Independent Living policy consultation

Report on phase 2 consultation feedback: Independent living and quality-of-life policies

Serious Injury Program value-for-money audit

Introduction

Since fall 2022, we’ve reviewed our independent living policies, leading practices and community feedback to ensure we’re providing the right benefits to people when they need them.

In spring 2024, we shared nine draft revised and new policies for public comment. Thank you to everyone who submitted feedback on the consultation drafts. We carefully reviewed the feedback and incorporated updates to the policies, which are now finalized for advance posting.

We expect to implement the policies in September 2026.

This consultation summary report includes background on the independent living policy review, an overview of the consultation process, a summary of what we heard from various groups and the WSIB’s responses, including where policies have been revised to respond to feedback.

Background

Under the Workplace Safety and Insurance Act, 1997 (WSIA), we must have an external firm review the cost, efficiency and effectiveness of one or more WSIB programs each year through a value-for-money audit. The Serious Injury Program was reviewed in 2020.

The Serious Injury Program value-for-money audit  found the program delivers value. It also identified challenges and opportunities within our independent living policies. In particular, the “severely impaired” threshold limits our ability to provide appropriate support based on individual needs.

The consultation process

Phase one (September 16, 2022, to October 14, 2022)

We asked for feedback to inform our review of the eligibility criteria for independent living benefits and services (policies 17-06-02 to 17-06-08).

We asked questions about the severely impaired threshold, as well as the timing and duration of entitlement.  

We received  15 submissions (PDF) . A summary is available in the “External feedback” section of Phase 2 below. Thank you to everyone who submitted feedback.

Phase two (April 18, 2024, to June 12, 2024)

We reviewed feedback from phase one and recommendations from the Serious Injury Program audit and developed two new policies and proposed revisions to existing independent living policies.  

In phase two, we asked for input on two new and seven revised draft policies.

The draft policies reflected:

• a new eligibility threshold (serious injury or illness)
• updated independent living benefits and services
• specific criteria for each benefit and service
• revisions to address benefit- and service-specific issues  

To support the review, we provided the draft policies and phase one consultation report, including:

• a summary of the main themes from phase one feedback
• a discussion about the severely impaired threshold
• highlights of proposed revisions for each policy
• highlights of two new policies

We received 10 submissions from the following groups:

• Canadian Vehicle Manufacturers’ Association
• Industrial Accident Victims Group of Ontario (IAVGO) Community Legal Clinic
• Injured Workers Community Legal Clinic
• L.A. Liversidge, LLB
• Northumberland Community Legal Centre
• Office of the Employer Advisor
• Office of the Worker Advisor
• Ontario Legal Clinics’ Workers’ Compensation Network
• Schedule 2 Employers Group
• Workers’ Health and Safety Legal Clinic

Thank you to everyone who  submitted feedback (PDF) . The following sections provide an overview of the feedback, our responses and links to the new policies.

Overview of key policy changes

Following a multi-phase consultation, we updated the policies to move away from a “one-size- fits-all” approach.

The new approach supports more individualized benefits and services for people with serious injuries and illnesses, based on their functional needs and ability to carry out daily activities.

These changes support fairness, transparency and independent living, and help people recover and return to work where possible.

A key change is the eligibility threshold for additional independent living benefits and services. It is now based on functional limitations that are expected to cause extreme difficulty or prevent a person from carrying out activities of daily living or instrumental activities of daily living for more than four weeks. The definition of serious injury or illness has been updated to reflect this.

Entitlement is based on an objective assessment of needs, not on whether a person’s limitations are considered significant or severe.

This approach ensures people with acute serious injuries and illnesses can access support when they need it, even if their ability to live independently is impacted for less than six months.

Overview policy

The new Independent Living and Quality of Life Measures: Overview and Definitions policy (17-06-01), outlines the independent living benefits and services available to people whose independent living is impacted by a work-related injury or illness and who meet the entitlement criteria.

These include:

• health care equipment and supplies
• assistive devices
• attendant care
• minor home and vehicle modifications
• travel for WSIB appointments and return to work
• home health care
• other necessary health care (for example, physiotherapy and chiropractic therapy)  

The new and revised policies also outline additional benefits and services available to people with serious injuries and illnesses who need support with independent living, including:

• independent living allowances
• independent living devices
• guide dogs and service dogs
• personal care allowance
• major vehicle modifications
• major home modifications  

The policies also:

• outline the measures we consider appropriate to improve the quality of life of people with severe impairments
• how we determine what is necessary, appropriate and sufficient in individual cases
• explain when alternate benefits and services may be provided

These changes align with the recommendation from the value-for-money audit to review and update the eligibility criteria.

Case study

Evan’s story shows how the updated benefits and services better support his ability to live independently and improve his quality of life.

Evan sustained a traumatic workplace injury resulting in a foot amputation. He is married, has a young child and lives on a large property. He is the sole earner and the only driver in the family.

During the acute phase of recovery, Evan faces significant challenges, including:

• difficulty performing activities of daily living, such as bathing and dressing
• inability to manage instrumental activities of daily living, including home maintenance and yard work
• temporary inability to drive, which limits his ability to transport himself and his family
• increased reliance on his spouse for personal care and household tasks
• emotional stress for the family as they adjust to new routines  

After Evan receives rehabilitation and prosthetic support, Evan reaches maximum medical recovery. At this point, it’s expected that:

• he will regain independence with most activities of daily living and instrumental activities of daily living
• he may continue to need independent living devices, such as mobility aids
• he will be able to drive again, with vehicle modifications
• some home modifications will be needed (for example, ramps, accessible bathroom features)
• occasional support for property maintenance may still be required

Under the current policies, Evan does not meet the eligibility threshold for most independent living benefits and services. He wouldn’t receive the independent living allowance, personal care allowance, home modifications, or independent living devices.

Under the revised approach, Evan would be eligible for a broader range of supports, including:

• home maintenance allowance: to support yard work and property upkeep
• transportation allowance: to support family mobility while he is unable to drive
• personal care allowance: temporary support until he regains independence
• home modifications: such as ramps and accessible bathroom features to improve safety and accessibility
• independent living devices: such as mobility aids and other supports, as needed

These benefits and services can be provided right away, without waiting for maximum medical recovery or confirmation of a specific level of impairment. With these supports, Evan and his family would experience:

• reduced stress and improved family functioning during the acute recovery phase
• greater independence and ability to participate in work, family and community life
• improved safety and accessibility at home and in his vehicle
• improved quality of life for the whole family

This example shows how the revised approach allows people like Evan to access the supports they need earlier, supporting independent living and well-being during recovery and beyond.

General feedback and responses

The feedback in this section relates to multiple independent living policies and is not specific to any one policy.

Concerns about consultation and engagement

Labour and employer groups said the consultation period was too short, given the volume and complexity of the information. Labour groups also identified a need for more engagement with people with injuries and illnesses, with accessibility in mind.

We value input and thank participants for sharing their feedback. The phase two consultation was open for two months, and we granted extensions where requested. This approach aligns with our  Framework for Operational Policy Development and Renewal (PDF) . 

Before starting the policy review, we also engaged people with severe impairments through workshops to better understand their experiences, concerns and priorities for improving independent living benefits and services.

Eligibility threshold and decision-making flexibility

We received many comments about entitlement to independent living benefits and services. Participants asked about the move from a fixed impairment threshold to an approach based on functional limitations. They raised concerns about fairness, consistency and when benefits would be approved.

Some participants suggested a hybrid model, with a lower impairment threshold for automatic entitlement and discretion below that level. While employers and labour groups have different views on the threshold, they agreed on the need for clear and fair criteria.

We recognize that a numerical threshold provides a quick way to determine entitlement. However, a diagnosis or impairment rating alone does not reflect how a person’s injury or illness affects their ability to live independently.

A person’s needs following a workplace injury or illness depend on their individual circumstances, including age, health, support network, socio-economic status, environment and other factors. To support independent living, each person’s needs are assessed across three key areas:

• the person
• their ability to engage in meaningful activities
• their environment  

This assessment considers physical, cognitive and emotional abilities. Activities can be adapted to match a person’s abilities and environmental barriers can be reduced through accessibility improvements, changes to the physical space or stronger supports.

By focusing on the whole person rather than a numerical threshold, we can tailor benefits and services to individual needs and better support health, well-being and quality of life.

The impact of a person’s functional limitations on their ability to carry out activities of daily living and instrumental activities of daily living are the first indicator of their independent living needs, or potential needs. Other benefit-specific criteria address the person’s ability to complete specific activities (e.g., home maintenance, driving) and consider their unique environment (e.g., proximity to health care).

Basing entitlement only on a minimum permanent impairment rating, without considering a person’s circumstances, can prevent people from accessing the supports they need to live independently.

By focusing on a person’s functional limitations and individual circumstances, we can provide benefits and services that are necessary, appropriate and timely. This approach allows us to respond more quickly to changes in a person’s needs, without waiting for an impairment rating to be reassessed.

Assessing each claim based on individual facts and circumstances also gives decision-makers more flexibility than the previous model. Moving away from the 60 per cent non-economic loss or 100 per cent permanent disability threshold addresses concerns during the first phase of consultation and is consistent with recommendations from the value-for-money audit.

As part of our  Framework for Operational Policy Development and Renewal (PDF) , we will continue to review and evaluate our policies to ensure they are working as intended and providing clear direction.

We will monitor the outcomes of the revised policies and update them as needed. We also continue to gather feedback outside of formal consultations to ensure our policies remain effective and responsive to people’s needs.

Feedback specific to the eligibility criteria for each benefit and service from phase two of the consultation is addressed in the corresponding policy sections.

Adjudication

Participants raised concerns about adjudication, including how decision-makers consider individual circumstances such as pre-existing or cumulative conditions, whether benefits and services are offered proactively, and the possibility for inconsistent decisions. They also asked whether guidance could be expanded in practice documents and how recommendations are validated through independent and objective assessment.

