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Operational policy manual

Initial Determination - Workers Who are Earning at Time of Determination

Benefit Payments
Application Date
This policy applies to all decisions made for entitlement periods on or after January 1, 2018, for accidents from January 2, 1990 to December 31, 1997.
Published
02-Jan-2018
Subject
Future Economic Loss (FEL) (Accidents from 1990-1997)
Title
Initial Determination - Workers Who are Earning at Time of Determination
Document No.
18-04-05

Policy

The WSIB determines the future economic loss (FEL) benefit for workers who are earning at the time of the initial determination based on their post-injury net average earnings (NAE) as a result of work reintegration activities.

For workers participating in a work transition assessment at the time of the initial determination, see 18-04-06, Initial Determination - Where Suitable Occupation has been Determined.

Purpose

The purpose of this policy is to outline how FEL benefits are calculated for workers who are earning at the time of the initial determination.

Guidelines

Definitions

Date of determination

For information on the time-frames that the WSIB uses to determine FEL benefits, see 18-04-03, Date of Determination.

FEL benefit

A FEL benefit is 90 per cent of the difference between the pre-injury NAE and post-injury NAE.

FEL determination

Formula

If a worker's post-injury NAE

  • are less than the pre-injury NAE at the time of the initial determination, the FEL benefit is 90 per cent of the difference between the pre-injury NAE and the post-injury NAE, or,
  • equals or exceeds the pre-injury NAE, but is not sustainable, the WSIB identifies the claim as entitled to a FEL sustainability benefit, see 18-04-13, FEL Sustainability Benefit.

Calculating pre-injury NAE

The WSIB calculates pre-injury NAE to determine FEL benefits the same way it does for temporary total disability benefits, see 18-06-01, Calculating Temporary Total Disability Benefits.

The statutory minimum does not apply to the calculation of the FEL benefit.

Escalated pre-injury earnings

If the earnings year is different than the year of the initial determination, the pre-injury earnings are updated to protect them against the effects of inflation. This is called escalation and is done by applying the appropriate indexing factor to the earnings for each indexing date between the pre-injury earnings date and the date of the initial determination. The applicable indexing factor for each indexing date can be found in 18-01-03, Benefit Dollar Amounts - Accidents before 1998.

Calculating post-injury NAE

To calculate the FEL benefit, the WSIB determines post-injury NAE by deducting from the gross earnings the probable

  • income tax
  • Canada Pension Plan (CPP) premiums and/or the probable Quebec Pension Plan (QPP) premiums, and
  • Employment Insurance premiums

payable by the worker.

CPP/QPP benefits

The CPP/QPP disability benefits a worker is receiving, either in whole or in part, due to the work-related injury/disease must be taken into account as post-injury earnings when determining the FEL benefit, see 18-01-13, Calculating CPP/QPP Offsets from FEL/LOE Benefits.

Annual indexing

On January 1 every year, the WSIB indexes ongoing FEL benefits by applying the indexing factor to the amount payable, see 18-01-14, Annual Indexing.

Loss of retirement income (LRI) benefit

The WSIB sets aside additional funds equal to 10 per cent of every FEL payment, including FEL supplements, for the worker's LRI benefit, see 18-04-17, Loss of Retirement Income Benefits (Accidents from January 2, 1990 to December 31, 1997).

Application date

This policy applies to all decisions made for entitlement periods on or after January 1, 2018, for accidents from January 2, 1990 to December 31, 1997.

Document history

This document replaces 18-04-05 dated February 15, 2013.

This document was previously published as:
18-04-05 dated October 3, 2007
18-04-05 dated June 1, 2005
18-04-05 dated October 12, 2004
18-04-05 dated March 1, 2002
18-04-05 dated June 15, 1999
7.4* dated January 1, 1998
05-05-06* dated November 22, 1993
*documents were replaced by 18-04-05 dated June 15, 1999.

References

Legislative authority

Workplace Safety and Insurance Act, 1997, as amended
Sections 102, 107, 107.1, 108

Workers' Compensation Act, R.S.O. 1990, as amended
Section 41, 43, 44

Minute

Administrative
#1, November 15, 2017, Page 543

Compass: Guiding you to a healthy and safe workplace