Workers' Compensation Claim Benefits (7:XI) - Revision history

Nate Russell at 22:15, 27 November 2025

2025-11-27T22:15:40Z

← Older revision		Revision as of 22:15, 27 November 2025
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	The re-opening provisions also have particular significance if the worker was injured prior to June 30, 2002, where the long-term wage rate was calculated as 75% of gross earnings and the definition of “average earnings” was different. This worker’s re-opening benefits would be calculated under the new policy provisions (90% of net average earnings).		The re-opening provisions also have particular significance if the worker was injured prior to June 30, 2002, where the long-term wage rate was calculated as 75% of gross earnings and the definition of “average earnings” was different. This worker’s re-opening benefits would be calculated under the new policy provisions (90% of net average earnings).

	It should be noted that a “recurrence” must be distinguished from a “deterioration.” In ''[https://www.canlii.org/en/bc/bcsc/doc/2006/2006bcsc722/2006bcsc722.html~~?autocompleteStr=Cowburn%2520v%2520Worker%25E2%2580%2599s%2520Compensation%2520Board%2520of%2520British%2520Columbia%252C%25202006%2520BCSC%2520722&autocompletePos=1~~ Cowburn v Worker’s Compensation Board of British Columbia]'', 2006 BCSC 722, the court found that it was patently unreasonable to treat a deterioration of a worker’s disability as a recurrence of an injury. Accordingly, when a worker’s permanent disability that began before June 30, 2002 becomes worse, the increased benefits are based on the older provisions that were in force when the disability first arose (such as pension entitlement). However, a new applicable wage rate may still have to be determined under policy #70.20.		It should be noted that a “recurrence” must be distinguished from a “deterioration.” In ''[https://www.canlii.org/en/bc/bcsc/doc/2006/2006bcsc722/2006bcsc722.html Cowburn v Worker’s Compensation Board of British Columbia]'', 2006 BCSC 722, the court found that it was patently unreasonable to treat a deterioration of a worker’s disability as a recurrence of an injury. Accordingly, when a worker’s permanent disability that began before June 30, 2002 becomes worse, the increased benefits are based on the older provisions that were in force when the disability first arose (such as pension entitlement). However, a new applicable wage rate may still have to be determined under policy #70.20.

	== C. Temporary Wage-Loss Benefits ==		== C. Temporary Wage-Loss Benefits ==
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	While the Board routinely relies on the vocational rehabilitation consultant’s decision regarding the worker’s employability, WCAT may not consider these vocational rehabilitation decisions as binding on them when adjudicating a loss of earnings pension issue on appeal. For example, a vocational rehabilitation consultant may find that a worker can adapt to working full-time in a particular occupation. If the worker disagrees about this decision, the worker may raise this issue and provide evidence about disability in their appeal of a denial of a loss of earnings pension, both at the Review Division and WCAT. WCAT does, on occasion, make decisions that essentially overturn a Review Division finding as to the employability of a particular worker. However, on judicial review, this may lead to difficulties as it can be argued that WCAT’s decision was made without jurisdiction.		While the Board routinely relies on the vocational rehabilitation consultant’s decision regarding the worker’s employability, WCAT may not consider these vocational rehabilitation decisions as binding on them when adjudicating a loss of earnings pension issue on appeal. For example, a vocational rehabilitation consultant may find that a worker can adapt to working full-time in a particular occupation. If the worker disagrees about this decision, the worker may raise this issue and provide evidence about disability in their appeal of a denial of a loss of earnings pension, both at the Review Division and WCAT. WCAT does, on occasion, make decisions that essentially overturn a Review Division finding as to the employability of a particular worker. However, on judicial review, this may lead to difficulties as it can be argued that WCAT’s decision was made without jurisdiction.

