Chapter: BENEFITS 'Subject : PERMANENT DISABILITY Authorization: BoD Resolution 96/10/53. impairment of earning capacity.

Transcription

1 Chapter: ' Authorization: BoD Resolution 96/10/53 POLICY : PART 11 Date : November 26, 1996 APPLICATION 1 : DETERMINING PERMANENT IMPAIRMENT OF EARNING CAPACITY 1. Why does the WCB need to determine the permanent impairment ofearning capacity resultingfrom the injury? 2. When does the WCB determine permanent impairment ofearning capacity? Medical plateau The WCB's estimate of the permanent impairment of earning capacity resulting from the injury is used to determine the benefits for which the worker is eligible. The Economic Loss Payment (for injuries on or after January 1, 1995) and Earnings Loss Supplements (for injuries before January 1, 1995) are both based on impairment of earning capacity. The WCB determines permanent impairment of earning capacity when the worker has reached both a medical and a vocational plateau. An exception is made when the worker is permanently totally disabled, in which case it is not necessary to reach a vocational plateau before determining impairment of earning capacity. The medical plateau is normally reached when the worker's medical condition has stabilized, further significant medical improvement is unlikely, and permanent work restrictions can be confirmed. In cases ofpermanent clinical impairment, the medical plateau and the medical assessment for permanent clinical impairment need not occur at the same time. Depending on the nature ofthe injury, the WCB may recommend an additional period oftime for minor changes to occur before assessing the permanent clinical impairment. If the worker has a deteriorating condition a series of reviews may be required as the condition deteriorates. Issue Date: June 1, 2001 Part II page 1 of 36

2 POLICY : 'PART II Chapter: Authorization : Date : APPLICATION 1 : DETERMINING PERMANENT IIVIPAIRMENT OF EARNING CAPACITY Vocationalplateau 3. How does the WCB determine whether there is a compensable impairment of earning capacity? 4. When does the WCB estimate earning capacity instead ofusing actualpost accident earnings? Generally, a vocational plateau is reached when the worker has completed the vocational rehabilitation plan and is considered employable. Ifthe worker is entering an apprenticeship program or other occupation with expected significant changes in earnings in the first few years, the vocational plateau is the point when the worker is employable in the occupation or ready to start the apprenticeship program. Once the worker has reached medical and vocational plateaus, the WCB compares the worker's annual net earnings at the time ofthe accident (calculated in accordance with the Act and General Regulations), with the worker's actual or estimated post-accident net earnings. The WCB then evaluates whether any reduction in earnings is attributable to the permanent disability. The WCB estimates the worker's earning capacity in suitable employment when, (a) despite ability, a worker does not engage in employment, or (b) a worker is unable to secure suitable employment, or (c) a worker engages in employment which fails to maximize earning capacity. Alberta Issue Deter June 1, 2001 Part II Page 2 of 3 6 Supersede: September 15, 1999

3 Subject: POLICY : PART 11 PERMANENT DISABILIT Authorization : Date : BoD Resolution 96/10/53 November 26,1996 APPLICATION 1 : DETERMINING PERMANENT IIVIPAIRMENT OF EARNING CAPACITY 5. What is suitable employment? 6. What is the estimate of earning capacity based on? 7. What earnings are used if the worker hadpersonal coverage at the time ofthe accident? This policy is effective January 1, 2001 BoD Resolution 2001/03/15 For the purposes of estimating earning capacity, suitable means employment which is consistent with the worker's ability and which is within the worker's locale or may be obtainable where relocation is reasonable. The WCB's assessment of ability will be based on physical, vocational, social, and psychological circumstances and such other factors as the WCB may consider relevant. The estimate of earning capacity is usually based on information related to the vocational plan. The plan identifies suitable employment and the worker's earning capacity in that employment. If the worker is selfemployed, the estimate will normally be based on the approved business case. The WCB may base the estimate on other information under some circumstances (for example, ifthe worker unexpectedly increases earning capacity with other employment, the worker's compensable work restrictions change, etc.). Each case will be judged on its own merits. See Policy for details on vocational services and the vocational plan. Ifthe worker had personal coverage at the time of the accident, the WCB uses the net earnings that were used to determine the date-of-accident compensation rate, plus any applicable cost-of-living adjustments (see Policy 04-01, Part II, Application 2, Question 2). Issue Date June 1, 2001 Part II page 3 of 36

4 POLICY : 04_04 PART II Authorization : Date : APPLICATION 1 : DETERMINING PERMANENT IMPAIRMENT OF EARNING CAPACITY 8. What ifthe impairment of earning capacity results from a non-compensable condition? The WCB will not pay an Economic Loss Payment or Earnings Loss Supplement ifthe remaining earnings loss is caused solely by a non-compensable condition (for example, if the worker's earnings loss is caused by a noncompensable, unrelated heart condition). The WCB does, however, consider impairment of earning capacity to be compensable when the following conditions are met : a) despite the pre-existing condition, the worker was able to perform the job duties prior to the compensable accident, and b) the worker is no longer able to do so because ofthe permanent effects of the compensable injury. Alberta Issue Date` June 1, 2001 Part II page 4 of 36 Supersedes. September 15, 1999

