LOE Benefits for Workers 55 Years of Age or Older - Archived April 9, 2021

Policy

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, or
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 work transition (WT) plan, see 19-03-05, Work Transition Plans.

Purpose

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 WT plan options.

Guidelines

Older workers

Workers who are 63 years of age or older on the day of injury are 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.

Older workers who experience 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

Criteria

Workers who are 55 years of age or older when the WSIB determines that the worker is entitled to LOE benefits, have reached MMR, and have completed a WT plan, 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. Decision-makers 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.

Workers between 63 and 65 years of age who elect the "no review" option are 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.

Time limit

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 he/she is entitled to LOE benefits, and who requires a WT plan consisting of vocational skills training to achieve employment in a suitable occupation (SO) has two options

participating in a WT plan aimed at achieving the SO, or
choosing a 12 month Transition Plan (TP) focused on self directed work reintegration to achieve the SO.

The self-directed TP 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 self-directed TP.

At the end of the 12 month self-directed TP, LOE benefits will be recalculated based on the estimated earnings of the identified SO as reflected in current labour market information, see 19-03-05, Work Transition Plans.

Application date

This policy applies to all decisions made on or after January 1, 2015, for all injuries/diseases on or after January 1, 1998.

Policy review schedule

This policy will be reviewed within three years of the application date.

Document History

This document replaces 18-03-04 dated February 15, 2013.

This document was previously published as:
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.

References

Legislative Authority

Workplace Safety and Insurance Act, 1997, as amended
Sections 43, 44(3), (4), (5), (6), 107

Minute

Administrative
#2, December 12, 2014, Page 521