When we use third parties to complete assessments, we confirm their credentials and expertise through their employer, education and regulatory or licensing requirements. Our decision-makers review all third-party reports and make independent decisions based on specific facts of each case, supported by claim file information and other evidence in the file.

Decision-makers use a range of tools and guidance, including medical reports and professional practices guidelines. These provide a framework for consistent decision-making while allowing flexibility to consider each person’s unique circumstances.

Removing the severe impairment threshold allows decision-makers to better consider individual circumstances. This approach supports decisions that focus on what benefits and services are appropriate, and ensures people receive the right support at the right time, not only what is requested.

The new Independent Living and Quality-of-Life Measures – Overview and Definitions policy (17-06-01), outlines a comprehensive set of benefits and services we may provide when they are necessary, appropriate and sufficient. This includes support for all injured and ill people, as well as additional supports for people with serious injuries and illnesses and severe impairments.

Under the previous model, entitlement to independent living benefits and services often required a non-economic loss determination or redetermination before support could be provided.

The new approach allows benefits and services to be provided as soon as they are needed, rather than waiting for a non-economic loss assessment. This helps ensure people receive timely support.

The policy also clarifies that various medical assessments are often completed at key transition points in a person’s recovery, such as when discharged from a care facility, and are also used to determine entitlement and ensure people receive the supports they need to live independently.

People do not need to be transferred to the Serious Injury Program to access many independent living benefits and services. People with greater needs will continue to be supported through the program. All decision-makers can provide certain independent living benefits and services to any injured or ill person that needs them, as long as benefit-specific criteria are met.

We aim to balance timely, consistent decision making with flexibility to respond to each person’s circumstances. By moving away from impairment thresholds, decision-makers can better assess the combined effect of injuries and illnesses on a person’s ability to live independently.

We have an implementation plan in place, including training for all decision-makers. Our teams also have access to clinical expertise such as nurse case managers and supporting adjudicative resources. While this change requires adjustments, our teams are equipped to implement the new approach.

We understand the challenges people face with independent living which has helped shape these changes. The revised policies give our teams the flexibility to provide the right support, at the right time, for as long as it’s needed.

Clarifying and ensuring transparency

In response to feedback, we revised the independent living policies to more clearly define the benefits and services we consider necessary and appropriate. The policies outline entitlement criteria, clarify the responsibilities of both the WSIB and injured and ill people, and explain when criteria and examples aren’t exhaustive.  

We also added detail across policies to clarify intent and reflect current practices. Updates align with best practices, legislative changes, scientific evidence and technological advances. These changes respond to a key recommendation in the value-for-money audit to review and strengthen practice guidelines that support consistent decision-making.

Benefit amounts in new and legacy claims

Participants raised questions about the dollar value of independent living benefits. Some supported higher values and broader entitlement to ensure people are reimbursed for injury or illness related expenses, while others supported caps on benefits.

They also raised questions and concerns about how benefits are paid, how current recipients may be affected, when benefits are reviewed, and the use of random reviews, lock-in provisions and stacking of benefits.

This report includes estimated allowances and rates. Final approval amounts will be published in the Table of Rates policy.

This report also explains the five-level flat rate model for the personal care allowance in section Personal Care Attendants and Allowance (17-06-05).

People who receive independent living, guide and support dog or personal care allowances before the new policies take effect will continue to receive their benefits under the applicable policy versions.

As with all our benefits and services, people must report any material changes to us. We may review the benefits and services they receive. Most policies now outline how material change reviews are conducted. People receive these benefits as long as they meet the entitlement criteria. We have not added lock-in provisions for independent living benefits and services. The goal is to provide the right benefits and services at the right time, with the flexibility to adjust support as needs change. This approach applies equally to all health care benefits, allowing for responsive and timely support.

Depending on the person’s circumstances and the type of benefit, support may be temporary, long-term or lifelong. While multiple benefits and services may address the same objective, we generally approve only one. We determine which option is most appropriate based on the person’s needs and preferences.

The policies also include transitional provisions. Existing entitlements continue until a material change occurs. If a legacy claim no longer meets the criteria, we assess entitlement under the revised policies.

Financial impacts

Participants raised concerns about the adequacy of benefits and services, others expressed concerns about controlling costs.

We deliver benefits and services in a financially responsible and sustainable way. We are also required to determine, in each case, what is necessary, appropriate and sufficient to support independent living and improve quality of life following a workplace injury or illness.

The value-for-money audit did not recommend cost savings or maintaining cost neutrality. Instead, it recommended that we review eligibility criteria and related policies to ensure that people with serious injuries and illnesses receive the benefits and services they need.

Based on the review, the revised eligibility will result in additional benefits and services to meet the needs of injured and ill people while remaining fiscally responsible. Allowances will be reviewed annually as part of the rate review to ensure they remain reasonable and reflect the types of expenses each is intended to cover.

Policy-specific feedback and responses

Participants provided feedback requesting clarification, suggesting changes, and supporting the policy direction outlined in the draft policies. The following outlines feedback received for each policy, along with our responses and any revisions made.

Independent Living and Quality-of-Life Measures - Overview and Definitions (17-06-01)

This policy defines key terms and concepts used across the independent living and quality-of-life policies. It sets out general entitlement criteria and outlines the independent living benefits and services available to injured and ill people, including additional supports for those with serious injuries and illnesses.

It serves as a roadmap, outlining what to consider when applying entitlement criteria in benefit and service-specific policies. It also highlights other available benefits when serious injury or illness criteria aren’t met.

Participants provided significant feedback on this policy, some of which is summarized and addressed in the General feedback and responses section.

The feedback not already commented on falls under three themes:

Definitions

Several participants noted that having different definitions for serious injury and serious illness could create a higher entitlement threshold for serious illnesses.

Our response

To address this, we revised the policy to use a single definition for serious injury and illness.

The definition focuses on how the injury or illness affects a person’s ability to live independently. It includes cases where the impact lasts more than four weeks or is permanent, as well as cases where recovery is unlikely or the condition is progressive and life-limiting (for example, may endure less than four weeks).

Functional limitations

Some suggested we reconsider the list of functional limitations. They noted that because the list wasn’t exhaustive, relying on it may result in the unwarranted denial of additional benefits.

In addition, several participants suggested that using both “significant” and “severe” to describe work-related impairments and functional limitations is confusing and may lead to inconsistent decision-making.

Our response

We revised the policy to provide a more complete list of functional limitations that may impact a person’s ability to live independently.

The policy now outlines categories of functioning that may be impacted by a work-related injury or illness. These are motor and mobility, neurocognitive, mental and/or behavioural, vision, and bilateral hearing.

A serious injury and illness is now defined by functional limitations that result in extreme difficulty or an inability to carry out activities of daily living or instrumental activities of daily living for more than four weeks. This approach focuses on how functional limitations impact a person’s ability to carry out activities of daily living or instrumental activities of daily living, rather than relying on severity labels such as “significant” or “severe,” which can be more subjective.

Injury and illness types

Multiple participants suggested we reconsider including specific injury and illness types that wouldn’t typically meet entitlement criteria for independent living benefits and services. They noted that because the list wasn’t exhaustive, relying on it may result in unwarranted denial of benefits.

Some also raised concerns about the perceived exclusion of conditions such as chronic pain, long COVID, musculoskeletal injuries (including fractures and amputations), cancers, minor traumatic brain injuries, concussions, psychological injuries, and cumulative injuries.

Our response

After considering this feedback, we added a list of injuries and illnesses that may typically qualify for additional benefits and services. We also refined the list of those that typically don’t qualify.

These lists aren’t determinative of entitlement. They are intended to provide a clearer sense of the range of injuries and illnesses that may qualify for additional benefits and services.

The policy also clarifies that the lists aren’t exhaustive and that each case will be assessed based on the person’s specific functional limitations and how they impact daily living.

It further confirms psychological injuries, brain injuries, occupational diseases and musculoskeletal injuries aren’t categorically excluded from entitlement to additional independent living benefits and services.

Independent Living Allowances (17-06-02)

Independent living allowances provide financial support to offset the costs of services (e.g., home maintenance, transportation) and other expenses (e.g., increased insurance for a modified vehicle) incurred by seriously injured or ill people to support independent living.  

We organized feedback and our responses under six themes:  

Value of the allowances

Participants asked about the dollar values of the revised independent living allowances. Some suggested maintaining the flat-rate allowance but increasing it and allowing reimbursement for expenses beyond that flat rate.  

Our response

The 2026 rates for each of the allowances are expected to be:

1. Home maintenance allowance: $200.35 per month
2. Transportation allowance: $72.47 per month
3. Additional expenses allowance: $63.94 per month
4. Quality-of-life allowance: $89.52 per month (now covered under Quality-of-Life Benefits and Allowance (17-06-09)).

Dollar values for each allowance will be set out in Table of Rates (18-01-05), once they take effect, and we will review and update them annually.

Rationale for the allowance

When we introduced the independent living allowance, we did not intend it to reimburse every expense related to a workplace injury and illness. Instead, it was designed to reasonably cover typical additional costs associated with living independently after a serious injury or illness.

The fixed, annual allowance provides flexibility, allowing people to decide how to best use the funds based on their needs, rather than submitting each expense for approval. This approach gives people more control and makes the process faster to administer by reducing the need to assess individual requests. The allowance balances fairness, flexibility and practicality. It supports seriously injured and ill people while keeping compensation manageable and consistent.

Supporting context

In “Reshaping Workers’ Compensation for Ontario”, Professor Paul Weiler discusses limits on compensation:  

       “By contrast with the tort remedy – for motor vehicle accidents, for example, -

        workers’ compensation does not aim at full redress for all damages inflicted on  

        the worker by his injury. But by contrast with the social welfare system (old  

        age pensions, unemployment insurance, et al.) workers’ compensation does aim

        to replace the bulk of the prior income lost by the injured claimant.” (page13/14)  

The underlying purpose of the allowance and the items it covers has not changed under the revised policies.

Separation of the allowances

Participants asked about the rationale for splitting the allowance into three independent living allowances and a quality-of-life allowance.