5 POLICY : PART II PERNL NENT DISABILITY Authorization : Date : APPLICATION 2 :NON-ECONOMIC LOSS PAYMENT - INJURIES ON OR AFTER JANUARY 1, What is the purpose ofthe NonEconomic Loss Payment? 2. Who is eligiblefor a Non- Economic Loss Payment? Thispolicy is effective August 1, 1999 and applies to all claims with a date of accident on or after that date BoD Resolution 99/07/47 3. What ifthe worker's compensable injury or condition results in death? This policy is effective August 1, 1999 and applies to all claims with a date of accident on or after that date BoD Resolution 99/07/47 The Non-Economic Loss Payment (HELP) is paid in recognition that a permanent clinical impairment may also impact the worker's life outside the workplace. To be eligible for a NELP, the worker must meet the following conditions : the date ofaccident is on or after January 1, 1995 " the worker has a measurable permanent clinical impairment. As explained in Q 1, the intent ofthe NELP is to compensate the worker for the impact the injury has on the worker's life outside the workplace. Therefore, the worker is not eligible for a NELP when there is an immediate fatality. For this policy, "immediate fatality" is defined as death within 30 calendar days ofthe date of accident. The 30 calendar days include the date of accident. If, however, death is not immediate and it is clear the worker has or will have a permanent clinical impairment if he or she lives, the worker is eligible for a NELP. If the WCB is unable to assess the degree of permanent clinical impairment before the worker's death, it will base the assessment on the documentary medical evidence. In these cases, the NELP will be paid to the worker's estate. Issue Date: June 1, 2001 Part II page 5 of 36

6 POLICY : PART II Chapter: Authorization : Date: APPLICATION 2 : NON-ECONOMIC LOSS PAYMENT - INJURIES ON OR AFTER JANUARY 1, When does the WCB With the exception of deteriorating conditions, the WCB determine the amount ofthe determines the value of a non-economic loss payment at Non-Economic Loss the medical plateau, when medical opinion indicates no Payment? further significant medical change is likely. If the injury is a deteriorating condition, the non-economic loss payment is assessed when the condition first stabilizes, and may be periodically reassessed as the condition deteriorates. 5. How does the WCB The degree ofpermanent clinical impairment is determined determine the degree of by a physician, using the WCB's approved rating schedule. permanent clinical impairment? 6. How does the WCB calculate As the Non-Economic Loss Payment is not intended to the NonEconomic Loss compensate the worker for lost earnings, the payment base Payment? is the same for all workers, regardless ofearnings. The payment is paid as a lump sum, and is based on the degree ofpermanent clinical impairment resulting from the compensable injury. The maximum payment (payable to workers who suffer a 100% permanent clinical impairment) is indicated in Addendum A of this policy. When determining a payment, the WCB will use the maximum amount in effect on the date ofthe noneconomic payment evaluation. Issue Date June 1, 2001 Part II page 6 of 36 Supersedes September 15, 1999

7 Chapter: PERMANENT I)ISABILITY Authorization: POLICY : PART 11 Date: APPLICATION 2: NON-ECONOMIC LOSS PAYMENT - INJURIES ON OR AFTER JANUARY Calculating NELP (continued) 7. How is the minimum NELP applied ifa worker becomes eligiblefor a NELP under a subsequent claim? This policy is effective August 1, 1999 BoD Resolution 99/07/47 8. Does the WCBperiodically adjust the maximum NELP? For less than permanent total clinical impairment, the payment is a proportionate amount ofthe maximum (for example, if the maximum is $60,000 and the permanent clinical impairment is 20%, the payment will be $60,000 x 20%, or $12,000). The minimum payment is 2% of maximum (for example, $60,000 x 2%, or $1,200). A worker with a permanent clinical impairment equal to or greater than 0.4% but less than 2% will receive a 2% payment. The WCB generally considers each claim separately. For example, a worker who receives a minimum 2% award for a 1% permanent clinical impairment of a finger will receive another minimum 2% award for a 1% permanent clinical impairment ofa different finger under a later claim. However, ifthe later accident is to the same body part and site (for example, the same site on the same finger), the WCB looks at the cumulative total ofthe actual clinical impairment. As the worker has already received a 2% award for the permanent clinical impairment ofthat body part and site, the WCB does not pay an additional NELP unless the cumulative compensable permanent clinical impairment is more than 2%. If the total is more than 2%, the additional NELP is based on the total percentage of permanent clinical impairment, minus 2%. Starting January 1, 1996, the maximum payment will be increased on the same date and by the same percentage as cost-of-living adjustments made pursuant to Section 53.1 ofthe Act (see Addendum A at the end ofthis policy). Alberta Issue Date June 1, 2001 Part II page 7 of 36

8 POLICY : 04-Q4 PART 11 Subject: Authorization : Date : APPLICATION 3 :ECONOIVIIC LOSS PAYMENT - INJURIES ON OR AFTER JANUARY 1, What is the purpose ofan The Economic Loss Payment (ELP) compensates the Economic Loss Payment? worker for loss of earnings if the injury results in compensable permanent work restrictions that cause a permanent impairment of earning capacity. 2. Who is eligiblefor an To qualify for an ELP, the worker must meet the following Economic Loss Payment? conditions : " the date ofaccident is on or after January 1, 1995 " the worker has a permanent impairment of earning capacity due to compensable work restrictions (see Application 1, Determining Permanent Impairment of Earning Capacity). 3. How does the WCB calculate The Economic Loss Payment is 90% ofthe difference the Economic Loss between : Payment? a) the worker's pre-accident net earnings, calculated in accordance with the Act and the General Regulations, and b) the greater of the worker's post-accident actual net earnings or estimated post-accident net earning capacity, calculated in accordance with the Act and the General Regulations. Subject to periodic review, the ELP is then normally paid until age 65 (or retirement age), at which time it is adjusted to reflect the impact on retirement income. Alberta Issue Date: June 1, 2001 Part II page 8 of 36

