Policy/Legislation
This section of the WSIA provides the authority and parameters for payment of LOE benefits.
What is section 43?
This is how the LOE benefit is calculated.
What is - worker's average earnings - probable deductions X 0.85?
Hourly rate of pay can be found in this section of the form 7
What is section G?
This is the screen where you will find the Benefit Authorization Button.
What is the benefit summary screen?
Section 55 of the WSIA provides that these probable deductions are made to determine NAE.
What are probable: income tax, CPP and EI premiums?
This policy provides a chart that tells decision makers which additional earnings can be included in the short term rate.
What is policy 18-02-02, Determining Short Term Average Earnings?
Average earnings for the first 12 consecutive weeks of a claim are referred to as...
What is the short term rate (short term average earnings)?
This section of the Form 7 indicates whether or not there is lost time in a claim.
What is section E?
You can review the checks that have been sent out on this screen.
What is the payment details screen?
These conditions must exist for a worker to be considered "concurrently employed".
What are: the accident employer must have WSIB coverage, the worker must have more than one contract of employment at the time of injury, and there must be evidence of more than one continuing contract of employment during the four week period prior to the injury or some lesser period, and the worker must have received earnings from all concurrent employment in any of the four weeks prior to the injury.
This section of the WSIA applies to determining average earnings.
What is section 53?
These three things must be considered when determining average earnings in a Bill 99 (current legislation) claim.
What are employment pattern, earnings from the incident employer, any other employment at the time of injury?
The Net Claim Code Amount can be found in this section of the Form 7
What is section H?
Benefit related debts can be found on this screen.
What is the Overpayments screen?
Section 43(3) tells us that a worker who is partially impaired and does not have an offer of suitable work is entitled to FLOE so long as these conditions are met.
What is: the worker is co-operating in health care measures and (a) his or her early and safe RTW; or (b) all aspects of a labour market re-entry assessment or plan?
This policy tells us that:
"The purpose of case management reviews is to ensure recovery and RTW goals are achieved and LOE benefits are paid correctly.
The WSIB conducts regular case management reviews while the worker is engaged in health care measures and RTW activities, after which time, the WSIB conducts annual reviews until the 72-month final review date."
What is Policy 18-03-02, Payment and Reviewing LOE Benefits (Prior to Final Review)
These are the three employment patterns.
What are Permanent, Non permanent, and concurrent?
Return to work information can be found in this section of the Form 7.
What is section F?
The cycle date in a claim can be found on this payment screen.
What is the Benefits Summary Screen?
These 6 factors must be considered in your LOE rationale.
What are: is there a work-related impairment; what is the current level of function; is the loss of earnings due to the worker's inability to perform pre-injury work duties; is there clinical evidence to show the inability to work is due to the work-related injury/disease; is suitable work available to cease the loss of earnings; is the worker co-operating in health care and RTW?
This section of the WSIA gives us the authority to make probable deductions from the worker's average earnings.
What is section 55?
Name four types of earnings that may be included when establishing short term average earnings for a worker.
What are: hourly/daily/weekly rate of pay with AE, shift differentials, voluntary overtime (if worked in each of the 4 weeks leading up to DOI), mandatory overtime, regular production bonuses and commissions, tips, room and board (if part of worker's pay), hourly/daily/weekly pay with other employers (if concurrently employed at time of injury)?
The employer can indicate if the worker is a repeating rotational shift worker in this section of the Form 7.
What is section I?
Case Managers can use this screen to extend or pullback benefits without sending a benefit authorization to a Payment Specialist.
What is APAY?
According to section 43 of the WSIA, the worker's entitlement to LOE benefits cease at this point.
What is the earliest of: the day on which the worker's loss of earnings ceases; the day on which the worker reaches 65 years of age, if the worker was less than 63 years of age on the DOI; two years after the DOI, if the worker was 63 years of age or older on DOI; the day on which the worker is no longer impaired as a result of injury?