Our response

The four allowance types reflect the categories of services and expenses identified when the independent living allowance and policy were first developed.

Separating the allowances allows us to provide the right benefits at the right time to the right people. Some people will need all three independent living and quality-of-life allowances, while others need only some.

This approach ensures people receive support tailored to their needs, rather than a single annual lump sum that may not reflect what they need.

The revised eligibility criteria also allow us to provide one or more allowances to individuals who wouldn’t have met the previous 60 per cent non-economic loss or 100 per cent permanent disability rating threshold, and who wouldn’t have qualified for support under the previous model.

Purpose of each allowance

Participants asked for clarity about the purpose of each independent living allowance.

Our response

There are three independent living allowances, each with a distinct purpose and flat rate.

1. The home maintenance allowance helps cover the cost of indoor and outdoor maintenance services at the person’s principal residence. A person is eligible if they have a serious injury or illness that is likely permanent and affects their ability to maintain their home.
2. The transportation allowance helps cover the cost of travel by public or commercial transportation so that a person can carry out instrumental activities of daily living (e.g., grocery shopping) and to support independent living. A person is eligible if they have a serious injury or illness that is likely permanent and affects their ability to travel to complete daily activities as they did before the serious injury or illness. If a vehicle has been modified to support independent living, the transportation allowance is generally not provided. However, we removed the example outlining this to allow for greater discretion in decision-making.
3. The additional expenses allowance helps cover extra costs related to WSIB-approved vehicle or home modifications and independent living devices (e.g., additional car insurance due to vehicle modification). A person may be eligible if they have a serious injury or illness that is likely permanent and receive other independent living benefits and services that result in additional costs.

Payment method

Participants requested clarity regarding whether receipts would be required for entitlement to the independent living allowances. One submission suggested the policy should be eliminated if receipts aren’t required.

Our response

To ensure that people are receiving the benefits they need, we may require receipts or documentation when first determining entitlement. Once entitlement is established, we do not require receipts or documentation for ongoing payments. People will continue to receive the allowance(s) until they no longer meet the criteria.

The revised policy clarifies that each allowance is paid monthly as a flat rate. Monthly payments ensure people receive supports regularly when they need it.

If it is clear that a person will need the home maintenance allowance on a long-term basis, they may request an annual lump sum to assist in securing seasonal services.

Transitional claims  

One submission suggested that people currently receiving the independent living allowance should continue to receive the same level of benefits.

Our response

People already receiving an independent living allowance will continue to receive the full value, indexed annually. The revised policy clarifies this.

The new policy applies to all new claims, and to requests for entitlement in current claims where the person wasn’t previously receiving an independent living allowance.

If a person in a current claim no longer meets the eligibility criteria following a material change review, we may assess entitlement under the revised policy. We will determine entitlement to each allowance based on the criteria set out in the policy.

Independent living devices costing less than $250  

Some viewed the change to reimbursement of devices costing less than $250 as a reduction of benefits.

Our response

The independent living allowance no longer covers devices under $250. Instead, we assess reimbursement for these devices separately under the Independent Living Devices policy (17-06-03) or the Health Care Equipment and Supplies policy (17-07-06).

By covering devices through these policies, the independent living allowance can focus on services, and its value has increased to provide greater support in those areas.

Independent Living Devices (17-06-03)

Currently, we reimburse expenses for devices costing more than $250 that help restore a person’s ability to communicate, be mobile and engage in self-care, or prevent further injury or health complications related to work-related injury or illness. Reimbursing these devices supports independent living.

Going forward, reimbursement isn’t limited to devices over $250. We have organized feedback and our responses under three themes:

Purpose of independent living devices

One participant commented that the policy is redundant as assistive devices are already covered under Health Care Equipment and Supplies (17-07-06).

Our response

The purpose of independent living devices is to restore a person’s ability to communicate, be mobile, engage in self-care and prevent further injury or health complications related to work-related injury or illness. Coverage isn’t limited to health care equipment or supplies. We may also cover other items if they support independent living.

Permanent impairment threshold

Participants asked the WSIB to limit entitlement to independent living devices only to people whose work-related injuries or illnesses are likely to result in permanent impairment.

Our response

Eligibility for independent living devices requires a serious work-related injury or illness that results in, or is likely to result in, permanent impairment. People who don’t meet this threshold may still access other health care and independent living benefits.

Excluded devices

Participants asked us to reconsider excluding certain devices, such as hot tubs, pools, all-terrain vehicles, tractors, snowplows and riding lawnmowers.

Our response

We generally don’t consider these items necessary or appropriate health care. However, we updated the policy to allow consideration in exceptional circumstances.

Guide Dogs and Service Dogs (17-06-04)

Under the revised policy, we’ll pay for the purchase and training of a guide dog or service dog for people with designated conditions. We also fund mobility training, provide an allowance for routine veterinary care and maintenance (such as nutrition, annual exams and vaccinations) and cover extraordinary veterinary treatment when needed.

Feedback on this policy and responses are organized under two themes:

Excluded conditions and animals  

We were asked to expand eligibility to include other injuries or illnesses beyond the designated conditions such as occupational disease, cancers, diabetes, seizures, and psychological conditions. Some also suggested extending eligibility beyond guide dogs and service dogs to include support animals.

Our response

We must determine appropriate measures to support independent living under the WSIA. In reviewing this policy, we considered available research on animal-assisted interventions. The evidence is strong and consistent for guide dogs and service dogs for specific conditions but limited for other uses.

While support animals provide comfort, current  scientific evidence on support animals (PDF)  for independent living is limited. As a result, we don’t consider emotional support dogs or other animals to be necessary, appropriate or sufficient health care under the insurance plan. People who don’t qualify for a guide dog or service dog may still access other health care supports to help with independent living and return to work.

Guide dogs and service dogs can access most private homes, public spaces and workplaces where physical support may be needed. Standardized training for these animals, delivered by internationally accredited facilities, is readily available in Ontario. Comparable training is not widely available for other types of animals.

We’re satisfied that the designated conditions in our policy align with scientific evidence on the effectiveness of animal-assisted interventions. We recognize this evidence continues to evolve and will monitor emerging research to ensure the policy reflects best available evidence.

The revised policy:

• supports timely and consistent decisions on entitlement to guide dogs and service dogs
• improves clarity and transparency around entitlement
• allows entitlement where it is safe and supported by evidence of therapeutic benefit

Contraindications

A participant suggested reconsidering some contraindications to owning a guide dog or service dog, including substance abuse, worsening symptoms and the inability to manage the animal.

Our response

We revised the policy to remove some contraindications to owning a guide dog or service dog.

Personal Care Attendants and Allowance (17-06-05)

People who need help with activities of daily living or instrumental activities of daily living may receive personal care through an agency that we pay directly.

People who meet the serious injury or illness criteria may receive a personal care allowance to hire their own attendants to support their activities of daily living or instrumental activities of daily living.

Feedback and our responses are organized under seven themes:

Levels of personal care

Participants asked for more clarity on how levels of care would be determined and reassessed. One questioned the efficiency of the new model.

Our response

We revised the policy to clarify how we assign personal care allowance levels. We base levels on the average of three criteria:

1. The number of activities of daily living or instrumental activities of daily living the person needs help with
2. The frequency of assistance required
3. The number of activities of daily living or instrumental activities of daily living requiring specialized care

These three criteria (number of activities of daily living and instrumental activities of daily living, frequency of care and required skill level) generate an overall score that aligns with one of five levels of care.

The new model supports faster decisions and payments. It also reduces the need to adjust allowances for minor changes in care needs. After a material change review, we only adjust the allowance if reassessment results in a change of at least one level of care (for example, from level 3 to level 4).

The current hourly rate model is time-consuming and can delay payments. The new approach simplifies assessments by removing the need to calculate minutes of care for each activity. This will also support faster decisions in claims involving retroactive entitlement, such as when new presumptions are introduced for certain occupational diseases.

The policy outlines redeterminations of care levels. A material change review may be requested by the injured or ill person, their health care professional, employer, or initiated by the WSIB. We may also review cases periodically or when we receive information that the person’s condition has changed. We determine whether a review is required and, in most cases, conduct a home visit and reassessment.

Activities of daily living scale form

Participants asked for a copy of the Activities of daily living scale form.

Our response

This form is in development and not publicly available yet.

The activities of daily living and instrumental activities of daily living captured by the form include: tracheostomy care, ventilator care, prosthetics and orthotics, equipment and supply maintenance, other therapies, genitourinary and bowel care, personal hygiene, oral hygiene, bathing, skin care, dressing, medication, exercise, mealtimes, mobility, cleaning, laundry, additional assistance, general hygiene and care coordination.

Amount of the personal care allowance

Participants asked about the dollar value of the personal care allowance. One suggested the flat rate may not adequately compensate non-agency attendants.

Our response

We’ll publish flat-rate personal care allowance amounts in Table of rates (18-01-05), and review them annually. The 2026 rates are expected to be:

Level 1: $840.16 per month

Level 2: $1,688.21 per month

Level 3: $3,165.18 per month

Level 4: $6,618.61 per month

Level 5: $10,795.16 per month

We developed these rates by analyzing current recipients’ monthly amounts and organizing them into five levels. Each level was optimized, ensuring that if current recipients were assessed under the five-level model, their needs would be adequately covered, while being financially responsible.

For example:

• Level 1 rate is approximately 1.5 hours of care per day at the 2026 general hourly rate.
• Level 5 rate is approximately 12 hours of care per day, including 1 hour at the general hourly rate, 3 hours at the personal hourly rate and 8 hours at the skilled hourly rate.

The levels provide a range, rather than a fixed amount. This approach avoids frequent adjustments for minor changes in care needs and helps ensure that people continue to receive appropriate support as their care needs change.

Employment standards

We were asked to clarify how the Employment Standards Act applies to agency and non-agency attendants. They also suggested we act as the employer for non-agency attendants, cover training costs, extend compensation for loss of retirement income and require coverage for all non-agency attendants regardless of hours worked.  

