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Key Differentiators
Windley Ely is considered both the leader and the top innovator in the disability management space in Canada. We offer many different programs depending on the needs of our clients.
Like our competitors, Windley Ely offers what we call our “traditional” disability management program, supported by a non-medical case manager managing claims as well as technology. Traditional programs (whether in-house or third-party), rely solely on non-medical Case Manager(s), who have limited access to medical information, and little if any ability to impact medical recovery timelines (the single largest driver of WCB premium costs).
These programs, although effective, lack effective medical management. The absence of effective medical management and intervention during the lifetime of the claim limits the returns on traditional programs, which usually plateau at a 2:1 return on investment ratio (for every $1 spent on these disability management programs, the employer saves/recovers $2). While an effective starting point, most companies would prefer to springboard into a more cost-effective program.
Medical Management
What differentiates Windley Ely is that we are the only Canadian provider offering a fully medically supported disability management program, employing Registered Nurses and Occupational Physicians and Specialists on every claim.
In this program, the Windley Ely Registered Nurse maintains regular weekly contact with injured employees, their physiotherapists, and their other care providers. Throughout the lifetime of the claim, the Nurses are supported by a team of Windley Ely Occupational Physicians and Specialists, who regularly review claims to ensure proper diagnoses, treatment plans, testing, and to establish return-to-work (RTW) goal dates on all claims from date of injury. This is done to ensure that injured employees are progressing to the established RTW goal dates throughout the life of the claim.
Using these medical protocols, we are able to dramatically reduce average claim durations, which, again, is the largest driver of WCB premium assessment costs; Windley Ely reports average claim durations inside of 32 days, whereas WCBs report average claim durations exceeding 50 days.
Windley Ely’s medically managed program (in conjunction with our Nurse Triage service) is achieving returns on investment of 5:1. More importantly, these programs ensure that your injured employees receive the best medical care possible. No other Canadian provider is able to deliver this value.
Nurse Triage
Windley Ely is also the only company that can offer and fully support a Nurse Triage service. This service is the first of its kind in Canada, and is more robust than those currently offered in the United States. It is also our fastest growing business unit; by using this service, employers have been able to close 28% of their claims as First-Aid only claims, reducing WCB filings by 28% and thereby reducing WCB-related costs.
In the Nurse Triage service, the injured worker and/or supervisor calls a telehealth hotline (24/7 availability) the moment an injury occurs. During the phone call, a Windley Ely Registered Nurse uses Schmitt-Thompson Nurse Protocols (the gold-standard protocol in North America), in conjunction with their own experience and medical knowledge, to dispense appropriate care advice to the injured employee. The Nurse then determines whether the incident can be monitored/maintained as a First-Aid claim, or whether the employee should be directed to a Doctor to get medical care, initiating a WCB claim. The Nurse maintains contact with the injured employee until the claim is either closed as a First-Aid claim or until the employee seeks medical. In cases where they seek medical treatment, the Nurse continues to manage the claim according to claims management protocols.
This program ensures that employees are getting the best medical care from the time of incident, and alleviates the need for supervisors and employers to make the difficult decision as to when an employee should see a physician.
Cost Relief
All WCBs have Cost-Relief provisions that allow employers to transfer/remove WCB costs from their WCB accounts when claims recoveries are delayed due to pre-existing conditions. For the most part, employers are unable to access the medical information on the WCB file, and are forced to request and/or rely on the WCB Case Manger to adjudicate cost relief. These files are rarely forwarded to a WCB Medical Advisor for a comprehensive medical review. Furthermore, due to the high caseloads experienced by WCB Case Managers, the reviews they conduct are often cursory or incomplete. As a result, employers are recovering less than 25% of the total cost relief amount available to them.
In our medically based programs, all cost-relief applications are documented by Windley Ely Occupational Physicians and Specialists. This is why we boast an 82% success rate: much higher than the 25% success rate of non-documented cost-relief applications. Medical Expertise is critical to Cost Relief – for example, it would be difficult to argue that any non-medical Case Manager could identify a pre-existing adhesive shoulder capsule on an MRI.
The average Windley Ely cost-relief award is approximately $20,000 per claim, which will result in $58,000 in related WCB assessment premiums; this is a significant cost recovery.
Legal Appeals
Another important area of Claims Assistance support is in the area of legal appeals. In most programs, legal appeals are represented and argued by Case Managers assigned to the file or by a paralegal. Windley Ely employs dedicated, experienced lawyers to represent WCB appeals. Our experience is that In-House Case Managers are intimidated by the WCB appeals process. They either do not take claims forward to appeal, or they argue appeals poorly.
Windley Ely lawyers represent over 3000 appeals per year, and are successful 76% of the time. Given an average cost to argue an appeal below $2,800, and an experience-rated cost savings of $58,000 per appeal, most decision makers see the clear financial advantage to employing experienced WCB lawyers. Windley Ely lawyers can also provide an invaluable resource for the interpretation of appeal-related policy.
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