9 POLICY: Authorization : BoD Resolution 96/10/ PART II Date : November 26, 1996 APPLICATION 3 : ECONOMIC LOSS PAYMENT - INJURIES ON OR AFTER JANUARY 1, 1995 Calculating Economic Loss Payments (continued) 4. How frequently is an ELP Normally, the ELP will be reviewed and confirmed 36 reviewed? months after it is first awarded, and again when the worker reaches age 65. However, the WCB may extend the review period or review more frequently if circumstances warrant. Before the ELP is confirmed The only exceptions are workers with 100% permanent clinical impairment and workers presumed to be 100% permanently disabled under Section 38(2) ofthe Act. In these cases, the WCB does not deduct any post-accident earnings, nor does it adjust the ELP at age 65. The following situations are examples ofwhen the WCB may extend the review period or conduct interim reviews : the worker or accident employer requests an interim review the worker is in an apprenticeship program the worker has just started in an occupation which traditionally has significant changes in earnings in the first few years* * This does not include general pay raises or cost-ofliving raises that a worker may receive from time to time. After the ELP confirmation review The following situations are examples of when the WCB may require additional reviews e the worker's compensable work restrictions have changed " the worker or accident employer requests a review " new evidence indicates significant change in the worker's earning capacity. Issue Date: June 1, 2001 Part II Page 9 of 36 Supersedes : September 15, 1999

10 POLICY : PART II Chap Subject: PERNJfANEINT DISAB Authorization : Date : APPLICATION 3 : ECONOMIC LOSS PAYMENT - INJURIES ON OR AFTER JANUARY 1, 1995 Worker reaches If a worker reaches retirement age (normally age 65) retirement age before before 36 months have elapsed since the initial the 36 month review determination, the WCB will not conduct a 36 month review. Instead, benefits will be adjusted according to the age 65 adjustment formula. 5. What earnings are The WCB will normally consider gross earnings from all consideredfor the review? employment sources for the full review period. At the 36 month review, for example, the WCB will require confirmation ofthe worker's earnings for the last three years. Revenue Canada records are the primary confirmation source. 6. When will the WCB adjust The WCB may increase or decrease an ELP if the review or terminate an ELP? findings show the worker's earning capacity differs from the previous estimate. Increases will only be considered if the worker's reduced earning capacity is due to the compensable work restrictions. The WCB will terminate an ELP ifnew evidence indicates the worker's earning capacity is not impaired by compensable work restrictions. 7. If an ELP adjustment is Ifthe adjustment is a consequence ofthe 36 month or required, when is it other scheduled review, increased benefits will normally be effective? effective the date of the review anniversary. Decreased benefits will normally be effective the date the review is completed, unless the review was delayed by the worker's conduct, in which case the adjustment will be effective the date the review is scheduled.,avbem Issue Date June 1, 2001 Part II page 10 of 36

11 POLICY PERNIANENT DISABILITY Authorization : BoD Resolution 96/10/ PART 11 Date : November 26, 1996 APPLICATION 3 : ECONONIIC LOSS PAYMENT - INJURIES ON OR AFTER JANUARY 1, 1995 ELP adjustment effective date (continued) 8. Will the ELP be terminated or adjusted ifthe worker leaves Alberta or Canada? 9. Why is the ELP adjusted at age 65? Ifnew evidence indicates the ELP determination was based on incorrect information or if the review is ad hoc (for example, at the request of the worker or employer), Policy 05-01, New Evidence, will apply. ELP will normally continue ifthe worker leaves the province or country. ELP is based on a permanent impairment ofearning capacity, and it is reasonable to assume the worker's permanent work restrictions will continue to impair earning capacity regardless ofthe place ofresidence. Workers who leave the province or country are still subject to the same reviews as workers who live in Alberta, and an ELP may be adjusted or terminated as discussed in question 6. ELP will not be increased if the economic conditions in the new place of residence result in reduced earnings. The WCB will estimate earning capacity as though the worker had continued to work in suitable employment in Alberta. At retirement, the impact on earning capacity is reduced as wages are replaced by pension/retirement income. The ELP is adjusted to reflect the changed earning capacity by using a formula similar to that used for standard retirement pensions. Age 65 is commonly considered to be normal retirement age, and the ELP will be adjusted when the worker reaches age 65 unless there is sufficient and satisfactory evidence to show that the worker would have continued to work past that age ifthe injury had not occurred. Alberta Issue Date. June 1, 2001 Part II page 11 of 36 Supersedes September 15, 1999

12 POLICY: Authorization: Date : PART n APPLICATION 3: ECONONIIC LOSS PAYMENT - INJURIES ON OR AFTER JANUARY 1, What is considered sufficient and satisfactory evidence that a worker would have continued to workpast age 65? As with any adjudicative issue, the decision will be made on the balance ofprobabilities. Workers are not required to provide absolute proof, however, there must be some independent evidence that the worker intended to work after age 65, and would have done so if not for the compensable injury. Examples ofsatisfactory independent evidence include : " confirmation from the worker's accident employer, union, or other independent employment source that the worker had planned to continue after age 65 and employment was available " continued employment post-age 65 at the same level and earnings as pre-age 65 [for example, a 51 year old worker with compensable permanent work restrictions returns to work with reduced earning capacity and is paid an ELS. The worker continues to work at that level (same type ofwork, same hours) until age 69] " continued employment post-age 65 at reduced earnings, when it is clear that the further reduction is due to a deterioration ofthe compensable work restrictions, rather than a personal choice of semiretirement. The WCB will also consider any other relevant factors such as the normal retirement age for workers in the same pre-accident occupation. Issue Date; June 1, 2001 Part II page 12 of 36