Our response

The Employment Standards Act sets limits on hours of work. The revised policy reflects these limits for all attendants, including non-agency attendants.

People who need more than 12 hours of care per day, or who can’t meet employer responsibilities, are eligible for agency care in addition to or instead of a personal care allowance. Agencies are responsible for meeting the Employment Standards Act requirements. We don’t oversee third-party employment relationships.

We updated the policy to reflect the Employment Standards Act requirements for vacation. Attendants who have worked for five years or more are entitled to three weeks of vacation annually.

People who receive a personal care allowance are the employers of the non-agency attendants they hire. We don’t act as the employer and don’t oversee hiring, training or payment of non-agency attendants. When these responsibilities can’t be met, the person is eligible for agency care.

We don’t compensate non-agency attendants for loss of retirement income or other employment benefits. Employment terms are between the injured or ill person and the attendant. People who hire non-agency attendants are responsible for Canada Pension Plan remittances.

If a non-agency attendant experiences a work-related injury or illness, we will provide benefits in accordance with the insurance plan, including consideration of loss of retirement income where applicable.

Where the person with a workplace injury or illness or the non-agency attendant aren’t satisfied with the personal care allowance and related benefits, they may choose to receive care through an agency.

WSIB coverage is mandatory for all personal care attendants who work more than 24 hours per week. This requirement isn’t new and applies to all private household employers. The person with an injury or illness is automatically registered as an employer with the WSIB, and we pay associated costs.

Retroactive claims

A participant suggested reimbursing people with injuries or illnesses for the full costs of personal care provided by a non-agency attendant in retroactive claims.

Our response

We revised the policy to clarify that we reimburse reasonable costs when receipts are provided.

If receipts aren’t provided, or costs aren’t reasonable, we pay the amount associated with the assessed level of care.

Transitional claims

A participant suggested that guidance for claims before January 1, 1998, imposes a higher entitlement standard than what is currently in place.

Our response

Under the Workers’ Compensation Act, Revised Statutes of Ontario 1980 and Workers’ Compensation Act, Revised Statutes of Ontario 1990, people must have a permanent total disability or impairment (100 per cent disability rating or 60 per cent non-economic loss rating) to be eligible for a personal care allowance. Under the new model this requirement is met with a serious injury or illness.

In contrast, the Workplace Safety and Insurance Act, 1997 doesn’t require a permanent impairment to establish entitlement to a personal care allowance.

For claims on or after January 1, 1998, a person who doesn’t have a serious injury or illness may still be eligible if they require assistance with activities of daily living or instrumental activities of daily living and:

• live outside an agency’s service area, or
• require personal care while receiving temporary treatment for a work-related illness

The Workers' Compensation Act, Revised Statutes of Ontario 1990 and the Workers' Compensation Act, Revised Statutes of Ontario 1980 don’t allow these exceptions for claims registered before January 1, 1998.

Powers of attorney

We were asked for clarity about the type of powers of attorney referenced in the policy.

Our response

The policy has been revised to clarify that the personal care allowance may be paid to a person’s continuing power of attorney for property. A person acting under a power of attorney for personal care may not also act as the person’s attendant.

Home Health Care (17-06-06)

A person may be entitled to a home care program to receive health care services such as nursing care, physiotherapy or occupational therapy, in their home when their needs can’t be met on an outpatient basis. Feedback on this policy and our responses are organized under two themes:

Travel distance

One participant suggested placing limits on how far a person must travel for outpatient services.

Our response

We don’t provide health care directly. We fund care and help arrange services, but we don’t control where they are offered. 

The policy has been revised to clarify that people who must travel for treatment related to work-related injury or illness are eligible for reimbursement under the Travel and Related Expenses policy (17-01-09).

Payment

It was suggested that we give preference to public home health care programs. One also suggested that the rates for home health care services can be negotiated.

Our response

Home health care is typically provided by public health care organizations. In some cases, we may arrange care through a private provider based on the location and the person’s treatment needs.

The policy has been revised to clarify that home health care program services are paid directly to the provider at the WSIB-approved rate.

Vehicle Modifications (17-06-07)

We reimburse the costs of vehicle modifications for eligible people when the modifications are essential for the safe operation of the vehicle or for a person’s ability to enter, exit or operate it. These modifications support a person’s ability to carry out instrumental activities of daily living and live independently.

Feedback on this policy and our responses are organized under four themes:

Eligible vehicles

A participant suggested that eligibility shouldn’t be limited to vehicles that can be used year-round or are the primary mode of transport.

Our response

For the purposes of this policy, a “vehicle” aligns with the definition of “motor vehicle” under the Ontario Highway Traffic Act and is designed for year-round use on highways.

We require vehicles to support “year-round” use. This supports the purpose of vehicle modifications, which is to help people carry out daily activities and live independently.

We revised the policy to clarify that the vehicle must be the person’s primary vehicle, not their primary mode of transportation.

Purchasing a vehicle to modify

It was suggested that we reconsider excluding the purchase or reimbursement of a vehicle, including purpose-built vehicles.

Our response

We modify existing vehicles. In some cases, we may contribute to the cost of a purpose-built vehicle.

Driver training

A participant suggested including the costs of training and documentation needed to ensure a modified vehicle is safe and operable.

Our response

To confirm, we reimburse required assessments, instruction and training.  

We also reimburse documentation, such as Safety Standards Certificates, needed to confirm the vehicle is safe and operable.

Insurance

It was suggested that we cover repair or replacement costs not paid by insurance when related to a compensable injury.

Our response

We may cover repair or replacement costs in exceptional cases when insurance does not fully cover the modifications. People must maintain appropriate vehicle insurance. If this cost is higher for a modified vehicle, they may be eligible to the additional expenses independent living allowance.

Home Modifications (17-06-08)

We authorize home modifications to help people with work-related injuries and illnesses live independently at home, where possible. The policy outlines who qualifies, which homes we may modify, the types of modifications we cover, and how we cover their maintenance, repair and replacement. Feedback and our responses are organized under six themes:

Entitlement

Participants suggested that we:

• allow home modifications to support live-in caregivers
• allow home modifications that create a hospital-like setting
• reconsider requiring the work-related injury or illness to be the primary factor in determining entitlement  

Our response

We cover home modifications that help a caregiver safely assist a person with activities or address changes to living arrangements caused by a work-related injury or illness.

We don’t cover modifications that support a caregiver living in the home. These are not required for a person to live independently or access areas of their home.

We don’t support creating a hospital-like setting in the home. People who need constant, complex or specialized care should receive care in appropriate clinical settings.

People with workplace injuries and illnesses may receive support from agency or non-agency attendants to help with independent living. See the Personal Care Attendants and Allowance policy (17-06-05).

We continue to require that the work-related condition be the primary factor in determining entitlement. However, we clarify in the policy that we may consider home modifications when a non-work-related injury or illness affects the person’s ability to access areas of their home needed for daily activities, where:

• there was no impact before the work-related injury or illness, or
• the impact is greater than before

Secondary homes

It was suggested that we:

• allow home modifications for secondary residences purchased after the work-related injury or illness
• allow modifications beyond specific rooms in secondary residences

Our response

We aim to restore people to their pre-injury living situation where possible.

We limit modifications to secondary residences that the person owned or used before the work-related injury or illness. We don’t consider residences purchased after the injury or illness.

We may allow limited modifications to a kitchen in a secondary residence when needed to support independent living, such as preparing meals.

These modifications must:

• not change the structural footprint of the home
• be completed without modifying other rooms or outdoor areas except to support access and use of the home

Rental properties

It was suggested that we:

• reconsider rent increases following a move
• contribute to the difference in rent between an initial and subsequent unit
• continue covering that difference for life or up to five years after the person’s death where a spouse or dependent lived with them

Our response

We cover rent increases related to a work-related injury or illness through the independent living allowance for additional expenses.

We may reimburse amounts above the allowance if the person provides receipts.

We encourage people to find a rent-controlled unit, where available, to reduce the need for future moves and support stable independent living.

We don’t reimburse rent increases if the move isn’t related to the work-related injury or illness.

Reimbursements for rent increases and the independent living allowance for additional expenses don’t continue to be paid to an injured or ill person’s survivors or others who lived with them after the injured or ill person’s death.

People who rent or own their homes may be eligible for:

• home modifications following a WSIB-approved relocation
• reimbursement for additional utility costs related to an illness or injury
• reimbursement for accessibility features if they purchase a home  

Existing structures, alternative homes and reimbursement approach

It was suggested that we:

• purchase homes on behalf of injured or ill people
• reimburse for home modifications in more than one home
• reimburse modification costs an alternative home that exceed the approved estimate in the existing home

Our response

We do not purchase homes or reimburse for the full cost of a home.

We reimburse accessibility features in a home purchased by the person. We encourage people to choose a home that already meets their accessibility needs or can be modified to meet them.

We may reimburse accessibility features more than once if:

• modifications to the current home aren’t structurally feasible
• the person’s work-related condition has significantly deteriorated, and
• all other policy criteria are met  

We reimburse the actual costs of modifications in the purchased home. This approach:

• reflects the person’s current needs
• avoids estimating costs for a home that can’t be reasonably modified  

If modifications to the current home are structurally feasible but cost more than expected based on the home’s age, condition or design, we conduct a cost-benefit analysis.

Based on the results, if the person chooses to purchase another home, we may reimburse the cost of the required accessibility features in that home.

Moving costs

It was suggested that we cover accommodation costs while modifications are underway.

Our response

We cover reasonable accommodation and meal expenses if the person can’t live in their home during major modifications, in line with the Travel and Related Expenses policy (17-01-09).

Ownership and removal

A participant suggested there shouldn’t be a time limit for requesting removal of a home modification.

Our response

We extended the timeline to request removal of a home modification or a device from one year to two years.

Two years provides a reasonable timeframe, including for grieving families, and allows us to plan for the cost of returning the home to its original condition.

