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Functional Abilities Form for Work Reintegration


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Application Date
This policy applies to all decisions made on or after February 15, 2013, for all accidents.
Published
15-Feb-2013
Subject
Work Reintegration
Title
Functional Abilities Form for Work Reintegration
Document No.
19-02-04

Document sections:| Policy | Guidelines | References |

Policy

When filing a claim, workers must consent to the disclosure of their functional abilities information by the treating health professional to the employer to assist in work reintegration.

The employer and worker (workplace parties) can obtain written functional abilities information either by using

  • the WSIB's Functional Abilities Form for Planning Early and Safe Return to Work (FAF), or
  • a form created by them which is specific to their own workplace.

When requested to do so by an employer or worker, the treating health professional must give the WSIB, the employer, and the worker such information concerning the worker's functional abilities as is required to complete the FAF.

Purpose

The purpose of this policy is to set out the rules around the request, completion, use, disclosure and payment of an FAF.

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Guidelines

NOTE

Unless specifically indicated, these guidelines only pertain to the use of the WSIB's FAF, not to the use of forms created by the workplace parties.

Purpose of the FAF

The FAF may be used by the workplace parties to help identify suitable jobs consistent with the worker's functional abilities. Its purpose is to highlight what a worker can do and what limitations apply.

The FAF does not contain either clinical or diagnostic information. It does not replace the health professional's reporting requirements to the WSIB. As well, the form does not replace the employer's initial-accident reporting obligations, see 15-01-02, Employer's Initial Accident-Reporting Obligations.

Discretionary use of the FAF

Although the Workplace Safety and Insurance Act, 1997 (WSIA) requires all workers who file a claim for benefits to consent to the disclosure of functional abilities information, see 15-01-03, Workers' Requirement to Claim and Consent, the workplace parties are not required to have an FAF completed by a health professional.

The decision to obtain functional abilities information, and to use the WSIB's FAF, rests with the workplace parties.

Using a form created by the workplace parties

In some cases, the workplace parties may decide to obtain functional abilities information but, instead of using the WSIB's FAF, may choose to use a form they created.

If so, the employer must obtain a separate consent from the worker, on a non-WSIB form. The initial consent given by the worker when filing a claim relates only to the disclosure of information on the WSIB's FAF.

Completion of FAF

A properly completed FAF contains information the workplace parties may need to assist them in a return to work.

Health professionals must answer all the questions on the FAF which are relevant to the worker, and may also attach a letter to describe functional capabilities and limitations.

Diagnostic information should not be included on the form or any attachments. The form may either be typewritten, or handwritten (in dark ink). Once completed, the health professional may deliver it to the workplace parties and the WSIB by

  • hand or courier
  • regular mail, or
  • FAX.

Because the treating health professional submits a copy of the completed form to the WSIB, it is not necessary for the workplace parties to submit their copies of the completed form to the WSIB.

Number of forms used per claim

Because the workplace parties are responsible for deciding when functional abilities information is necessary, the WSIB does not limit the number of forms which can be used to achieve WR.

FAFs may be used for recurrences, see 15-03-01, Recurrences.

Confidentiality of report

Neither employers nor employer representatives may disclose the information contained in an FAF except to a person assisting the workplace parties in meeting their WR obligations.

Anyone who contravenes this confidentiality is guilty of an offence. If prosecuted and convicted, they are liable for a fine of up to

  • $25,000 or up to 6 months in jail, or both, for individuals, or
  • $100,000 for corporate entities.

For more on offences and penalties, see section "Compliance" in the Operational Policy Manual.

Use by WSIB staff

Although the FAF is designed for the use of the workplace parties, WSIB staff may use the information contained in the form for decision-making purposes.

For example, the FAF could be used by WSIB decision-makers to help determine whether the post-injury job is suitable for the worker.

Because the FAF does not contain clinical information, it is not used to determine initial entitlement to benefits under the insurance plan.

Pre-1998 claims

Although the WSIA does not require workers with pre-1998 claims to consent to the disclosure of functional abilities information, the workplace parties may want to obtain such information to achieve WR.

In these cases, the workplace parties may use either the FAF or a form they created. With either type of form, the workplace parties should consult the treating health professional to see what type of consent he or she requires.

Who is a treating health professional?

Health professional means a member of a College of a health profession as defined in the Regulated Health Professions Act, 1991.

Generally, the treating health professional is the person who is responsible for the ongoing care of the worker. However, health professionals who treat the worker on a one-time basis may also be called upon by the workplace parties to complete an FAF.

NOTE

Given the nature of emergency care, emergency room professionals may not be ideally suited to provide functional abilities information to the workplace parties. However, the decision to ask an emergency room professional to complete an FAF rests with the workplace parties.

WSIB- or employer-requested health exams

Generally, a health professional who examines a worker at the request of either the WSIB or the employer is not considered the treating health professional for the purposes of completing an FAF.

For more information on employer-requested or WSIB-requested health examinations, see 17-04-02, Employer-Requested Health Examinations, and 17-04-03, WSIB-Requested Health Examinations.

Two or more health professionals

In some cases, more than one health professional may treat the worker (e.g., a general practitioner and a physiotherapist, two specialists). If the workplace parties believe that each health professional can provide useful functional abilities information, two separate FAFs can be completed.

Role of the treating health professional

The workplace parties and the WSIB depend on the treating health professional to complete the form and provide it to the workplace parties and the WSIB in a timely manner. Therefore, the health professional who is selected by the workplace parties should complete the FAF, and if requested, complete subsequent FAFs.

Changing health professionals

The WSIB does not allow the worker to change health professionals for the sole purpose of obtaining an FAF unless the treating health professional

  • does not complete and submit the FAF in a timely manner, or
  • refuses to complete the FAF.

In these cases, the workplace parties can ask another health professional to complete the form.

For more information on choice and change of health professionals, see 17-01-03, Choice and Change of Health Professional.

Payment to health professionals

Using an FAF

The WSIB pays for the completion of the FAF except if the treating health professional is employed by the employer. In these cases, the employer must pay the costs of the form directly.

Health professionals are not permitted to charge workers for completion of the form.

For information on the WSIB's fee schedules, see 17-03-01, Health Care Fees.

Using a form created by the workplace parties

If the workplace parties choose to use a form created by themselves, the employer is responsible for paying the health professional directly.

Pending or rejected claims

As with the payment of clinical assessments/reports requested for adjudication, see 17-02-03, Payment of Clinical Assessments/Reports Requested for Adjudication, the WSIB pays for a completed FAF in claims which are pending or which are subsequently rejected.

No-lost time claim

The WSIB pays for completed FAFs in a no-lost time claim.

Costs on accident cost statement

The costs of FAFs are shown on an employer's accident cost statement as a health care expense.

Application date

This policy applies to all decisions made on or after February 15, 2013, for all accidents.

Document history

This document replaces 19-02-04 dated August 1, 2007.

This document was previously published as:

19-02-04 dated October 12, 2004

19-02-04 dated May 23, 2000

19-02-04 dated June 15, 1999.

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References

Legislative authority

Workplace Safety and Insurance Act, 1997, as amended

Sections 22(5), 33, 37, 150(1), 158

O.Reg. 456/97

Minute

Administrative

#39, January 28, 2013, Page 508

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