13 Chapter: Subject: POLICY Authorization : BoD Resolution 96/10/53 04-{l4 PART 11 Date : November 26, 1996 APPLICATION 3 : ECONOMIC LOSS PAYMENT - INJURIES ON OR AFTER JANUARY 1, Will the WCB adjust the The WCB will not apply the retirement adjustment to ELP ELP earlier than age 65 if a until the worker reaches age 65. As the injury may have worker chooses early been a factor in the worker's decision to retire or to not retirement? pursue other employment, the WCB will presume that the worker's permanent work restrictions continue to affect earning capacity and employment options until the worker reaches usual retirement age. 12. How is the retirement To estimate the impact ofthe disability on the worker's adjustment calculated? retirement income (due to the reduced opportunity to contribute to retirement plans), economic loss payments will be adjusted according to the following formula : Average Annual Compensation* x (Number of years of compensable earnings loss [to a maximum of 35 years] x 2%) * Average Annual Compensation is based on economic loss payments for the five year period ending with the month in which the worker reaches retirement age. If the economic loss payment has been in effect for less than five years, the annual average will be calculated using the actual period the payment was in effect. The adjusted benefits will normally be payable on a monthly basis for the lifetime ofthe worker. Alberta Issue Date. June 1, 2001 Part ii page 13 of 36 Copyright All rights reserved

14 POLICY : `PART II Authorization : Date: APPLICATION 3 : ECONOMIC LOSS PAYMENT - INJURIES ON OR AFTER JANUARY 1, Are periods oftemporary Periods oftemporary disability are included when disability included in the age calculating the number ofyears ofcompensable earnings 65 adjustment? loss. For example, a worker injured at age 50 who receives 2 years of temporary benefits followed by 13 years of ELP has a total of 15 years of compensable earnings loss. Periods oftemporary disability are not included when calculating the Average Annual Compensation. This amount is based on ELP, and is an average of the last five year period (or shorter period ifapplicable). 14. Does the age 65 adjustment Benefits will not be adjusted at age 65 if the worker has a apply to workers who are 100% clinical impairment, or if the worker is conclusively permanently totally presumed to be permanently totally disabled under Section disabled? 38(2) ofthe Act. Alberta Issue Date June 1, 2001 Part ii page 14 of 36 Copyright All rights reserved

15 POLICY : 04_04 PART II PERMANENT' DISABILITY Authorization : Date : APPLICATION 4 : INJURIES PRIOR TO JANUARY 1, What is a Permanent A permanent disability award is a pension which includes Disability Award, and who is compensation for permanent clinical impairment and eligiblefor it? assumed permanent loss ofearning capacity resulting from the clinical impairment. The pension is based on a medical determination of the extent ofthe compensable clinical impairment. The WCB uses the WCB-approved rating schedule (see Appendix D at the back of this manual) as a guide to determine the extent to which the compensable clinical impairment impairs or may impair earning capacity, and expresses that impairment as a percentage of disability. Workers are eligible for a permanent disability award when they have a permanent clinical impairment due to a compensable accident which occurred on or before December 31, How is thepension amount The pension is calculated as a proportion of permanent determined? total disability. The pension for permanent total disability is based on 90% of the worker's annual net earnings at the time of the accident, calculated in accordance with the Act and Regulations. Partial permanent disability pensions are a proportion of that amount, based on the degree of disability. For example, a worker with a permanent partial disability of 20% would receive a pension equal to 20% of 90% of annual net earnings. The pension is subject to minimum and maximum amounts, as ordered by the Act, and the Board ofdirectors. Pensions may be adjusted by cost-of-living increases, as set out in the Act or ordered by the Board of Issue Date: June 1, 2001 Part II page 15 of 36

16 POLICY Authorization : BoD Resolution 96/10/ PART II Date : November 26, 1996 APPLICATION 4 : INJURIES PRIOR TO JANUARY 1, 1995 Determining the pension amount (continued) 3. At what stage in the worker's recovery is thepension determined? 4. What ifthe WCB cannot locate the worker to assess permanent clinical impairment? 5. How long is the pension paid? Directors. (see Appendix F at the back ofthis manual for minimum amount for permanent total disability, maximum insurable earnings, and cost-of-living increases in effect since January 1, 1982). The WCB usually waits until medical opinion confirms the injury has stabilized with no frther recovery expected, before assessing the permanent disability. When the injury is a deteriorating condition (for example, a progressive occupational disease), the WCB may reassess several times as the condition deteriorates, and adjust the pension accordingly. When a worker's whereabouts are unknown and documentary or other evidence indicates the worker is entitled to a permanent disability award, the WCB may establish a provisional award. Provisional awards are calculated in the same my as otherpermanent disability awards, but are based on the medical information already onfile. The capitalized costs are charged to the employer's experience account, but payments to the worker are held until the worker can be located. When the worker is located the WCB will, ifnecessary, arrange for a re-assessment ofthepermanent disability. The pension is paid for the worker's lifetime. The WCB may increase or decrease the pension amount ifthere is a change in the degree of disability. The pension may be reduced or discontinued ifthe WCB discovers part or all of the pension was obtained by fraudulent means (see Policy 05-01, New Evidence). Issue Date June l, 2001 Part II page 16 of 36 Copyright All rights reserved