Quality-of-Life Benefits and Allowance (17-06-09)

This policy outlines the measures we will consider to improve the quality of life for people with a severe impairment, the criteria for entitlement and how benefits are paid and reviewed.

We have organized feedback under five themes:

Purpose of the quality-of-life benefits

Participants asked:

• what the quality-of-life benefits are intended to support
• whether people can receive all three types of benefits
• whether independent living allowances affect entitlement to the quality-of-life allowance  

Our response

There are three quality-of-life benefits, each with its own purpose and eligibility criteria. People may receive one, more than one, or all three benefits.

The quality-of-life allowance helps people participate in activities such as fitness, education, recreation and leisure.

We pay the allowance monthly, as a flat rate. People don’t need to submit receipts.

Independent living allowances do not affect entitlement to the quality-of-life allowance. Once a person qualifies, they continue to receive the allowance until they no longer meet the criteria.

We may reimburse hobby expenses, including:  

• equipment and supplies
• equipment modifications
• related training
• reasonable startup costs  

This approach doesn’t change current entitlement that was previously provided under the Independent Living Devices policy (17-06-03). The policy now provides more detail on what is covered.  

We may also approve mental health supports for family members of people with severe impairments.

Amount of the quality-of-life benefits

Participants asked:

• how the allowance amount is set
• whether additional expenses above the flat rate should be reimbursed
• whether there should be a cap
• how often the allowance is paid
• whether hobby and family mental health supports should be included in the allowance

Our response

The 2026 rate for the quality-of-life allowance is expected to be $89.52 per month. We don’t offer an annual payment option.

We based this amount on the historical portion of the independent living allowance used for quality-of-life measures. We review the allowance each year and update it in the Table of Rates policy.

Hobby expenses require pre-approval. We reimburse these expenses after the person submits receipts.

We pay approved mental health services for family members directly to the health professional providing therapy or counselling services.

Quality-of-life allowance

It was suggested that we reconsider limiting entitlements for individuals living in institutions.

Our response

Institutions often provide supports that the quality-of-life allowance would cover. If a person lives in an institution on a permanent or long-term basis, we assess eligibility for the allowance case-by-case. People living in institutions may still access other independent living benefits, including reimbursement for hobby expenses.

Hobbies

It was suggested that we:

• purchase hobby supplies, equipment and trial or rental costs for people with severe impairments
• shouldn’t limit reimbursements to certain types of hobbies
• restrict entitlement to hobbies with clear therapeutic value, where costs and outcomes can be monitored and where there may be labour market value
• clarify when a person may be eligible for a subsequent hobby
• shouldn’t require people with severe impairments to describe their interest and goals for the hobby

Our response

We don’t purchase hobby equipment or supplies. We reimburse pre-approved expenses. We may:

• pay for an assessment to help a person choose a safe, appropriate hobby
• reimburse reasonable start-up costs, such as instruction or training

Community organizations may provide free or low-cost options for people to try a hobby.

We may consider funding one additional hobby after a significant life change. We reassess eligibility using the same criteria as the first hobby.

We decide whether a hobby is necessary, appropriate and sufficient. We consider the person’s interests and goals, but they do not determine eligibility. We also consider safety.

We don’t reimburse excluded hobbies. We respect the person’s choice of hobbies and support them in finding options that meet the criteria.

Mental health supports for family members

Participants raised concerns about whether we have legal authority to provide mental health supports for family members.

They also suggested that we:

• ensure mental health supports for family members are available as soon as possible
• reconsider limiting supports to a set number of sessions (e.g., 10)
• cover medications prescribed to family members by a mental health professional  

Our response

Mental health support for family members is a quality-of-life measure for people with severe impairments.

These supports may be provided when appropriate to improve quality of life.

Requests are assessed on a person’s needs and circumstances, and we provide approved services in a timely way.

If more than 10 sessions are needed, family members will be directed to public or private mental health providers.

We don’t cover medication prescribed to a person’s family members.

Phase two - Independent living policy consultation (Serious Injury Program value-for-money audit consultation)

Introduction

Under the Workplace Safety and Insurance Act, 1997 (WSIA), we are required to have an external firm review the cost, efficiency, and effectiveness of one or more programs through a value-for-money audit. Our Serious Injury Program was the focus of a recent value-for-money audit.

The main conclusion of the Serious Injury Program value-for-money audit is that the Serious Injury Program demonstrates value for money. The audit also identified challenges and opportunities that exist with our independent living policies, which we agree with. Separate from policy-specific issues, the audit identified a common challenge underlying the policies as a whole: the “severely impaired” threshold that forms part of the entitlement criteria for most of the benefits and services in our independent living policies. In some cases, this threshold limits our ability to provide the most appropriate benefits and services based on individual needs. Because the underlying challenge with the threshold impacts most of the related policies, we reviewed the policies in two phases. The focus of phase one was cross-policy issues, such as the severely impaired threshold. In phase two, we are sharing proposed revisions to address the cross-policy issues consulted on in phase one; and identifying and proposing revisions to address policy-specific issues.

Consultation

Phase one (September 16, 2022, to October 14, 2022)

We sought feedback from stakeholders to support our review and analysis of the entitlement criteria for the various benefits and services in the independent living policies (OPM documents 17-06-02 to 17-06-08). We asked a series of questions about the severely impaired threshold entitlement criteria, as well as questions about the timing and duration of entitlement. 

We received 15 submissions from stakeholders (see “Phase one stakeholder submissions” for a list of stakeholders and their responses). A general overview of stakeholder feedback is provided in the section, “External stakeholder feedback”. Thank you to everyone who submitted feedback.

Phase two (April 18, 2024 to June 12, 2024)

We carefully reviewed and considered all stakeholder feedback in developing our proposed revisions to the independent living policies. In phase two, we sought stakeholder input on revised draft independent living policies following recommendations from the Serious Injury Program value-for-money audit.

The draft policies included both the refreshed entitlement criteria proposed for each policy and revisions to address benefit and service-specific issues.

To supplement stakeholder review of the draft policies, the consultation report included: 

• a summary of the main themes we heard from stakeholder feedback in phase one of the consultation
• a discussion about the severely impaired threshold
• highlights of proposed revisions for each policy, and
• highlights of two new policies.

We are reviewing the submissions received and will update this page with stakeholder submissions, a summary of the consultation, and the updated independent living policies once they are finalized.

Note: In the sections that follow, reference to “permanent impairment” or “temporary impairment” should be read to include a permanent disablement or temporary disablement for accidents before January 2, 1990.

Phase 1 report back and proposed draft policies

External stakeholder feedback

Overall, while stakeholder feedback acknowledges the administrative ease offered by the non-economic loss or permanent disability rating threshold, there is strong support for focusing entitlement criteria on individual needs. Stakeholders offered a variety of thoughts about how to do this. For example:

• Maintain the current non-economic loss or permanent disability rating levels or move to a lower non-economic loss or permanent disability rating as a means of automatic entitlement, with decision-maker discretion for case-by-case entitlement for lower non-economic loss or permanent disability ratings.
• Consider the individual circumstances of each case – do not use a non-economic loss or permanent disability rating. 
• Consider the impact of the work-related injury or illness on the person’s function and quality of life. 
• Consider the person’s work-related injury or illness and its impact to their function given their individual circumstances (e.g., social determinants of health).

The feedback of many stakeholders suggests that non-economic loss or permanent disability ratings are not a reliable indicator or are not the only indicator of the impact the work-related injury or illness has on someone’s independent living or quality of life. The implication of this is that while many of the people who meet the current threshold are entitled to and receive the independent living and quality of life benefits and services they need, there are:

• some people who meet the rating threshold and therefore are entitled to be considered for all the independent living and quality of life benefits and services, but may not need every benefit and service 
• some people who do not meet the rating threshold and therefore are not entitled to be considered for the independent living and quality of life benefits and services, despite being unable to function independently on a permanent basis, and,
• some people who will not meet the rating threshold on a permanent basis and therefore are not entitled to be considered for the independent living and quality of life benefits and services despite being unable to function independently on a temporary basis.

Stakeholders also provided feedback supporting: 

• providing entitlement to certain benefits and services in the independent living policies sooner than currently occurs
• making short-term or temporary entitlement available, and, 
• reviewing entitlement to benefits and services as someone’s condition changes. 

Stakeholder feedback also suggested considering whether any of the benefits and services provided for in the independent living policies may be necessary, appropriate, and sufficient for workers with psychological injuries – most of whom do not currently meet the rating threshold. The WSIB provides supports and services specific to psychological injuries. In doing so, people with these types of injuries have access to the health care most appropriate for psychological injuries, which may include benefits and services in the independent living policy suite where they meet the applicable criteria. Despite this, several stakeholders expressed a view that the independent living policies focus primarily on addressing physical functional limitations and this does not adequately address the needs of people with psychological injuries. 

Among employer stakeholders, there was recognition of our obligation to administer the workers’ compensation system in a financially responsible and accountable manner. There were also questions about the fairness of the last employer of record bearing responsibility for all costs in claims where someone becomes severely impaired through injuries or illnesses with multiple employers. Our rate-setting model features various tools to ensure fairness when considering an employer’s individual claims experience, such as claim cost limits, a defined claim cost review period, and excluding claim costs for some long-latency conditions and diseases. Our Health and Safety Excellence program also helps make workplaces safer and reduces the risk of injuries and illnesses, thereby reducing claim costs. While changes to the rate-setting model and the last employer of record are outside the scope of this review, we have noted this feedback for the next time these items are subject to review. 

In addition to feedback about entitlement and its timing and duration, some stakeholders provided opposing feedback about specific benefits or services. For example: 

• The independent living allowance lump sum amount is adequate.
• The independent living allowance lump sum amount is inadequate given the services and equipment this benefit is intended to cover. 
• The current allowance amounts should be the minimum amounts paid, with the opportunity to pay more depending on the facts of the case. 
• The independent living allowance should continue to be provided as a lump sum, giving people discretion to choose which services and items to purchase to facilitate their independent living and improve their quality of life. 
• The independent living allowance should be replaced with a reimbursement model and/or fee schedule.
• Emotional support/therapy dogs should be included in the Guide and Support Dogs policy.

