Policy
A worker may be entitled to benefits/services if a work-related accident occurs and the worker loses time from work and/or has a loss of wages/earnings.
Guidelines
A "lost time" claim is created when a worker suffers a work-related injury which results in
- being off work past the day of accident
- loss of wages/earnings, or
- a permanent disability/impairment.
Decision-makers review the information on file to determine a worker's entitlement to benefits. Clinical evidence on file must show that the inability to work is due to the work-related accident. If the worker does not have clinical authorization to be off work, wage loss benefits or loss of earnings benefits cannot be paid.
Once entitlement has been determined and the initial payment has been made, decision-makers are responsible for issuing wage loss benefits or loss of earnings benefits and monitoring the treatment and recovery of the worker.
Periods of disability/impairment can be prolonged by
- age
- pre-existing conditions [see 14-05-03, Second Injury and Enhancement Fund (SIEF)]
- complications
- accidents resulting from treatment (see 15-05-02, Accidents Resulting from Treatment)
- psychological conditions (see 15-04-02, Psychotraumatic Disability), or
- malingering.
If the disability/impairment is prolonged, the decision-maker requests the medical consultant's opinion regarding the treatment program. In this way, the WSIB ensures that the worker gets appropriate treatment.
Length of disability/impairment
Approximate recovery times for a number of common disabilities/impairments can be found in the Length of Disability Chart in 11-01-05, Determining Maximum Medical Recovery (MMR).
Total disability/impairment
While the worker is unable to perform any type of work, the WSIB issues wage loss benefits or loss of earnings benefits. Decision-makers monitor the claim through the use of progress reports, which are reviewed as often as the severity and expected recovery time of the injury dictate.
Return to work
Decision-makers determine, through the review of clinical information, when a worker is fit to go back to regular, or suitable and available work.
If the worker is able to do suitable work only, and such work is available at a partial loss of wages/earnings, the worker may be entitled to a partial wage loss benefit or a partial loss of earnings benefit (see 18-03-02, Payment of LOE Benefits, 18-06-02, calculating Temporary Partial Disability Benefits}.
Labour Market Re-entry (LMR)
The WSIB provides the worker with a Labour Market Re-entry (LMR) assessment and, if necessary an LMR plan, if the early and safe return to work (ESRTW) activities do not result in a return to work that
- is suitable
- is available, and
- restores the worker's pre-injury earnings.
While participating in the LMR program, the worker continues to receive wage loss or loss of earnings benefits, see 19-03-01, Overview.
Application date
This policy applies to all decisions made on or after September 1, 1989, for all accidents.
Document history
This document replaces 02-03-03 dated March 4, 1997.
References
Legislative authority
Workplace Safety and Insurance Act, 1997, as amended
Sections 2(1), 43
Workers' Compensation Act, R.S.O. 1990, as amended
Sections 1(1), 37
Minute
Administrative
#12, June 23, 2004, Page 376