17 POLICY : Authorization: Date : PART II APPLICATION 4: INJURIES PRIOR TO JANUARY What ifthe worker's actual impairment ofearning capacity is greater than the pension? 7. What ifthe worker has permanent work restrictions, but does not have a measurable permanent clinical impairment? 8. How does the WCB adjust the award ifthe worker's clinical impairment changes over time? Ifthe worker's actual loss of earning capacity due to compensable permanent work restrictions exceeds the value ofthe permanent disability award, the worker may be eligible for an earnings loss supplement, under Section 60 ofthe Act (see Application 5). Workers with permanent work restrictions who, because they do not have a permanent clinical impairment, do not qualify for a permanent disability award may be eligible for an earnings loss supplement (see Application 5). The permanent disability award may be revised if, on fiuthey examination, it is determined that the worker's degree of clinical impairment is different from that previously assessed. If it is evident the initial assessment was incorrect, or there has been an unanticipated gradual improvement in the worker's physical condition, Policy 05-01, New Evidence, will apply when determining the date ofthe adjustment. If it appears the initial assessment was correct but the disability has since increased, the WCB will assume the increase was a gradual, even progression, unless the contrary is shown. The increased pension award will be effective the mid-point between the date of the initial assessment and the date ofthe examination which confirmed the increased disability. * This method does not apply to claims for chest conditions resulting from accidents prior to January 1, Issue Date: June l, 2001 Part II page 17 of 36 Supersedes: August 1, 2000

18 Chapter POLICY : Authorization : Date : PART II APPLICATION 4 : INJURIES PRIOR TO JANUARY 1, What specialprovisions are therefor claims occurring prior to April 1, 1975? 10. What are the limitations when a worker is entitled to more than one permanent disability award? Accidents on or before June 30, 1976 If a worker : a) is receiving compensation for a permanent disability resulting from an accident prior to April 1, 1975, and b) the aggregate degree of permanent disability resulting from the pre-april 1, 1975 accident(s) is at least 50% of total, the WCB will pay an additional supplement calculated in accordance with Section 53 of the Act, until the worker reaches age 65. If a worker is entitled to receive more than one permanent disability award and the cumulative percentage exceeds 100% (total disability), the compensation paid will depend on the dates of accident. The legislation in force prior to July 1, 1976, prohibited the WCB from paying compensation for the portion ofthe cumulative percentage that exceeds 100%. Ifall the claims involved occurred prior to July 1, 1976, compensation for the claim that puts the cumulative total over 100% will be calculated as 100%, minus either : a) the dollar amount of the earlier award(s), or b) the percentage of the earlier award(s), whichever gives the greater benefit to the worker. Accidents on or after July 1, 1976 If all the claims involved occurred on or after July 1, 1976, compensation is based on the full percentage value ofthe combined awards, with no reduction. Alberta Issue Date: June 1, 2001 Part ii page 18 of 36 Supersades: August 1, 2000

19 POLICY : PART 11 Authorization : Date : APPLICATION 4 : INJURIES PRIOR TO JANUARY 1, 1995 Combination ofpre andpost-july 1, 1976 accidents Ifthe claims are a combination ofpre-july l, 1976 and post-june 30, 1976 claims, compensation is based on the full percentage value ofthe combined awards, with no reduction. Issue Date June 1, 2001 Part II page 19 of 36

20 Chapter: - POLICY : Authorization : Date : OMQ4 PART II APPLICATION 5: EARNINGS LOSS SUPPLEMENTS 1. What are Earnings Loss Earnings Loss Supplements (ELS) are discretionary, Supplements? compensation payments made when a permanent disability award (pension) does not fully compensate the worker for the loss of earning capacity caused by the compensable injury- 2. Who is eligible for an To be eligible for an ELS, the worker must meet the Earnings Loss Supplement? following conditions : 1) the worker has compensable permanent work restrictions which cause a loss in earning capacity*, and 2) the loss in earning capacity caused by the compensable permanent work restrictions is greater than any pension the worker is receiving for the same injury. * See Application 1, Determining Permanent Impairment of Earning Capacity. The worker may or maynot be receiving a pension, depending on whether the permanent disability includes a measurable clinical impairment. An ELS is applicable only ifthe accident occurred on or before December 31, Claims occurring on or after January 1, 1995 are considered under the provisions of Economic Loss Payments (see Application 3). Alberta Issue Date June 1, 2001 Part II page 20 of36

21 POLICY : PART II Chapter: Subject: Authorization : Date : APPLICATION 5 : EARNINGS LOSS SUPPLEMENTS 3. How does the WCB The WCB determines loss of earning capacity by determine the supplement comparing the worker's post-accident earning capacity amount? with earning capacity at the time of accident, as follows : (a) (b) the worker's pre-accident net earnings*, calculated in accordance with the Act and the General Regulations, LESS any periodic compensation the worker is receiving for the same accident and the greater ofthe worker's post-accident actual net earnings or estimated post-accident net earning capacity, calculated in accordance with the Act and the General Regulations. * pre-accident net earnings may be either the earnings from date of accident or a rate adjusted under s.55 ofthe Act (see Policy 03-03) The WCB then calculates an amount up to 90% of the earnings loss, according to the percentage of the earnings loss which, in the WCB's opinion, is caused by the compensable disability. Depending on the time period for which the ELS is being paid, the WCB may deduct the full value of any CPP disability entitlement for the same injury from the supplement amount. WCB does not deduct CPP benefits for periods on or after June 1, 1996 ; however, CPP disability benefits are deducted from supplements paid for periods prior to June 1, The WCB reviews ELS annually to confirm the amount and the worker's continuing eligibility. Alberta Issue Date June 1, 2001 Part ii page 21 of 36