The above offers a summary of the main themes from the stakeholder feedback. Stakeholder feedback in its entirety is available in the individual submissions.

Entitlement threshold

As validated by the value-for-money audit and stakeholder feedback, using a 60% non-economic loss/100% permanent disability rating as the threshold for many of the independent living benefits and services is not the most appropriate or the best measure of the impact of the work-related impairment. It results in a misalignment between injured peoples’ needs and their eligibility for the benefits and services available to support independent living and quality of life following a work-related injury or illness. 

As we saw in the stakeholder feedback, the needs and potential of each person following a workplace injury or illness will depend on more than their non-economic loss or permanent disability rating. Individual circumstances such as age, general health, personal support network, socio-economic status, physical environment, and more, all play a role. 

We propose ending the use of a specific non-economic loss or permanent disability rating as a criterion for entitlement to the benefits and services in the independent living policies. This will better meet the individual needs of people whose serious work-related injury or illness impacts their independent living and/or quality of life, permanently or for more than the initial acute period following the injury or illness onset.

Going forward, we propose new entitlement criteria in the place of a specific non-economic loss or permanent disability rating. In developing or revising the criteria for each benefit and service, we considered: 

• the objective of providing the benefit or service (e.g., mobility, communication, self-care) 
• the other benefits and services available in the independent living policies and all our other health care policies that serve the same objective (e.g., attendant services instead of a personal care allowance), and 
• which measures are likely to be necessary, appropriate, and sufficient¹, and in which circumstances (e.g., a temporary ramp may be sufficient to meet the mobility needs of someone with a temporary impairment rather than structural modifications to their front porch). 

The intended outcome is to provide people with the benefits and services that are necessary, appropriate, and sufficient to support their independent living, and in some cases quality of life, as soon as they need them, for as long as they need them. 

Note: Despite proposing to end the use of the non-economic loss or permanent disability rating, we are committed to maintaining benefits and services already approved and provided under the existing independent living policies, such as the independent living allowance and personal care allowance, unless there is a material change in circumstances. We intend for the revised policies to apply to requests for benefits and services that result from a new entitlement or a material change in circumstances for an existing entitlement, and to requests for maintenance, repair, or replacement of previously approved and provided devices and equipment.

¹ Under s. 33 (1) of the Workplace Safety and Insurance Act, 1997, a worker who sustains an injury is entitled to such health care as may be necessary, appropriate, and sufficient as a result of the injury.

Independent living and quality of life policies

**NEW** 17-06-01, Independent Living and Quality of Life Measures - Overview and Definitions draft

This new policy defines serious injury, serious illness, and severe impairment for the purpose of independent living and quality of life benefits and services. It also provides information about the measures we consider appropriate to facilitate independent living and quality of life.

17-06-01, Independent Living and Quality of Life Measures - Overview and Definitions draft (PDF)

Highlights of new draft policy

• Define key terms used throughout the independent living and quality of life policies, including serious injury, serious illness, and severe impairment.
• Provide guidance about the injury and illness outcomes that may impact someone’s ability to live independently. 
• Explain that independent living measures are those that assist a worker in carrying out their activities of daily living and instrumental activities of daily living and identify the specific benefits and services we find appropriate to facilitate independent living.
• Explain that quality of life measures are those that that will increase a worker’s ability to participate in personal, family, and social activities and identify the specific measures the WSIB considers appropriate.
• Explain that entitlement to an independent living or quality of life benefit or service depends on a finding that it is necessary, appropriate, and sufficient based on the individual facts and circumstances of someone’s case. 
• Identify benefits and services available to someone whose injury or illness has a temporary, short-term impact on their ability to live independently. 
• Identify benefits and services available to someone whose injury or illness has a longer term or permanent impact on their ability to live independently or on their quality of life.
• Outline where a potential benefit or service is not considered to be necessary, appropriate, and sufficient, based on the individual facts and circumstances of someone’s case.

Independent Living Allowance (17-06-02)

The independent living allowance provides financial assistance to eligible people to offset the costs of services (e.g., home maintenance, taxis), devices under $250, and other items or expenses (e.g., increased insurance for modified vehicle) that improve their ability to function independently and improve their quality of life.

Key challenges and opportunities

• The 60% non-economic loss/100% permanent disability entitlement threshold prevents people with injuries or illnesses that significantly impact a person’s ability to live independently, but that have not resulted in severe permanent impairments from receiving the allowance, even where it could help improve their outcomes following the injury.
• The 60% non-economic loss/100% permanent disability entitlement threshold results in eligible people not receiving the allowance as soon as they could benefit from it. 
• The allowance structure of a single, annual lump sum covering a variety of services, devices, and expenses is not conducive to providing the right benefits and services to the people who need them, when they need them, for as long as they need them. 
• The dollar value of the allowance is insufficient given the range of services, devices, and expenses people must cover using the allowance.

Highlights of proposed revisions

To address challenges such as those listed above, we propose a number of revisions to 17-06-02, Independent Living Allowance. Some of these are described below. The changes we are proposing may be viewed in their entirety in the draft policy 17-06-02, Independent Living Allowances proposed revisions (PDF) .

• Replace the 60% non-economic loss/100% permanent disability entitlement threshold with criteria that take diagnosis into account and the temporary or permanent functional impairment resulting from the work-related injury or illness.
• Pending technological feasibility, separate the single, annual lump sum into four monthly allowances, each with a specific purpose: 1) home maintenance, 2) transportation, 3) additional expenses for WSIB-approved modifications or devices, and 4) quality of life. 

• Reduce the scope of services, devices, and items to be covered by the allowances. Entitlement to devices costing less than $250 would be considered under 17-06-03, Independent Living Devices proposed revisions (PDF) , similar to devices costing $250 or more. Entitlement to hobby-related expenses would be considered under the new policy, 17-06-09 Quality of life benefits draft (PDF) .

• Publish the dollar values for each allowance in 18-01-05, Table of Rates to preserve the opportunity to annually revisit the values of these allowances in future years.

Note: The proposed guidelines for the quality of life allowance are available in the new policy, 17-06-09 Quality of life benefits draft (PDF)

17-06-03, Independent Living Devices

We reimburse the costs of devices costing more than $250 that help restore eligible peoples’ ability to communicate, be mobile, engage in self-care, or help them avoid further injury or prevent future health complications due to the work-related injury or illness. Reimbursing the cost of these devices helps eligible people to function independently.

Key challenges and opportunities

• The 60% non-economic loss/100% permanent disability entitlement threshold prevents people with injuries or illnesses that significantly impact their ability to live independently, but that have not resulted in such a rating from being considered for independent living devices that could help them to function independently.
• The policy precludes reimbursing people for independent living devices costing less than $250 even where they may be necessary, appropriate, and sufficient. Instead, people are required to use their independent living allowance for such devices. 
• It is unclear which devices should be considered under the Independent Living Devices policy (17-06-03) versus other policies that provide for health care items (e.g., 17-07-04, Hearing Devices, 17-07-05, Orthopaedic, 17-07-06, Health Care Equipment and Supplies) and hobby equipment (e.g., 17-06-02, Independent Living Allowance).

Highlights of proposed revisions

To address challenges such as those listed above, we propose a number of revisions to 17-06-03, Independent Living Devices. Some are described below. The changes we propose may be viewed in their entirety in the draft policy 17-06-03, Independent Living Devices proposed revisions (PDF) .

• Replace the 60% non-economic loss/100% permanent disability entitlement threshold with the criteria that the person have a permanent impairment as a result of the work-related injury or illness that results in a permanent or long-term functional limitation. In addition to this, similar to the current policy, the independent living device must serve one of the objectives outlined in the policy and meet the criteria for devices identified in the policy. 
• Consider entitlement to devices costing less than $250 rather than requiring people to use their independent living allowances for these expenses.

• Consider entitlement to hobby equipment under the new policy, 17-06-09 Quality of life benefits draft (PDF) .

• Cross-reference to policies that provide for other health care items someone may be eligible for to improve clarity about the scope of the independent living devices policy.

17-06-04, Guide and Support Dogs

We pay for the purchase and training of a guide dog or support dog, and for mobility training for the person. We also provide an allowance to cover routine veterinary care and maintenance costs (e.g., nutritional needs, annual examinations, and inoculations) and pay for extraordinary veterinary care and treatment.

Key challenges and opportunities

• The 60% non-economic loss/100% permanent disability entitlement threshold prevents some people with significant injuries from being considered for guide and support dogs that could help them to live independently.
• Key terminology is outdated and is not defined in the policy, making it unclear what types of service animals are eligible for coverage.

Highlights of proposed revisions

To address challenges such as those listed above, we propose revisions to 17-06-04, Guide and Support Dogs. The changes we propose may be viewed in their entirety in the draft policy 17-06-04, Guide and Service Dogs proposed revisions (PDF) .

• Clarify that someone may be considered for entitlement to a guide or service dog where their ability to live independently is impacted as a result of a work-related designated condition, regardless of their non-economic loss/permanent disability rating.
• Clarify that the designated conditions listed are the only ones for which we consider there to be evidence of the effectiveness of animal-assisted intervention in reducing the impact of the work-related condition on someone’s ability to live independently. 
• Outlines the criteria for determining that a guide or service dog is necessary, appropriate, and sufficient for someone with a work-related designated condition.

Personal Care Allowance (17-06-05)

People who have difficulty with their activities of daily living are entitled to a personal care attendant arranged through an agency that we pay directly. Severely impaired people are entitled to a personal care allowance to hire their own attendants to help them complete their activities of daily living.

