What is a Non-Economic Loss (NEL) Benefit?
When you sustain a permanent impairment (PI) due to a work-related injury or illness, you are eligible for a NEL benefit under Section 46 of the Workplace Safety and Insurance Act, 1997 (WSIA). A NEL benefit is for your degree of permanent impairment. It is not for pain and suffering. 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 (MMR). We use the term MMR to identify the date that your work-related impairment reached a plateau and no further significant improvement is expected.
A NEL benefit is separate from any loss of earnings you may be entitled to due to your work-related injury or illness and is not related to your ability to work. In addition to your work-related impairment, you may also have non-work-related pre-existing conditions. The NEL benefit relates only to the work-related impairment. This is a requirement under the WSIA.
How do we determine the degree of your permanent impairment (PI)?
To determine the degree of your PI, the WSIB employs a team of registered nurses (NEL Clinical Specialists) who have extensive training and expertise in the evaluation of PIs. These decision-makers use a legislated rating schedule, the American Medical Association Guides to the Evaluation of Permanent Impairment, Third Edition, Revised (AMA Guides), all relevant health care information in the case file and, if required, a report from an independent medical assessment.
A comprehensive review and assessment of the relevant health care and other information in your case file is conducted. Relevant information is assessed against the evaluation criteria set out in the AMA Guides, policy and/or supplementary practice guidelines for your specific impairment diagnosis. Once this review is completed, the degree of your permanent impairment is determined and expressed as a “whole person impairment” percentage. This percentage represents 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 whole person.
We are currently reviewing 4,500 decisions about NEL benefits that were made between January 2012 and December 15, 2017. As a result of the review, it is now taking longer than eight to 10 weeks to complete a decision for newly referred NEL 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 NEL benefit calculated?
The dollar value of your NEL benefit is determined 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 NEL benefit, we use the base amount for the year you reached MMR. This base amount is then adjusted according to your age at the time of your injury. The age adjustment amount 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.
Sample NEL 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 2014. The base amount for workers whose MMR date is in 2014 is $57,929.41, and the adjustment factor is $1287.79. As a result, the WSIB reduces the base amount of $57,929.41 by the age adjustment factor of ($1,287.79 x 7) to get the adjusted base amount:
$57,929.41 - ($1,287.79 x 7) = $48,914.88 (adjusted base amount)
The WSIB multiplies the adjusted base amount by your whole person impairment percentage to calculate your NEL benefit. If your whole person impairment is rated at 15% your NEL benefit is:
$48,914.88 x 15% = $7,337.23
Now let’s say you were 40 years old at the time of injury (5 years under age 45), the base amount of $57,929.41is increased by the adjustment factor of ($1,287.79 x 5) to get the new base amount:
$57,929.41 + ($1,287.79 x 5) = $64,368.36 (adjusted base amount)
Using the adjusted base amount, the NEL benefit is:
$64,368.36 x 15% = $9,655.25
How is the NEL benefit paid?
NEL benefits are paid 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 worker.
The NEL benefit threshold is set annually. The NEL threshold for each worker is based on the year the worker reaches MMR. For a complete list of the NEL 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.
NEL benefits at or under the threshold are automatically paid as a lump sum. NEL benefits over the threshold are automatically paid as a lump sum after 30 days unless you elect to have the benefit paid monthly. If you are eligible to elect a monthly NEL benefit payable for life, you have 30 days from the date of the decision letter to make the election. This election is irrevocable. This time frame applies to both initial NEL benefit determination decisions and NEL benefit redetermination decisions.
What if my condition gets worse?
We can review your NEL benefit provided your work-related impairment has significantly and permanently worsened, and 12 months have passed since your last NEL decision. This review is called a NEL Redetermination. To request a NEL Redetermination, you must contact your Case Manager who will provide you with additional information about the NEL Redetermination process.
About the Workplace Safety and Insurance Board
The Workplace Safety and Insurance Board (WSIB) is an independent trust agency that administers compensation and no-fault insurance for Ontario workplaces. We are committed to delivering what matters to the workers and employers of Ontario: fast, accessible service and fair benefits at a fair price. The WSIB provides wage loss benefits, medical coverage and help getting back to work – the best possible outcome following an injury on the job.