22 POLICY PART II Subject: PERNIANENT DISABILITY Authorization : Date : APPLICATION 5 : EARNINGS LOSS SUPPLEMENTS Limitations The combined dollar values ofan ELS and a permanent disability award under the same claim are not to exceed the compensation the worker would have been entitled to, had the accident resulted in permanent total disability. ELS,for - periods on or after June The combined dollar values ofan ELS, post-accident net employment earnings, and an awardforpermanent disability under the same claim are not to exceed the worker's pre-accident annual net earnings used in calculating the ELS, subject to the provisions ofs ELS,for -periods before June The combined dollar values ofan ELS, post-accident net employment earnings, an awardforpermanent disability under the same claim, and any CPP disability entitlement for the same injury are not to exceed the worker's preaccident annual net earnings used in calculating the ELS, subject to theprovisions ofs How long do Earnings Loss Ifgranted, an ELS will continue until the earnings loss Supplements continue? ends or the worker reaches retirement age, whichever is first. This policy is effective August 21, 1990 BoD Resolution 99/07/48 Age 65 is commonly considered to be normal retirement age. The ELS will end when the worker reaches age 65 unless there is sufficient and satisfactory evidence to show that the worker would have continued to work past that age if the injury had not occurred Issue Date June 1, 2001 Part ii page 22 of 36 Supersedes: September 15,1999

23 POLICY : PART 11 Authorization : Date : APPLICATION 5: EARNINGS LOSS SUPPLEMENTS 5. What is considered sufficient and satisfactory evidence that a worker would have continued to workpast age 65? This policy is effective August 21, 1990 BoD Resolution 99/07/48 As with any adjudicative issue, the decision will be made on the balance ofprobabilities. Workers are not required to provide absolute proof, however, there must be some independent evidence that the worker intended to work after age 65, andwould have done so ifnot for the compensable injury. Examples of satisfactory independent evidence include : confirmation from the worker's accident employer, union, or other independent employment source that the worker had planned to continue after age 65 and employment was available " continued employment post-age 65 at the same level and earnings as pre-age 65 [for example, a 51 year old worker with compensable permanent work restrictions returns to work with reduced earning capacity and is paid an ELS. The worker continues to work at that level (same type ofwork, same hours) until age 69] " continued employment post-age 65 at reduced earnings, when it is clear the reduction in earnings is caused by a deterioration ofthe compensable work restrictions, rather than a personal choice of semiretirement. The WCB will also consider any other relevant factors such as the normal retirement age for workers in the same pre-accident occupation. Issue Date June 1, 2001 Supersedes : September 15, 1999 part ii page 23 of 36

24 POLICY: Subject: Authorization : BoD Resolution 96/10/53 X4-44 PART 11 Date : November 26, 1996 APPLICATION 5 : EARNINGS LOSS SUPPLEMENTS 6. What happens if a worker with an ELS becomes unemployed? The action taken will depend on the reason the worker became unemployed. If termination was in some way due to the compensable disability, the WCB will review the worker's medical condition and vocational profile, and readjust the ELS if appropriate. Iftermination was for reasons unrelated to the disability, the WCB will usually continue to estimate the worker's earning capacity as though employment continued (see Application 1, Q4). The WCB may adjust the ELS, however, ifthe termination was not the fault ofthe worker (for example, a plant closure), and there are unusual circumstances which prevent the worker from obtaining similar employment elsewhere. For example, ifit is not reasonable to expect the worker to relocate ; thejob had been modified extensively to accommodate compensable work restrictions so it is unlikely the worker would be able to obtain similar employment with another employer ; or the termination occurs soon after completion ofthe approved vocational plan, and the plan had identified the employment as being suitable and accessible. Each situation will be judged on its own merits. Alberta Issue Date: June 1, 2001 Part II page 24 of 36 Copyright All rights reserved

25 POLICY : Chapter: Subject: Authorization: BoD Resolution 96/10/ PART II Date: November 26, 1996 APPLICATION 5 : EARNINGS LOSS SUPPLEMENTS 7. How are benefits paid ifa worker with an ELS has a new compensable accident? If the new injury is : a) unrelated to the disability for which the ELS is being paid and b) results in temporary or permanent disability, the WCB will continue to pay the ELS and will calculate temporary and permanent disability benefits for the new injury based on the worker's employment earnings at the time ofthe new accident. WCB benefits from prior claims are not considered to be part of the worker's employment earnings. Ifthe new injury results in permanent disability, the worker may also be eligible for an Earnings Loss Supplement or Economic Loss Payment (determined by the date of accident) for the new injury. Alberta Issue Date June 1, 2001 Part ii Page 25 of 36

