Loading...
Skip to content

Operational policy manual

Supplements for Programs and Work Reintegration Activities Before and After 24 Months

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
Supplements for Programs and Work Reintegration Activities Before and After 24 Months
Document No.
18-04-11

Policy

Workers in receipt of a future economic loss (FEL) benefit, or a FEL sustainability benefit, are entitled to receive a FEL supplement while co-operating in a medical rehabilitation (MR) program or work reintegration (WR) activities that

The supplement is added to the FEL benefit. The combined total of the FEL benefit and the supplement equals 90 per cent of the worker’s pre-injury net average earnings, see 18-04-06, Initial Determination - Where Suitable Occupation has been Determined.

A supplement paid based on participation in a MR program or WR activities ends upon completion of the program or activities.

Purpose

The purpose of this policy is to outline when a worker is entitled to receive the FEL supplement both before and after 24 months from the initial FEL determination date.

Guidelines

Supplementary benefit entitlement - before 24 months

Workers in receipt of a FEL benefit or a FEL sustainability benefit are entitled to a FEL supplement while they are co-operating in WR activities (including a work transition (WT) assessment and, if required a WT plan) that began within 24 months from the initial FEL determination date.

Supplementary benefit entitlement - after 24 months

Workers in receipt of a FEL benefit or a FEL sustainability benefit are entitled to a FEL supplement while they are co-operating in WR activities (including a WT assessment and, if required a WT plan) that began after the 24-month post-initial determination date if

  • it is a continuation of WR activities, or
  • the WT services began before the 24-month date.

WR activities continuation

The continuation of WR activities is accepted if, before 24 months from the initial FEL determination date, the claim file information indicated concerns relating to the

  • suitability or sustainability of the job
  • availability of the accommodated employment, or
  • need to revise or initiate new WR activities.

If the worker continues to be unable to perform the pre-injury job past the 24-month date due to the work-related permanent impairment, the worker is considered to

  • have begun WR activities before the 24-month date, and
  • to be continuing past the 24-month date.

Job suitability/sustainability concerns

If a worker returns to a job that is subsequently determined to be unsuitable or unsustainable after the 24-month post-initial determination date, the worker is eligible to receive WT services. In these cases, it is assumed that job suitability and/or sustainability concerns existed about the worker’s ongoing ability to perform the job before the 24-month date.

Accommodated employment

The worker’s job may be considered to be accommodated if it

  • includes work or workplace modifications
  • pays the worker at a rate significantly higher than what the employer pays for similar jobs, or is one where the productivity required of the worker is significantly lower than would normally be expected
  • was created especially for the worker (e.g., tasks and work processes have been specifically accommodated for the worker’s impairment and are not likely to exist with, or be provided by, another employer), or
  • is eliminated, and the worker’s work-related injury/disease restricts the worker’s ability to find new employment with similar clinical precautions/accommodations in the general labour market.

If the worker returns to accommodated employment and the accommodated job is no longer available prior to the final FEL review, the WSIB may refer the worker for WT services. This guideline applies as long as the claim file information indicates that, due to the work-related permanent impairment, the worker is unable to perform the pre-injury job and may require WT services.

MR program

Workers co-operating in an MR program before or after the 24-month date are eligible for a FEL supplement, see 18-04-12, Supplement Following Significant Deterioration.

For information about

Co-operation

For information concerning the co-operation guidelines, see 22-01-03, Workers' Co-operation Obligations and 19-02-02, Responsibilities of the Workplace Parties in Work Reintegration.

Impact of zero per cent NEL rating

If a worker who is receiving a FEL benefit and supplement is assessed at 0 per cent for non-economic loss (NEL), the WSIB stops paying the FEL benefit and supplement, see 18-04-15, Effect of a 0% NEL Rating on FEL Benefits.

Significant deterioration

For information regarding entitlement to a FEL supplement following a significant deterioration in the work-related condition, see 18-04-12, Supplement Following Significant Deterioration.

Exceptional cases - post 60 months

After the 60th month post-initial determination, workers may be entitled to further supplementary benefits if

  • they were provided with a WT plan and the plan is not completed when the 60th month period is reached, or
  • the worker suffers a significant deterioration in his/her work-related condition and co-operates and participates in an MR program.

For more information about reviewing FEL benefits and the payment of supplementary benefits beyond 60 months post-initial determination, see 18-04-20, Final FEL Benefit Review.

Annual indexing

On January 1 every year, the WSIB indexes ongoing FEL benefits, including the supplement, 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 18-04-11 dated January 2, 2015.

This document was previously published as:
18-04-11 dated February 15, 2013
18-04-11 dated August 1, 2007
18-04-11 dated October 12, 2004
18-04-11 dated February 20, 2003
18-04-11 dated December 24, 2003
18-04-11 dated August 1, 2003
18-04-11 dated April 11, 2003
18-04-11 dated May 23, 2000
18-04-11 dated June 15, 1999
7.10* dated January 1, 1998
05-05-11* dated February 13, 1992
documents were replaced by 18-04-11 dated June 15, 1999.

References

Legislative authority

Workplace Safety and Insurance Act, 1997, as amended
Sections 102, 106, 107, 107.1, 108

Workers’ Compensation Act, R.S.O. 1990, as amended
Sections 42, 43, 44

Minute

Administrative
#3, November 15, 2017, Page 543

Compass: Guiding you to a healthy and safe workplace