A worker who has a loss of earnings as a result of the injury is entitled to loss of earnings (LOE) benefits beginning when the loss of earnings begins.
If the worker is 63 years of age or older on the date of injury, LOE benefits continue until the earliest of:
- the day the loss of earnings ends
- the day on which the worker is no longer impaired as a result of the injury, or
- two years after the date of injury.
A worker may direct the WSIB not to review the LOE benefit if the worker:
- is 55 years of age or older when the WSIB determines that the worker is entitled to LOE benefits
- has reached maximum medical recovery (MMR), see 11-01-05, Determining Permanent Impairment, and
- has completed a return-to-work (RTW) plan (with training), see 19-02-10, RTW Assessments and Plans.
The purpose of this policy is to outline:
- the date LOE benefits stop for workers 63 years of age or older on the date of injury, and
- the criteria for workers 55 years of age or older to elect the "no review" and RTW plan options.
A worker who is 63 years of age or older on the day of injury is only entitled to LOE benefits for up to two years from the date of injury. The WSIB cannot consider ongoing LOE benefit entitlement, or LOE benefit entitlement for a recurrence after the two-year period.
An older worker who experiences a significant deterioration in their work-related impairment after the two-year review period may request a non-economic loss (NEL) redetermination. If the NEL redetermination results in an increase, the worker will receive the increased NEL benefit. For more information, see 18-05-09, NEL Redeterminations. The LOE benefit, however, may not be reviewed after the close of the two-year window. For more information, see 18-03-02, Payment and Reviewing LOE Benefits (Prior to Final Review).
Electing “no review” option
A worker who is 55 years of age or older when the WSIB determines that they are entitled to LOE benefits, has reached MMR, and has completed a RTW plan (with training), may elect the “no review” option. Once a worker directs the WSIB not to review the LOE benefit, the LOE benefit is locked in until age 65. The WSIB must recognize when a worker becomes eligible to consider the “no review” option, and advise the worker in writing as soon as possible after the worker meets all the criteria.
A worker between 63 and 65 years of age who elects the "no review" option is only entitled to receive LOE benefits until age 65. Workers 65 years of age or older are not eligible to elect the “no review” option.
To exercise the “no review” option, a worker has 30 calendar days from the date of the notice letter to advise the WSIB. The election of the “no review” option should be in writing. The WSIB considers the election to be made as soon as the letter is received at the WSIB’s offices, at which point it is irrevocable.
If the worker does not wish to exercise the “no review” option, no response is required.
Benefit duration - “no review” option
Once the worker elects the no review option the worker is entitled to the same LOE benefit payments until age 65.
Exception - failure to report material change
The “no review” option is irrevocable, with one exception. The WSIB may review the worker’s LOE benefit entitlement if, before the option was chosen, the worker failed to notify the WSIB of a material change in circumstances or engaged in fraud or misrepresentation in connection with the claim.
WT plan - option for workers 55 and older
A worker who is 55 years of age or older when the WSIB determines they are entitled to LOE benefits, and who requires a RTW plan (with training) consisting of vocational skills training to achieve employment in a suitable occupation (SO) has two options:
- participate in the RTW plan (with training), or
- choose a 12-month self-directed transition plan.
The self-directed transition plan option is chosen in conjunction with the irrevocable no review option for LOE benefits payable to age 65. After the worker signs the irrevocable election, full LOE benefits will continue for the 12-month period of the plan.
At the end of the 12 months, LOE benefits will be recalculated based on the estimated earnings of the identified SO as reflected in current labour market information, see 19-02-10, RTW Assessments and Plans.
This policy applies to all decisions made on or after March 1, 2021, for all injuries/diseases on or after January 1, 1998.
Policy review schedule
This policy will be reviewed in 2023.
This document replaces 18-03-04 dated January 2, 2015.
This document was previously published as:
18-03-04 dated February 15, 2013
18-03-04 dated July 15, 2011
18-03-04 dated December 1, 2010
18-03-04 dated July 18, 2008
18-03-04 dated Ocotber 3, 2007
18-03-04 dated Ocotber 12, 2004
18-03-04 dated February 20, 2004
18-03-04 dated December 24, 2003
18-03-04 dated June 15, 1999
5.6 dated January 1, 1998.
Workplace Safety and Insurance Act, 1997, as amended
Sections 43, 44(3), (4), (5), (6), 107
#28, March 24, 2021, Page 588