Policy
A worker is entitled to partial compensation benefits, when the medical evidence substantiates continuing partial disability and an extension of temporary total benefits under s.37(2)(b) of the Workers' Compensation Act (the Act) does not apply.
Where regular weekly earnings information is unavailable for the calculation and timely payment of benefits, the WSIB shall deem a rate and a period of entitlement that falls within the reasonable expectations defined by the labour market re-entry (LMR) plan for the worker to achieve an earnings goal. Back to top
Guidelines
When a worker returns to modified work at a wage loss due to temporary partial disability, Temporary Partial Difference benefits (T. P. Diff.) are paid at 90% of the difference between the net average earnings before the accident (or most recent earnings - see 18-06-04, Most Recent Earnings) and the net amount earned on the modified job.
If the worker loses time from the modified job because of
- illness not related to the accident covered in the claim
-
personal reasons
-
no reason given, or
-
statutory holidays or vacation
the time lost is deducted from the total number of days within the pay period and the earnings are pro-rated over the actual days worked.
However, if the lost time is due to
- illness due to the compensable injury, or
-
a new compensable accident
the time lost is not deducted from the pay period.
Maximum & minimum compensation rates
When both the worker's pre-accident and post-accident gross earnings exceed the maximum earnings ceiling, the worker is not considered to have suffered a work-related loss of earnings.
When only the pre-accident wages exceed the maximum, the Temporary Partial Difference benefits are calculated as the difference between the post-accident earnings and the maximum.
When the pre-accident or most recent earnings fall between the minimum gross earnings and the minimum compensation rate, and the worker returns to work at a wage loss, the payable difference in earnings is calculated at the higher of
- the difference between the minimum and the new net average earnings, or
-
90% of the difference between the original net average earnings and the new net average earnings.
When both the pre-accident or most recent earnings and the modified duty wages are below the minimum compensation rate, the actual difference between the wages is paid.
Irregular post-accident earnings
In situations involving irregular post-accident earnings such as self-employed or commission earnings, a schedule of benefit rate reviews is established in conjunction with the LMR plan. These occur every four weeks and involve an assessment of current and projected earnings.
Decision-makers review the employment details of the LMR plan such as
- type of employment
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type of remuneration; i.e., commission or business profit
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frequency of remuneration
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expected length of time for earnings goal to be achieved
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part or full time employment
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the amount of time before the worker is expected to achieve full working capacity
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expected period to achieve proficiency in essential tasks of the new job
in order to determine an appropriate benefit rate and period of entitlement.
Section 37(2)(a) benefits end when the worker returns to pre-accident earnings, or with the determination of future economic loss.
Temporary partial helper's difference
T. P. Helper's Difference benefits are paid when a partially disabled worker must hire a helper to assist in the performance of the worker's regular job duties.
The benefit amount is calculated using the same formula as T. P. Diff. benefits, with the helper's rate of pay taking the place of the worker's current rate of pay in the formula.
T. P. Helper's Difference does not apply when a self- employed individual who has optional insurance hires a helper. In such a case, Temporary Partial Percent benefits are paid.
Temporary partial percent
Temporary Partial benefits are paid as a percentage of the Temporary Total Disability rate when the worker remains partially disabled due to the compensable disability, and
- does not meet the criteria of s.37(2)(b) of the Act
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has personal coverage at a specified rate and is unable to resume full pre-accident duties
-
returns to modified work with the accident employer at full pay and the employer specifically requests reimbursement for the worker's loss of productivity (on a percentage basis), or
-
experiences the same wage loss each week while on modified work.
The percentage paid is determined by the degree of on-going disability and the wage loss, and is referred to as "T.P.__%".
Self-employed worker
When a worker who was self-employed prior to the accident is medically unable to do pre-accident duties, but does return to limited duties, the decision-maker must obtain
- details of pre-accident job
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details of present work
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aspects of the job that cannot be performed due to the work-related disability, and
-
an estimate of the worker's current working abilities, expressed as a percentage (25%, 50%, or 75%).
The decision-maker examines this information and the clinical information provided by the attending health professional to determine the percentage of benefits payable.
Employer requests reimbursement
If an employer is paying wages to a worker with a temporary partial disability and the
- work being performed is worth less than the employer is paying
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loss of productivity is the result of the worker's disability
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employer requests reimbursement for the worker's loss of productivity
the decision-maker may use either of the following two approaches to calculate payments to the employer:
- (Pre-accident net average earnings) X 90% X (Estimated productivity loss as a %)
-
(Pre-accident net average earnings - Net amount worker able to earn from suitable employment) X 90%
To determine the estimated productivity loss, the decision-maker must evaluate the current job relative to the pre-accident job.
To determine the estimated post-accident net amount the worker is able to earn in some suitable employment, the decision-maker must compare the current job with the salaries of similar positions or estimate how much the employer would have to pay to have the job done.
Application date
This policy applies to all decisions made on or after November 1, 1990, for all accidents prior to January 1, 1998.
Document history
This policy replaces 05-02-03 dated January 4, 1999.Back to top
References
Legislative authority
Workers' Compensation Act, R.S.O. 1990, as amended
Sections 37, 38, 39
Minute
Administrative
#13, June 11, 2004, Page 366 Back to top |