of ODSP staff and service providers when a claim is made under the Workplace Safety and Insurance Act, 1977 or Ontario's Accident Insurance Plan.

Application of Policy

Where clients participate in workplace training in a work environment arranged by the service provider, claims arising from a work-related injury or illness are covered by either the Workplace Safety and Insurance Act, 1997or Ontario's Accident Insurance Plan.

Where the employer is required to carry coverage under the Workplace Safety and Insurance Act, 1997, clients in a paid work placement are considered to be employees and would be included under the employer's regular WSIB coverage. Clients participating in an unpaid training placement (e.g. job trial or work experience) with an employer are also extended WSIB coverage, but any costs incurred as a result of a work-related accident or illness are paid by the ministry.

Where the employer is not required to carry coverage under the Workplace Safety and Insurance Act, 1997, the client is extended accident insurance under Ontario’s Accident Insurance Plan for both paid and unpaid training placements arranged by a service provider.

Coverage for Workplace Safety and Insurance Benefits - Unpaid Placements

Clients participating in an unpaid work/ training placement with employers who are required to carry Workplace Safety and Insurance coverage are covered under the Workplace Safety and Insurance Act, 1997. The costs of any workplace safety and insurance benefits paid to the client by the Workplace Safety and Insurance Board (WSIB) will be charged to the ministry.

If an accident occurs while a client is attending an unpaid work/ training placement, the following occurs:

  • The client must inform the employer immediately of the accident. The employer gives the client a Workplace Safety and Insurance Treatment Memorandum (Form 156) to be completed by the doctor or hospital department providing the initial treatment.
  • The employer notifies the service provider who informs the ODSP staff of the accident. The ODSP staff completes the first part of the Letter of Authorization, outlining ministry information, the name of the client and the date of the accident. The Letter is then forwarded to the employer, who completes the remaining part and signs it. The Letter informs the Board that the ministry will represent the employer in matters pertaining to this claim including claims management.
  • As per the usual WSIB process, the employer immediately completes the Workplace Safety and Insurance Employer's Report of Injury/Disease (Form 7) and forwards it, along with the Letter of Authorization, to the WSIB within three days. The employer forwards a copy of the completed Form 7 to the service provider who forwards a copy of the completed Form 7 to the ODSP staff along with any other relevant information. Please note that the firm number to be completed on the Form 7 is that of the ministry regional office, and not that of the employer. This ensures that the accident costs are not applied in the employer's account.

    The corresponding firm numbers are as follows:

    Toronto Region Office

    825049

    South East Regional Office

    825056

    Eastern Regional Office

    825057

    Central East Regional Office

    825050

    Central West Regional Office

    825051

    Hamilton/Niagara Regional Office

    825052

    South West Regional Office

    825053

    Northern Regional Office

    825059

    North East Regional Office

    825060

     

     

  • Any correspondence relating to the accident is sent to the client’s local ODSP office by the WSIB claims adjudicator. The WSIB pays all eligible costs related to the claim, including doctor's visits and medication. These costs are forwarded to the regional office identified by the firm number on the Form 7.
  • ODSP staff, with assistance from the service provider, will verify the information on any invoice from WSIB including statements related to the claim (e.g. eligibility of the client, whether the accident happened on the job, the legitimacy of expenses) and forward the verification to staff at the Regional Business Unit in the regional office. Based on verification of information on the invoice, the Regional Business Unit will provide a budget code and authorization for payment from Ontario Shared Services.
  • When an accident occurs, but the participant does not require medical attention, the Form 7 should be completed and kept on file by the service provider.

Coverage under Ontario's Accident Insurance Plan

Where employers are not required to carry Workplace Safety and Insurance coverage, Ontario's Accident Insurance Plan will cover the eligible costs of a work-related accident or illness suffered by a client in an unpaid or paid work/ training placement arranged by the service provider. The plan is a group plan with other training ministries and arranged with the ACE INA Insurance Company. The cost of the insurance is borne corporately by the ministry.

Employers and clients are to be advised of the accident insurance coverage. Copies of ACE INA Insurance claims forms are available, in English and French, on the SAMO extranet.

The ministry's Social Assistance and Municipal Operations Branch estimates annually the number of work/ training placement weeks with employers. Within approximately one month from the end of each fiscal-year quarter, regional office staff will be asked by the Social Assistance and Municipal Operations Branch to report the quarterly number of placement weeks based on information provided by the service providers in their region. This data is rolled up at the regional office along with the data from other ministry programs that provide workplace training placements (e.g. Ontario Works and Developmental Services) and forwarded to the Social Assistance and Municipal Operations Branch. This information is required to determine the annual cost of the insurance which is based on a premium rate multiplied by the number of placement weeks.

If an accident occurs while a client is attending a workplace training placement where no Workplace Safety and Insurance coverage is required, the following occurs:

  • The initial claim must be made within 30 days of the accident.
  • Service provider provides the employer with the Accident Report - Statement of Work Placement Employer and Training Agency form from ACE INA Insurance. The employer completes the Accident Report - Statement of Work Placement Employer and Training Agency form in conjunction with the service provider. The form must be signed by an authorized representative of both parties and maintained on file. ONLY in the event of a claim should the form be sent to ACE INA.
  • Service provider provides participant/trainee with the appropriate claim form from ACE Insurance.
    • Where claims are made for medical, or vision care benefits the client should complete the Accidental Medical Claim form and supply other information as required by the insurer. Other forms which cover weekly disability benefits and dental care benefits are the Claimant's Statement of Disability and the Accidental Dental Expenses Claim, respectively.
    • For claims that are not for medical, dental, vision care, i.e. accidental death, loss or loss of use of limb(s), sight, speech, hearing or paralysis, the service provider will contact the Claims Department of ACE INA Insurance at 1-877-772-7797. ACE INA Insurance will provide the necessary claim forms and assist in completing the forms.
  • The ACE INA Insurance Authorization to Obtain Information form should be obtained by the service provider and completed by the participant/trainee. The Authorization to Obtain Information form provides the trainee's authorization to medical practitioners and others to give information to ACE INA Insurance.
  • In the event of a claim, the service provider sends the Accident Report, the claim form, the Authorization to Obtain Information form with the work placement agreement to:

    ACE INA Insurance
    1400 - 25 York Street
    Toronto, Ontario
    M5J 2V5
    ATTENTION: Claims Department

    Policy No. SG10284501 should be noted in any correspondence to ACE INA Insurance. Copies of the submission to ACE INA Insurance are sent by the service provider to the local ODSP office.

Related Directives

4.1 Job Development and Placement
4.2 Job Retention and Advancement