26 POLIO' : PERMANENTDISABILITY Authorization : Date : PART R APPLICATION 6: ENHANCEMENT FACTOR 1. What is an enhancement factor? 2. What does the WCB take into consideration when determining whether to include an enhancement factor? 3. What limitations are there? When the combined effect oftwo or more disabilities is greater than the sum ofthe separate impairments (for example, immobility ofthe ankle joint is rated at a 12% impairment, according to the Alberta Permanent Clinical Impairment Guide, but the combined effect of immobility ofboth ankle joints may be greater than 24%), the WCB may, in certain circumstances, increase the permanent clinical impairment award to a higher percentage. The percentage increase is called an "enhancement factor". The WCB will usually include an enhancement factor only when the worker's disabilities involve parts ofthe body with identical functions (for example, both arms, both legs, both eyes). The disabilities may all be compensable, or may be a combination of compensable and noncompensable. Each case will be considered on its own merits. If one of the disabilities is non-compensable, the enhancement factor will usually be considered only when the non-compensable condition pre-existed the compensable (for example, a worker who lost the use of an arm as a child loses the use ofthe remaining arm due to a compensable injury). The only exception is loss ofvision. The enhancement factor is normally limited to a maximum of50% of the lesser disability. For example, ifthe two disabilities are a below knee amputation (35%) and immobility of the anklejoint (12%) on the opposing leg, the enhancement factor would normally be limited to 6% (50% of 12%). Once again, loss ofvision is the exception. Issue Date: June 1, 2001 Part II page 26 of 36

27 POLICY : PART II ` PERMANENT' DISABILITY Authorization : Date : APPLICATION 6 : ENHANCEMENT FACTOR Limitations (continued) 4. How is the enhancement factor applied to loss of vision? 5. How is the enhancement factor applied when a compensable lung condition affects a non-compensable heart disease? The combination of disability and the enhancement factor will under no circumstances be more than 100% total disability. The permanent disability rating for the loss ofvision in one eye is normally 16% or 18% (depending on the individual circumstances), while the compensable loss ofvision in both eyes is considered total (100%) disability. If a worker who has a complete loss ofvision in one eye due to a compensable injury subsequently loses the vision in the remaining eye for non-compensable reasons, the WCB will increase the permanent disability award to 50%. This increase is made on the basis that the worker now has a 100% clinical impairment, one half (50%) ofwhich is attributable to the compensable injury. When, at the same time, a worker has both: 1) a compensable permanent impairment of the respiratory system, and 2) a disabling degree of non-compensable heart disease, the WCB considers that the compensable impairment of lung function affects the non-compensable heart disease. In recognition ofthe resulting increased disability, the WCB will pay the worker an enhancement supplement. The supplement is equal to 50% of the permanent disability award based on the permanent clinical impairment rating assigned to the respiratory disease. For example, ifthe permanent clinical impairment rating assigned to the worker's compensable respiratory condition is 35%, the supplement is a monthly payment in Issue Date; June 1, 2001 Part II page 27 of 36 Supersedes : September 15, 1999

28 POLICY : Authorization : Date : PART II APPLICATION 6: ENHANCEMENT FACTOR Compensable lung condition/non-compensable heart condition (continued) Duration Limitations an amount equal to the monthly pension amount the worker would receive for a 17.5% permanent clinical impairment. If the clinical impairment for the compensable respiratory condition increases, the supplement will be increased proportionately, provided the combined value does not exceed 100% disability. The supplement is effective from : " the date the heart disease is diagnosed, or " the date the claim for the respiratory disease is allowed, whichever is the later. The supplement is payable until the worker reaches age 65. In no case will the combined value ofpermanent disability benefits and supplement exceed the amount payable for permanent total disability. The worker's benefit entitlement for the non-compensable heart disease is limited to the supplement paid under this policy. The WCB will not accept any responsibility for death attributable to the heart disease unless the conditions for acceptance outlined in Application 4 of Policy 03-01, Injuries, are met. Issue Date June 1, 2001 Part II page 28 of 36 Supersedes: September 15,1999

29 'POLICY' Authorization : BoD Resolution 96/10/ PART II' Date : November 26, 1996 APPLICATION 7 : LUMP SUM COMMUTATIONS 1. What is a lump sum A lump sum commutation is a lump sum payment of commutation? permanent disability or dependant's benefits which would otherwise be paid as periodic payments (normally once a month). The lump sum is calculated in accordance with s.42 ofthe Act. 2. Under what circumstances As the method of calculating permanent disability benefits will the WCB commute changed as ofjanuary 1, 1995, the date of accident permanent disability determines the circumstances under which the WCB will benefits? commute benefits. The WCB will usually commute permanent disability benefits in the following circumstances : " the accident was on or before December 31, 1994 and the permanent disability has been assessed at 10% or less, or " the accident was on or after January 1, 1995 and the annual Economic Loss Payment is no more than 10% ofthe worker's annual net earnings at the time ofthe accident (calculated in accordance with the Act and General Regulations).* Ifthe permanent disability benefits are over 10%, certain conditions must be met before the WCB will consider paying the benefits as a lump sum. * The WCB will not consider a full commutation ofthe Economic Loss Payment until after the final confirming review (usually 36 months after the ELP was established - see Application 2). Alberta Issue Date: June 1, 2001 Part II page 29 of 36 Supersedes : September 15,1999