Key challenges and opportunities

• The policy does not address entitlement to an agency attendant for those who do not meet the 60% non-economic loss/100% permanent disability threshold.
• The 60% non-economic loss/100% permanent disability entitlement threshold prevents some people with injuries or illnesses that impact their ability to complete their activities of daily living from being considered for a personal care allowance that could help them.
• The three categories of attendant care, each with its own hourly rate, require complex calculations that may delay payments of the allowance.
• The policy does not address the provision of personal care on a temporary basis.

Highlights of proposed revisions

To address challenges such as those listed above, we propose revisions to 17-06-05, Personal Care Allowance. The changes we propose may be viewed in their entirety in the draft policy 17-06-05, Personal Care Attendants and Allowance proposed revisions (PDF) .

• Clarify that people who need help to complete their activities of daily living on a temporary or permanent basis will be entitled to a personal care attendant provided by an agency, regardless of their non-economic loss/permanent disability rating.
• People who need help to complete their activities of daily living on a permanent basis or who need temporary personal care while undergoing treatment for a serious illness will be entitled to a personal care allowance to hire their own attendant, regardless of their non-economic loss/permanent disability rating.
• Pending technological feasibility, people who qualify for the allowance will be assigned to one of five levels of care based on their ability to complete their activities of daily living. Each level of care will have its own flat monthly rate which will be indexed annually. Monthly amounts currently being paid will not be reduced. 

17-06-06, Home Care

A person may be entitled to a home care program to receive health care services (e.g., nursing care, physiotherapy, occupational therapy) in their own home when their needs cannot be met on an out-patient basis.

Key challenges and opportunities

• The home care program is not clearly outlined in 17-06-06, Home Care.

Highlights of proposed revisions

• Clearly outline the home health care program, its purpose, and key features in the draft policy 17-06-06 Home Health Care proposed revisions (PDF) .

17-06-07, Vehicle Modifications

We reimburse the costs of vehicle modifications for eligible people where these modifications are essential to the safe operation of, or to the person’s ability to enter, leave, and operate their vehicle. Reimbursing the costs of vehicle modifications so that a person can perform their instrumental activities of daily living enables their independent living.

Key challenges and opportunities

• Greater clarity could be provided about which vehicles are eligible for modification. 
• Greater clarity could be provided about the scope of what we do and do not reimburse with respect to vehicle modifications (e.g., upgrades in new vehicles purchased by the person, multiple vehicles). 
• Greater clarity could be provided about responsibility for costs related to vehicle modifications (e.g., maintenance, repair and replacement, insurance, damage arising from motor vehicle accidents). 
• There may be circumstances where it is more timely or cost-effective to procure a purpose-built accessible vehicle, rather than modifying someone’s existing vehicle.

Highlights of proposed revisions

To address challenges and opportunities, such as those listed above, we propose revisions to 17-06-07, Vehicle Modifications. The changes we propose may be viewed in their entirety in the draft policy 17-06-07, Vehicle Modifications proposed revisions (PDF) .

• Introduce a definition of vehicle as well as criteria the vehicle must meet before we will consider it eligible for modification.

• Clarify our longstanding interpretation and/or practice to:  
  • reimburse the cost of features in a new vehicle purchased by the person that are required due to the functional impairment resulting from the work-related injury or illness, where these features are not standard in the base model of the vehicle
  • approve modifications to a subsequent vehicle once the useful lifespan of someone’s current modified vehicle expires or where there are permanent changes in the work-related injury or illness and it is not practical to further modify the current vehicle
  • reimburse for maintenance, repair, and replacement of modification equipment, and
  • not reimburse for general vehicle maintenance, insurance, and repairs arising from motor vehicle accidents.
• Introduce a new guideline where we will contribute a portion of the cost of a purpose-built accessible vehicle where this is a similar or lower cost than the value of someone’s current vehicle and the cost of modifying it.

17-06-08, Home Modification

We authorize home modifications to facilitate independent living where the person meets the 60% non-economic loss/100% permanent disability entitlement threshold due to a work-related injury or illness.

Key challenges and opportunities 

• People with a temporary need for home modifications, and those who do not meet the 60% non-economic loss/100% permanent disability threshold, are excluded from provisions of the policy.
• Provisions of the policy regarding secondary residences, rental properties, relocation, and the purchase of a home by the person are not clearly outlined.
• The policy does not address moving costs or increased rent following an approved relocation, or the ownership of home modifications and installed devices.

Highlights of proposed revisions 

To address challenges and opportunities, such as those listed above, we propose revisions to 17-06-08, Home Modification. The revised policy aligns with our practice. The changes we propose may be viewed in their entirety in the draft policy 17-06-08, Home Modifications proposed revisions (PDF) .

• Clarify that entitlement is considered for people who need home modifications to live independently but who do not meet the 60% non-economic loss/100% permanent disability threshold.
• People with a temporary need for home modifications will be entitled to minor modifications (e.g., grab bars, railings, ramps), regardless of non-economic loss/permanent disability threshold. 
• People with a permanent need for home modifications will be entitled to major modifications (e.g., widened doorways, lifts, additions to the home), regardless of non-economic loss/permanent disability threshold.
• Clarify the criteria for modifications to secondary residences, relocations following a significant life change, and the reimbursement of the costs of accessibility features in a home purchased by the person instead of paying for modifications to a current home.
• Clarify that people who rent or lease their homes are entitled to the same home modifications as those who own their homes.
• Introduce reimbursement for moving costs and increased rent following an approved relocation or home purchase by the person.
• Clarify that the person owns all home modifications and installed items.

**NEW** 17-06-09, Quality of Life Benefits draft 

This new policy will introduce a quality of life allowance that is currently provided as a component of the independent living allowance. The policy will also address entitlement to hobby equipment and related expenses, as well as mental health supports for eligible family members.

17-06-09 Quality of life benefits draft (PDF)

Highlights of draft policy

• People with a work-related severe impairment that is permanent may be entitled to a quality of life allowance that covers physical fitness and recreational programs, and/or general interest courses.
• To be eligible, a maximum medical recovery date must have been determined, the person must be following their return-to-work activities, where applicable, and the work-related severe impairment must impact the person’s ability to integrate into or participate in personal, family, or social activities. 
• Pending technological feasibility, the quality of life allowance will be paid monthly, like the allowances related to independent living.
• People with a work-related severe impairment that is permanent may also be entitled to the reimbursement of certain hobby-related expenses. The same criteria as for the quality of life allowance apply, except the severe impairment must reduce the person’s ability to participate in the hobby. 
• The policy outlines that it must be feasible, safe, and practical for the person to participate in the hobby.
• Hobby-related expenses include required equipment and modifications, supplies, instruction or training, and start-up costs.
• The policy also includes mental health supports for eligible family members of people with a work-related severe impairment.

Appendix

Phase one stakeholder submissions (PDF)

Canadian Manufacturers and Exporters (CME)

Eugene Lefrancois

IAVGO Community Legal Clinic

Injured Workers Community Legal Clinic (IWCLC)

LA Liversidge, LLB

Mechanical Contractors Association Ontario (MCA)

Northumberland Community Legal Clinic 

Office of the Worker Adviser (OWA)

Ontario Federation of Labour (OFL)

Ontario Network of Injured Workers Groups (ONIWG)

Schedule 2 Employers Group (S2EG)

The Legal Clinic

Thunder Bay & District Injured Workers Support Group

United Steelworkers District 6 (USW)

Workers’ Health and Safety Legal Clinic (WHSLC)

Note: Submissions are posted in the format they were received. If you require them in an alternate format, please contact the [email protected].

Phase one - Serious Injury Program value-for-money audit consultation - Review of the Independent Living policy suite

Introduction

Under the Workplace Safety and Insurance Act, 1997 (WSIA), the WSIB is required to have an external firm review the cost, efficiency, and effectiveness of one or more WSIB programs through a value-for-money audit (VFMA). The WSIB’s Serious Injury Program (SIP) was the focus of a recent VFMA.

The SIP provides people who experience serious injuries at work with the specialized treatment, equipment, and services they need to enable functional recovery; support return to work where possible; facilitate independent living to the extent possible; and improve quality of life.

The main conclusion of the Serious Injury Program VFMA is that the program demonstrates value for money. To further improve the program’s performance, recommendations were made across nine themes. The following observation (observation three) and recommendation (recommendation one) appear under theme 5.5, Policies, processes, and procedures:

• Observation summary: Specific policies have not been reviewed to determine if threshold criteria and benefits continue to match the needs of injured workers, and have not been updated to reflect changes in the needs of injured workers and/or workers' needs.
• Recommendation: Review and refresh benefits related eligibility criteria and services provided for in the suite of benefits policies to ensure they meet the needs of workers across the spectrum of service delivery, including seriously injured workers. As needed, engage key stakeholders as part of the consultation.

As identified in the VFMA, leading practice for eligibility criteria is to base severe impairment criteria on medical (e.g., diagnosis) and functional definitions (e.g., ability to participate in day-to-day activities) and tools, rather than solely or primarily a permanent impairment rating (whether through a single or multiple claims). Most Canadian workplace compensation boards consider the person’s needs and reduced abilities resulting from their work-related injury or illness, rather than an impairment percentage, when determining entitlement to benefits and services similar to those provided for in the independent living policy suite. The boards that do identify an impairment percentage as part of their criteria will still consider providing benefits and services despite the permanent impairment percentage in some circumstances.

The VFMA and its recommendations present the opportunity to assess whether the current entitlement criteria result in people with serious work-related injuries being provided with the personalized benefits and services they need for improved recovery and return to work outcomes, to facilitate independent living, and to improve quality of life.

The VFMA identified the challenges that exist with the independent living policy suite; challenges that SIP staff have validated. The common challenge underlying the suite as a whole is the “severely impaired” threshold that forms part of the entitlement criteria for most of the benefits and services covered in the policy suite. Noting this, the policy review will occur in two phases: 

• Phase one: The WSIB will seek information from stakeholders to support its analysis of the entitlement criteria for the benefits and services provided for in the independent living policy suite with a focus on the severely impaired threshold.
• Phase two: The WSIB will share its findings from phase one, and, if applicable, the refreshed entitlement criteria being recommended as a result. Revisions to improve the consistency and equity of benefits and services may also be proposed at this time.

