What is a non-economic loss benefit?
If you have a permanent impairment due to a work-related injury or illness, you are eligible for a non-economic loss benefit under Section 46 of the Workplace Safety and Insurance Act, 1997 (WSIA). We pay you a non-economic loss benefit when you have an ongoing impairment after your work-related injury or illness has reached a point where it is not expected to improve. This point is called the maximum medical recovery date. The WSIA defines “permanent impairment” as a physical or functional abnormality or loss (including disfigurement) which results from an injury and any psychological damage arising from the abnormality or loss that continues to exist after you reach maximum medical recovery.
A non-economic loss benefit is not related to any loss of earnings benefit you may be receiving and it is not related to your ability to work. The non-economic loss benefit you receive is only for the impairment resulting from your work-related injury or illness.
In addition to your work-related impairment, you may also have non-work-related pre-existing conditions. The non-economic loss benefit relates only to the work-related impairment. This is a requirement under the WSIA.
How do we decide the degree of your permanent impairment?
A non-economic loss benefit compensates you based on the degree of your permanent impairment. To determine the degree of your permanent impairment, we have a team of registered nurses who have extensive training and expertise in the evaluation of permanent impairments review your claim. In the WSIA it says we must use the evaluation criteria set out in the American Medical Association Guides to the Evaluation of Permanent Impairment, Third Edition, Revised when we decide the degree of your permanent impairment. We also use policy and/or supplementary practice guidelines for your specific impairment diagnosis, all relevant health- care information in your file and, if needed, a report from an independent medical assessment.
Once we decide the degree of your permanent impairment for the specific area of your injury or illness, we determine the “whole person impairment” percentage. This percentage is the degree that your whole body is impaired as a result of your work-related impairment.
For example, a complete amputation of the index finger represents a 100% impairment of the finger. The 100% impairment of the finger represents a 20% impairment of the hand. The 20% impairment of the hand represents an 18% impairment of the arm, and the 18% impairment of the arm represents an 11% impairment of the entire body.
We are currently reviewing 4,500 decisions about non-economic loss benefits that were made between January 2012 and December 15, 2018. As a result of the review, it is now taking longer than eight to 10 weeks to complete a decision for newly referred non-economic loss cases. We are working hard to improve the timelines so that we can get your decision to you as soon as possible.
How is your non-economic loss benefit calculated?
We decide the dollar value of your non-economic loss benefit by multiplying your whole person impairment percentage by a base dollar value. The base dollar amount is set out in the WSIA. To calculate a non-economic loss benefit, we use the base amount for the year you reached maximum medical recovery. This base amount is then adjusted according to your age at the time of your injury. There is an age adjustment amount that is added for every year you were under the age of 45 at the time of the injury, or subtracted for every year you were over 45, up to a maximum of 20 years.
Example of a non-economic loss benefit calculation
Let’s say that you were 52 years old at the time of injury (7 years over age 45) and you reached maximum medical recovery in the year 2018 . The base amount for people whose maximum medical recovery date is in 2018 is $59,981.69 , and the adjustment amount is $1,333.42 . As a result, we reduce the base amount of $59,981.69 by the age adjustment factor of ($1,333.42 x 7) to get the adjusted base amount:
$59,981.69 - ($1,333.42 x 7) = $50,647.75 (adjusted base amount)
We multiply the adjusted base amount by your whole person impairment percentage to calculate your non-economic loss benefit. If your whole person impairment is rated at 15%, your non-economic loss benefit is:
$50,647.75 x 15% = $7,597.16
Now let’s say you were 40 years old at the time of injury (five years under age 45), the base amount of $59,981.69 is increased by the adjustment amount of ($1,333.42 x 5) to get the new base amount:
$59,981.69 + ($1,333.42 x 5) = $66,648.79 (adjusted base amount)
Using the adjusted base amount, your non-economic loss benefit is: $66,648.79 x 15% = $9,997.32
How do we pay the non-economic loss benefit?
We pay non-economic loss benefits as a lump sum or monthly payment depending on whether the benefit amount is under or over an established threshold, and in some cases, on the payment option selected by the person.
The non-economic loss benefit threshold is set annually. The threshold for each person is based on the year the person reaches maximum medical recovery. For a complete list of the non-economic loss benefit threshold amounts to date, see Policy 18-01-02, Benefit Dollar Amounts - Accidents from 1998 and Policy 18-01-03, Benefit Dollar Amounts - Accidents before 1998.
If non-economic loss benefits are at or under the threshold, we automatically pay them as a lump sum. If non-economic loss benefits are over the threshold, we automatically pay them as a lump sum after 30 days unless you choose to have the benefit paid monthly. If you are eligible to choose a monthly non-economic loss benefit payable for life, you have 30 days from the date of the decision letter to decide the method of payment. Once the method of payment is decided, it can’t be changed.
What if my condition gets worse?
We can review your non-economic loss benefit if your work-related impairment has significantly and permanently worsened, and if 12 months have passed since your last non-economic loss decision. This review is called a non-economic loss redetermination. To request a non-economic loss redetermination, contact your Case Manager and they will provide you with more information about the process.