30 POLICY : '' PERIVIANENT DISABILITY Authorization : BoD Resolution 96/10/ PART II Date : November 26, 1996 APPLICATION 7: LUMP SUM COMMUTATIONS 3. What conditions must be met The WCB will only consider commutations over 10% if all when the disability is more of the following conditions are met : than 10%? " the disability does not cause a significant earnings impairment, " medical evidence indicates the worker's injury has stabilized and will not likely deteriorate, " the clinical impairment and associated work restrictions are not likely to restrict the worker's future employability, and " the worker is not dependent on the monthly pension for the necessities of life. 4. Will the WCB make an Ifthere are extraordinary circumstances, a committee of at exception in extraordinary least three members of WCB senior management (director circumstances? and above) may authorize a lump sum commutation greater than 10% as the last resort for dispute resolution. This committee may only consider commutations when the issue has not been appealed. Ifthe issue has been appealed, the appeal body which has given the most recent ruling on the issue may authorize a commutation on the same basis. The Vice President, Claimant & Health Care Services will report all commutations made under this section to the Board ofdirectors at its next meeting. Aberm Issue Date June 1, 2001 Part II page 30 of 36

31 Chapter: Subject: POLICY: Authorization: 04=04 PART II Date: APPLICATION 7: LUMP SUM COMMUTATIONS 5. How do the criteria for lump sum commutations affect payment ofthe NonEconomic Loss Paymentfor claims occurring on or after January I, 1995? 6. By accepting a lump sum commutation, do workers give up their rights to any other WCB benefits? The criteria for lump sum commutations do not apply to the Non-Economic Loss Payment (HELP). NELP is always paid as a lump sum, regardless of the degree of disability. Workers who accept a lump sum commutation in full settlement of a claim are still eligible for medical aid, vocational services, and temporary benefits when appropriate. Workers who receive a partial lump sum commutation are eligible for the remaining permanent disability benefits, as well as medical aid, vocational services, and temporary benefits when appropriate. In all cases, the WCB may later adjust the permanent disability benefits ifthere is a change in disability. Issue Date June 1, 2001 Part II page 31 of 36

32 POLICY : 'PART II Authorization: Date: APPLICATION 8: BENEFIT ADVANCES 1. What conditions must be met for the WCB to consider allowing an advance on permanent disability benefits? 2. What does the WCB consider to be "interest or pressing need"? The WCB may consider a permanent disability benefit advance when all the following conditions are met: " the worker does not qualify for alternative options such as other WCB benefits (for example, a lump sum commutation or vocational services) or a loan from a financial institution, " the worker is not dependent on the monthly benefit for the necessities of life, and " in the WCB's opinion, allowing an advance is in the worker or dependant's interest or pressing need. The WCB takes into consideration the intended purpose of the advance. The WCB may consider an advance for purposes such as helping protect the worker's home equity or consolidating, reducing or eliminating non-recurring debts which resulted from hardship caused by an extended period of disability. The WCB will not usually allow advances for such things as : " consolidating, reducing or eliminating recurring debts " purchasing a recreational vehicle " financing a vacation " financial investment in business or stocks " any other purpose not considered to be in the worker's interest. Alberta Issue Date: June 1, 2001 Part II page 32 of 36 Copyright All rights reserved

33 - POLICY : PERMANENT'DISABILITY Authorization: PART II Date: APPLICATION 8: BENEFIT ADVANCES 3. Ifan advance is allowed, Interest is charged on all advances. The interest rate is set what conditions are there? annually. The maximum advance allowed and the repayment terms are determined according to the circumstances ofeach claim. 4. What repayment terms are Advances may be repaid according to one of the following : available? a stop on all permanent disability payments until the principal and interest are recovered reduced permanent disability payments until the principal and interest are recovered " a single repayment. As well, the WCB may withhold any cost-of-living or other adjustment and apply the amount against the outstanding balance. When the advance, including principal and interest has been repaid, the WCB will resume normal permanent disability benefits. Alberta Issue Date. June 1, 2001 Part ii page 33 of 36 Copyright All rights reserved

34 POLICY : PART II ' Authorization : Date: BoD Resolution 2000/11/61 December 12, 2000 APPLICATION 9 : PERMANENT INJURY AWARD - INJURIES FROM JANUARY 1, 1985 TO DECEMBER 31,1994 INCLUSIVE 1. What is thepurpose ofthe A permanent injury award (PIA) is intended to provide Permanent Injury Award? compensation for accidents resulting in serious and permanent disfigurement or other permanent injury that, in the WCB's opinion, the worker is not already appropriately compensated for, and for which the WCB has no other means to compensate the worker. 2. Under what circumstances might a worker be eligible for a Permanent Injury Award? A PIA is not intended to provide additional compensation for wage loss, including loss of future income or opportunity, nor is it to be used to extend maximum compensation rates or the basis upon which individual compensation rates are set. To be eligible for a PIA all ofthe following must apply: " the worker was injured in a work-related accident during the period ofjanuary 1, 1985 to December 31, 1994 inclusive. This policy is based on the version ofs. 63 in force on January 1, Previous versions of s. 63 differ significantly. Accidents occurring on or after January 1, 1995 are governed by Policy 04-04, Part II, Application 2, Non Economic Loss Payments " the accident resulted in serious and permanent disfigurement or other permanent injury. See Policy 04-04, Part I for information on permanent disability and Policy 04-07, Part I for information on severely injured workers. " medical evidence indicates that no further medical improvement is likely, and " the WCB has no other means to compensate the worker in a manner and to the extent the WCB considers appropriate under the circumstances. Eligibility for a PIA is assessed separately for each claim. Issue Date June 1, 2001 Part II page 34 of 36 Sees: September 15, 1999