Clothing Allowance

Policy

The WSIB

  • may authorize clothing allowances for workers with permanent impairments, to replace or repair clothing worn or damaged by the wearing of an assistive device or prosthesis (device)
  • determines what are devices within the meaning of the Workplace Safety and Insurance Act (the Act). Use of these devices may entitle a worker to a clothing allowance when all entitlement criteria are met
  • determines the maximum annual clothing allowance based on the usual patterns of damage caused by the devices and reasonable replacement costs for the clothing
  • does not pay for more than two clothing allowances per year
  • may request evidence of the actual damage caused to clothing by the use of an authorized device.

Guidelines

To be considered for a first clothing allowance

  • the worker must have reached maximum medical recovery (MMR), and have a permanent impairment/disability that results in either a non-economic loss (NEL) benefit, or a permanent disability (PD) benefit
  • the WSIB must have authorized and/or supplied the device
  • the worker must have worn the device one full year after receiving the permanent impairment/disability benefit.

Applying for the allowance

Workers must apply annually for a clothing allowance by submitting a written application and information indicating the type of damage to the clothing.

Exception

Severely injured workers who receive an initial clothing allowance for using an approved device, and whose need for the device is unlikely to change from year to year, may be exempted from applying annually for the allowance.

Entitlement criteria

Workers applying for a clothing allowance must annually submit a report from the treating health professional indicating

  • the objective clinical findings confirming the continuing need for the device, and
  • that the worker is wearing the device with the same frequency as was prescribed.

NOTE

The WSIB retains the right to determine the appropriateness of all health care and to request the report be completed by an orthopaedic specialist when necessary.

Exceptions

Exceptions may be made for workers who do not meet the entitlement criteria, and

  • began using the device before November 1, 1996, and
  • continue to be dependent on the device.

Entitlement to the device and the related clothing allowance continues as long as the treating health professional's clinical report authorizes the continued use of the device.

When exceptions are made, the WSIB may recommend other types of treatment to help reduce dependency on the device. This treatment must be designed to return the worker to MMR after the use of the device is reduced or discontinued.

A clothing allowance restored under the exceptions category is payable as of the worker's 1999 NEL/PD anniversary date for the preceding 12 months only.

Payments

Clothing allowances are always paid for past periods. The initial allowance is paid

  • from the first anniversary of receiving the NEL/PD benefit
  • back to the date the worker first purchased the device, or the date of MMR, whichever is later.

The next allowance is paid

  • from the second anniversary date
  • back to the first NEL/PD anniversary date, and so on.

Upper/lower body devices

Devices are considered to be either upper body or lower body, based on the clothing (e.g., shirts or pants) to which they cause the most damage. Clothing allowance payments must relate to a reasonable pattern of clothing deterioration caused by wearing the approved devices. Regardless of the number of devices approved by the WSIB, the worker is allowed only one clothing allowance for an upper body device and one for a lower body device per year.

The following are considered upper body devices:

  • back brace
  • back support or corset
  • cervical brace
  • arm prosthesis
  • under-arm crutches
  • arm brace
  • wrist gauntlet(s)
  • forearm-supported crutches, and
  • wheelchair.

The following are considered lower body devices:

  • leg prosthesis
  • knee brace, and
  • permanent leg brace.

Schedule of benefits

The WSIB classifies devices according to the amount of clothing damage they usually cause. This determination is made based on input from orthotic specialists and product manufacturers.

The WSIB may pay a clothing allowance for

  • devices which cause major damage to clothing up to the maximum rate annually for major damage, and
  • devices which cause minor damage to clothing up to the maximum rate annually for minor damage.

NOTE

For the current maximum rates for major damage and minor damage, see 18-01-05, Table of Rates.

The following qualify as devices which can cause major damage to clothing

  • back brace (Harris-type rigid frame e.g., rigid plastic with steel stays to support back)
  • back support or corset (canvas belt/corset with steel stays to support back)*
  • leg prostheses
  • custom-made knee brace
  • permanent leg brace, and
  • manual wheelchair.

*NOTE

A clothing allowance benefit for a back support or corset is paid up to the maximum rate for major damage, as of the worker's 2006 NEL/PD anniversary date, for the preceding 12 months only.

The following qualify as devices which can cause minor damage to clothing

  • cervical brace
  • arm prostheses
  • arm brace
  • wrist gauntlet(s)
  • forearm-supported crutches
  • off-the-shelf knee brace such as the "Generation 2"
  • power wheelchair, and
  • under-arm crutches.

NOTE

A prosthesis worn as the result of an amputation must be at or above the ankle or wrist. There is no entitlement for ankle/foot orthotics. There is no entitlement for soft cervical collars.

Partial allowance

If workers use such devices on a part-time basis, the WSIB may approve a partial clothing allowance. If workers who use such devices are provided with uniforms or work garments free of charge, the WSIB may pay no more than 50% of the maximum.

Allowance calculation

Full and partial clothing allowances are calculated as a percentage of the maximum dollar limit found in the schedule, and based on the number of hours per week the worker uses the device.

Table for calculating partial allowances
Hours used per week Percentage of benefit
less than 15 hours 0%
15 - 19 hours 50%
20 - 24 hours 75%
more than 25 hours 100%

Application date

This policy applies to all decisions made on or after January 1, 2006, for all accidents.

Document History

This document replaces 17-07-03 dated October 12, 2004.

This document was previously published as:
17-05-02 dated April 6, 2001.

References

Legislative Authority

Workplace Safety and Insurance Act, 1997, as amended
Section 39

Workers' Compensation Act, R.S.O. 1990, as amended
Section 50(3)

Minute

Administrative
#8, December 6, 2005, Page 418