Paul Spooner

Workers' compensation professional with approximately nine years of direct experience within the Ontario Workplace Safety and Insurance Board (WSIB), including four years as a Case Manager in a claims adjudication and decision-making role. Extensive knowledge of WSIB legislation, operational policy, claims processes and entitlement frameworks. Experienced in analyzing complex claim evidence, identifying entitlement issues, assessing benefit eligibility, investigating conflicting information and preparing clear, evidence-based decisions and rationales. Brings first-hand understanding of how WSIB claims are adjudicated, documented, reconsidered and managed through recovery and return-to-work processes.

• Microsoft Office
• Stakeholder Management

1. Case Manager

   WORKPLACE SAFETY AND INSURANCE BOARD (WSIB)

   Jan 2022 to Present

   • Independently manage complex Ontario WSIB workplace injury and illness claims, making evidence-based decisions regarding entitlement, benefits, recovery and return-to-work outcomes. • Interpret and apply WSIB legislation, operational policy and adjudicative principles to individual claim circumstances. • Conduct detailed reviews of medical, functional, vocational, employment and claim evidence to determine ongoing entitlement and appropriate case direction. • Analyze entitlement issues and identify gaps, inconsistencies or conflicting evidence requiring additional investigation or clarification. • Make consequential administrative decisions affecting benefit entitlement, employer and worker obligations and claim outcomes. • Prepare clear, comprehensive and defensible claim documentation setting out evidence, analysis, decisions and rationale. • Review benefit and entitlement information for accuracy and take appropriate action when claim circumstances or evidence affect ongoing entitlement. • Manage disputed and escalated claims involving competing stakeholder positions while maintaining impartiality and procedural fairness. • Communicate directly with workers, employers, health-care providers and specialized WSIB resources to obtain evidence, resolve issues and advance claims. • Apply detailed knowledge of WSIB operational practices and decision-making frameworks when developing claim strategies. • Manage high-volume claim inventory while maintaining accuracy, timeliness, documentation quality and service standards. • Support recovery and return-to-work outcomes through analysis of functional abilities, workplace demands, modified work and barriers to recovery.

2. Customer Service Representative

   WORKPLACE SAFETY AND INSURANCE BOARD (WSIB)

   Jan 2017 to Jan 2022

   • Provided front-line claims support to workers and employers within Ontario's workers' compensation system. • Responded to complex inquiries regarding claims, entitlement, benefits, employer and worker responsibilities and WSIB processes. • Reviewed claim information and identified matters requiring adjudication, escalation or specialized intervention. • Explained WSIB legislation, policy and administrative processes clearly to workers and employers. • Managed high-volume and challenging interactions requiring accuracy, judgment, problem-solving and professional communication. • Developed extensive knowledge of WSIB claims administration before progressing into a Case Manager adjudicative role.

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