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Operational policy manual

Initial Determination - Where Suitable Occupation has been Determined

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 - Where Suitable Occupation has been Determined
Document No.
18-04-06

Policy

The WSIB determines the future economic loss (FEL) benefit for workers who are not earning at the time of the initial determination based on the suitable occupation (SO) and earnings identified at the time of the work transition (WT) assessment.

A WT plan may be prepared to achieve the SO, see 19-03-03, Determining Suitable Occupation. At the completion of the plan, the WSIB reviews the SO earnings identified at the time of the WT assessment, and confirms or varies these earnings, see 18-04-14, Reviewing FEL Benefits (Prior to Final Review).

Purpose

The purpose of this policy is to outline how FEL benefits are calculated for workers who are not earning at the time of initial determination.

Guidelines

Definitions

Suitable occupation

A SO represents a category of jobs suited to a worker’s transferable skills that are safe, consistent with the worker’s functional abilities, and that to the extent possible, restores the worker’s pre-injury earnings. The SO must be available with the injury employer or in the labour market, see 19-03-03, Determining Suitable Occupation.

Date of determination

For information about the time-frames 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 pre-injury net average earnings (NAE) and post-injury NAE.

FEL determination

Calculate pre-injury NAE

The WSIB calculates pre-injury NAE to determine FEL benefits in 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.

Determine the SO and earnings

For details about the determination of the SO and earnings, see 19-03-03, Determining Suitable Occupation.

Calculate post-injury NAE

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

  • income tax payable by the worker
  • Canada Pension Plan (CPP) premiums and/or the probable Quebec Pension Plan (QPP) premiums payable by the worker, 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.

Formula

Post-injury earnings that equal or exceed pre-injury earnings

If the worker is participating in a WT assessment or plan, and the SO will result in the post-injury NAE equaling or exceeding the pre-injury NAE, the WSIB identifies the claim as entitled to a FEL sustainability benefit, and a FEL supplementary benefit is paid to the worker for the duration of the WT plan.

For information about

Post-injury earnings less than pre-injury earnings

If the worker is participating in a WT assessment or plan, and the SO will not restore pre-injury NAE, the worker is entitled to a FEL benefit based on the difference between the pre-injury NAE and the NAE of the SO. A FEL supplementary benefit is paid to the worker for the assessment or plan's duration, see 18-04-11, Supplements for Programs and Work Reintegration Activities Before and After 24 Months.

Non-co-operation

Workers are not entitled to a FEL supplement if they do not co-operate in a WT assessment or plan. The WSIB identifies the SO and earnings, and bases the FEL benefit on the proposed SO and earnings, see 19-02-02, Responsibilities of the Workplace Parties in Work Reintegration.

Annual indexing

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

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 18-04-06 dated February 15, 2013.

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

Reference

Legislative authority

Workplace Safety and Insurance Act, 1997, as amended
Sections 40, 42, 44, 102, 107, 107.1, 108

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

Minute

Administrative
#2, November 15, 2017, Page 543

Compass: Guiding you to a healthy and safe workplace