Policy
Where the worker is seriously and permanently disfigured about the face or neck, the WSIB may allow a lump sum in compensation, which is separate and distinct from a benefit for impairment of earning capacity. Benefits are based on the maximum compensation rate in effect at the time of the accident.
Guidelines
NOTE
This document applies only to accidents occurring before January 2, 1990. For accidents occurring on or after that date, disfigurement claims are rated according to the policies on NEL (see section 18-05).
Definition
Disfigurement is defined as substantial structural damage affecting the function or shape of the nose, mouth, eyes, or ears and/or substantial scarring which is cosmetically offensive. This also includes loss of hair which substantially interferes with appearance and comfort.
Referral for rating
Before a rating for disfigurement, reconstructive surgery must be considered and a conclusion made that no further improvement is probable. A report from a plastic surgeon and/or the opinion of the WSIB clinical staff on the need for such a referral should be on file.
Evaluation
The WSIB evaluates the degree of disfigurement according to the categories described in Exhibit A.
At the time of the interview, the worker is informed of the
- level of the organic impairment benefit
- level of the disfigurement benefit
- manner in which it is calculated, and
- approximate dollar value.
For record purposes, photographs may be taken by a professional photographer. The studio is notified 48 hours before the appointment.
The WSIB records its findings and recommendations in a memo. A copy of this memo and photographs (if available) are kept in a confidential file in the Regional office.
Compensation basis
The quantum of the disfigurement benefit is based on the maximum compensation basis in effect at the time of the accident, taking into consideration the worker's age at the time of accident.
If the accident occurred at any time before August 1, 1968, the disfigurement benefit is based on the maximum compensation basis in effect in 1968, considering the worker's age on August 1, 1968 (effective date of the Board Order).
Benefits for accidents occurring before April 1, 1985 are calculated at 75% of the maximum.
Benefits for accidents from April 1, 1985 to January 2, 1990 are based on 90% of the net average of the maximum utilizing the worker's tax exemption code at the time of accident.
Method of payment
Benefits for disfigurement are paid as a lump sum using the Devitt's 4% Table. Authorization of payment is done via form 1643A, "Facial Disfigurement Assessment". The worker is informed of the details of the benefit in writing.
Exhibit A
| Category | Medical Criteria | Amount of Permanent Disability Award |
|---|---|---|
| 1 | Noticeable scarring or disfigurement affecting the shape of the facial features, or loss of hair which cannot reasonably be replaced without difficulty. | 3% - 5% |
| 2 | Substantial scarring, burns or disfigurement affecting the shape or function of facial features. | 6% - 8% |
| 3 | Major disfigurement caused by scarring, burns, etc., which affect or partially obliterate the shape or function of facial features. | 9% - 11% |
| 4 | Gross disfigurement with obliteration of features and normal skin appearance due to burns, multiple scarring or other causes. | 20% - 25% |
NOTE
Compensation Basis
The amount of the disfigurement award is based on the maximum compensation basis in effect at the time of accident and takes into consideration the worker's age at the time of accident.
Accidents prior to April 1, 1985
Calculated at 75% of the maximum earning defined in the Workers' Compensation Act.
Accidents from April 1, 1985 to January 2, 1990
Calculated at 90% of the net average of the maximum earnings utilizing the worker's tax exemption code at the time of accident.
Application date
This policy applies to all accidents occurring before January 2, 1990.
Document History
This document replaces 15-04-07 dated October 12, 2004.
This document was previously published as:
03-03-11.
References
Legislative Authority
Workers' Compensation Act, R.S.O. 1980
Sections 45(10), 132
Minute
Board of Directors
#8 (VI), June 10, 2004, Page 6618
Administrative
#5, October 15, 2008, Page 465