Background

WSIB Serious Injury Program

The SIP is for people who experience a serious work-related injury (including those who are severely impaired as defined in the Operational Policy Manual).¹ The serious injury may result from a single incident, or a worsening of a prior impairment, or an accumulation of multiple impairments. Generally, this would be:

• a new catastrophic work-related injury (e.g., certain spinal cord injuries, major amputations, industrial blindness, extensive burns, moderate and severe brain injuries) with an anticipated non-economic loss (NEL) benefit of 60 per cent or greater,
• a new significant work-related injury that meets the criteria for acute care (e.g., certain bilateral fractures, bilateral hand burns, certain brain injuries),
• a 60 per cent NEL under one or more claims,
• a 60 per cent NEL equivalent after a composite rating which combines NEL and permanent disability (PD) benefits, or
• an injury prior to January 1, 1990, and a PD benefit of 100 per cent.

Legislation

A person who experiences a work-related injury or illness is entitled to such health care as may be necessary, appropriate and sufficient as a result of the injury or illness and as determined by the WSIB. The WSIA (s.32) provides that health care means:

• professional services provided by a health care practitioner
• services provided by or at hospitals and health facilities
• (prescribed) drugs
• the services of an attendant
• modifications to a person’s home and vehicle and other measures to facilitate independent living as in the Board’s opinion are appropriate
• assistive devices and prostheses
• extraordinary transportation costs to obtain health care
• such measures to improve the quality of life of severely impaired workers as, in the Board’s opinion, are appropriate.

Many of the aforementioned forms of health care are oriented toward recovery, to the extent possible, from the injury or illness itself (e.g., prescribed drugs) or minimizing the functional impact of the injury or illness (e.g., assistive devices and prostheses). These forms of health care are broadly available to all people with work-related injuries or illnesses, provided the WSIB finds they are necessary, appropriate and sufficient as a result of the injury or illness.

In addition to these more broadly available forms of health care, the WSIB has discretion to provide coverage for measures its finds are appropriate to: a) facilitate independent living and b) improve the quality of life for those with severe impairments. The WSIA does not define independent living, quality of life, severe impairment, or serious injury.

Policy framework

The OPM includes a suite of policies that provide guidance about the benefits and services the WSIB has determined are appropriate to facilitate independent living and/or quality of life: the independent living policy suite.

These benefits and services are primarily available to injured people within the SIP. Most of these benefits and services require that the severely impaired threshold is met. However, not all injured or ill people in the program meet that threshold, particularly those in the acute care stream, and are therefore not eligible for many of these benefits and services.

* Details about the benefit/service specific criteria are available in Appendix one: Entitlement criteria for independent living policy suite

Severely impaired entitlement threshold

Most of the benefits and services provided for in the independent living policy suite include the severely impaired threshold as part of the entitlement criteria. An injured person is considered severely impaired if their disabilities/impairments are:

• permanent and have been rated for either PD benefits totaling at least 100 per cent, or NEL benefits totaling at least 60 per cent, or
• likely to be permanent in the opinion of a WSIB medical consultant, and are likely to meet one of the criteria above.

The origins of the severely impaired threshold can be traced back to the pre-1989 Act², which provided for “…such other treatment, services or attendance as may be necessary as a result of the injury for those rendered helpless through permanent total disability”, which was interpreted as being a 100 per cent PD rating. The 100 per cent PD rating was thus established as the threshold for those benefits and services available to people with the most serious injuries.

The pre-1997 Act³ contained a similar provision to that in the pre-1989 Act, but identified people “rendered helpless through permanent total impairment”. The WSIA references neither total disability nor total impairment. Rather, the WSIA provides for health care measures specific to injured people with severe impairments.

The use of the 60 per cent threshold for NEL ratings (versus 100 per cent for PD ratings) arises from the difference between permanent disability and permanent impairment. As outlined in the pre-1997 Act, “disability” means “the loss of earning capacity of the worker that results from an injury”, while “impairment” means any “physical or functional abnormality or loss (including disfigurement) which results from an injury and any psychological damage arising from the abnormality or loss”, and does not take into consideration the impact on ability to earn.

The basis for rating PDs is the Ontario Rating Schedule that estimates the impairment of earnings capacity in an average unskilled worker in more traditional jobs⁴. The basis for rating permanent impairments is the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Third Edition (Revised) (AMA Guides) that assesses “what is wrong with a body part or organ system and its functioning”⁵ as opposed to the impact of the impairment on employability. Of note, neither rating tool specifically measures the impact of the impairment on the person’s ability to carry out their activities of daily living and other activities outside of employment. Very few medical conditions are assessed as 100 per cent under the AMA Guides. Requiring a 100 per cent NEL rating would result in people with injuries the same as or similar to those rated at 100 per cent PD not having access to the same benefits and services. To address this, the WSIB sought to identify a NEL threshold that was equivalent to 100 per cent PD. It was concluded that setting the threshold at 60 per cent NEL would result in similar benefits being available for similar groups of injured people under both the PD and NEL systems.

Opportunity

The severely impaired threshold is a policy requirement for entitlement to certain health care benefits and services. While the threshold has been used as a way to identify which claims should be managed in the SIP, admittance into the program appropriately is not set out in policy. This is because the criteria for entitlement to the health care benefits and services set out in policy and the criteria for having a claim managed in the program are not necessarily the same.

In the past, admittance into the program was limited to those already rated or likely to be rated as meeting the severely impaired threshold. More specifically, catastrophic injuries, cumulative NELs/PDs, and worsening NELs/PDs were managed in SIP. The scope for admittance into the program has since expanded to include those with an injury meeting the criteria for acute care: those with a significant injury that temporarily requires specialized benefits and services similar to those required by an injured person who meets the severe impairment threshold.

People with injuries meeting the criteria for acute care often have immediate and significant needs given the impact of the work-related injury on their basic activities of daily living (ADLs). However, once maximum medical recovery is reached in these cases, the resulting permanent impairment does not usually meet the severely impaired threshold. The SIP temporarily manages these claims, immediately following the injury and up until the injured person reaches independence in their ADLs (typically up to nine months).

The benefits and services provided for in the independent living policy suite were not subject to a corresponding substantive review at that time, to take into consideration this change in scope for admittance into the program. Thus, while the SIP is able to leverage the benefit of the program’s specialized and dedicated case management in these acute care claims, the severely impaired threshold limits the benefits and services available in these claims relative to others in the program. This, despite the fact that an injured person with an acute care claim actually may have similar or greater limitations and needs than others in the program, whether on a temporary or permanent basis. 

As suggested in the VFMA, using the severely impaired threshold may be contributing to a misalignment between people’s needs and the benefits and services to which they are entitled, as demonstrated by the two personas below.

Some injured people in the SIP are not considered for entitlement to benefits and services that could improve functional outcomes, return-to-work outcomes (where applicable), independent living and quality of life.

Some injured people in the SIP are considered for entitlement to benefits and services they need and to benefits and services they may not necessarily need.

The VFMA and its recommendations present the opportunity to review the scope of benefits and services provided to people in the SIP and the associated entitlement criteria. In particular, to consider whether the current entitlement criteria result in people with serious injuries receiving the personalized benefits and services that:

• improve recovery and return to work outcomes
• facilitate independent living and improve quality of life by enabling participation in all aspects of life.

Questions for stakeholders

Below are questions about entitlement criteria, as well as the timing and duration of entitlement. Responses to these questions will support the WSIB’s review and analysis of entitlement to the benefits and services provided for in the independent living policy suite.

1. Does the severely impaired threshold continue to be a suitable criterion for considering entitlement to the benefits and services in the independent living policy suite?
2. Is someone’s permanent impairment rating or expected permanent impairment rating a reliable indicator of the scope and duration of the benefits and services they are likely to need as a result of the work-related injury or illness?
3. Does the severely impaired threshold result in people with serious injuries receiving the benefits and services they need as a result of the work-related injury or illness?
4. Identifying entitlement criteria for benefits and services supports consistent and predictable decision-making. Aside from the NEL and PD rating, are there other criteria or measures that would better indicate whether someone might need a particular benefit or service? For example, lack of independence with activities of daily living (ADLs), independence with instrumental activities of daily living (I-ADLs), combination of diagnosis and function, standardized tests or assessments.
5. Many of the benefits and services in the independent living policy suite contemplate long-term, permanent needs. Are there circumstances in which it would be beneficial to provide any of these benefits or services on a short-term or temporary basis?
6. Immediately following a work-related injury or illness, treatment and recovery are the primary focus.
   1. At what point in a person’s recovery should benefits and services to facilitate independent living be considered? Are there specific factors or indicators that should be considered?
   2. At what point in a person’s recovery should benefits and services to improve quality of life be considered? Are there specific factors or indicators that should be considered?
7. Are there benefits and services that should be provided immediately and reviewed as the injured person’s needs change?
8. Are there benefits and services that should be provided only once it is clear what the injured person’s long-term needs are/likely are?
9. Do universal benefit amounts (e.g., flat rate for the independent living allowance) continue to be appropriate for meeting the needs of people with serious injuries?
10. Aside from the severely impaired threshold, do the other entitlement criteria in each of the individual policies in the independent living policy suite allow for the provision of benefits and services that align to the needs of those with severe/significant injuries? 

¹The Occupational Disease and Survivors Benefit Program manages the claims of people with occupational diseases, including those who meet the severely impaired threshold as a result of an occupational disease.

² Workers’ Compensation Act, R.S.O. 1980, as amended. Applicable to accidents on or before January 1, 1990

³ Workers’ Compensation Act, R.S.O. 1990, as amended. Applicable to accident dates from January 2, 1990 and December 31, 1997 (inclusive)

⁴ Operational Policy Manual document 18-07-02, The Ontario Rating Schedule. WSIB. October 2004.

⁵ American Medical Association. Guides to the Evaluation of Permanent Impairment, Third Edition (Revised)