	:'''NOTE''': Many difficulties in this area arise from different concepts of disability and employability. The Board tends to assess a worker’s permanent disability in terms of impairment and to limit its assessment of impairment to “medical restrictions and limitations” (“R&Ls”),i.e., specific activities which the worker cannot do or should not do at all because of potential harm. R&Ls may or may not include other aspects of limited ability such as tolerance or endurance (such as an inability to sit for more than 10 minutes) which are key elements of work function. Also, disabled workers often face discrimination and other barriers to employment. Court decisions have been clear that vocational rehabilitation processes must address the whole worker, including any pre-existing disabilities or factors affecting employment (''[https://www.canlii.org/en/bc/bcsc/doc/2011/2011bcsc1209/2011bcsc1209.html~~?autocompleteStr=2011%2520BCSC%25201209&autocompletePos=1~~ Young v WCAT]'', 2011 BCSC 1209), but this remains a contentious area and one that the Board does not consider part of the “compensable” condition		:'''NOTE''': Many difficulties in this area arise from different concepts of disability and employability. The Board tends to assess a worker’s permanent disability in terms of impairment and to limit its assessment of impairment to “medical restrictions and limitations” (“R&Ls”),i.e., specific activities which the worker cannot do or should not do at all because of potential harm. R&Ls may or may not include other aspects of limited ability such as tolerance or endurance (such as an inability to sit for more than 10 minutes) which are key elements of work function. Also, disabled workers often face discrimination and other barriers to employment. Court decisions have been clear that vocational rehabilitation processes must address the whole worker, including any pre-existing disabilities or factors affecting employment (''[https://www.canlii.org/en/bc/bcsc/doc/2011/2011bcsc1209/2011bcsc1209.html Young v WCAT]'', 2011 BCSC 1209), but this remains a contentious area and one that the Board does not consider part of the “compensable” condition

	== G. Permanent Disability Pensions ==		== G. Permanent Disability Pensions ==

LSLAP at 19:06, 13 October 2025

2025-10-13T19:06:00Z

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	{{REVIEWED LSLAP \| date= ~~September 2, 2024~~}}		{{REVIEWED LSLAP \| date= 18 July 2025}}
	{{LSLAP Manual TOC\|expanded = workers}}		{{LSLAP Manual TOC\|expanded = workers}}

LSLAP: /* F. Vocational Rehabilitation Benefits */

2025-09-28T07:47:40Z

F. Vocational Rehabilitation Benefits

← Older revision		Revision as of 07:47, 28 September 2025
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	While the Board routinely relies on the vocational rehabilitation consultant’s decision regarding the worker’s employability, WCAT may not consider these vocational rehabilitation decisions as binding on them when adjudicating a loss of earnings pension issue on appeal. For example, a vocational rehabilitation consultant may find that a worker can adapt to working full-time in a particular occupation. If the worker disagrees about this decision, the worker may raise this issue and provide evidence about disability in their appeal of a denial of a loss of earnings pension, both at the Review Division and WCAT. WCAT does, on occasion, make decisions that essentially overturn a Review Division finding as to the employability of a particular worker. However, on judicial review, this may lead to difficulties as it can be argued that WCAT’s decision was made without jurisdiction.		While the Board routinely relies on the vocational rehabilitation consultant’s decision regarding the worker’s employability, WCAT may not consider these vocational rehabilitation decisions as binding on them when adjudicating a loss of earnings pension issue on appeal. For example, a vocational rehabilitation consultant may find that a worker can adapt to working full-time in a particular occupation. If the worker disagrees about this decision, the worker may raise this issue and provide evidence about disability in their appeal of a denial of a loss of earnings pension, both at the Review Division and WCAT. WCAT does, on occasion, make decisions that essentially overturn a Review Division finding as to the employability of a particular worker. However, on judicial review, this may lead to difficulties as it can be argued that WCAT’s decision was made without jurisdiction.

	:'''NOTE''': Many difficulties in this area arise from different concepts of disability and employability. The Board tends to assess a worker’s permanent disability in terms of impairment and to limit its assessment of impairment to “medical restrictions and limitations” (“R&Ls”),i.e., specific activities which the worker cannot do or should not do at all because of potential harm. R&Ls may or may not include other aspects of limited ability such as tolerance or endurance (such as an inability to sit for more than 10 minutes) which are key elements of work function. Also, disabled workers often face discrimination and other barriers to employment. Court decisions have been clear that vocational rehabilitation processes must address the whole worker, including any pre-existing disabilities or factors affecting employment ([https://www.canlii.org/en/bc/bcsc/doc/2011/2011bcsc1209/2011bcsc1209.html?autocompleteStr=2011%2520BCSC%25201209&autocompletePos=1 ''Young v WCAT'', 2011 BCSC 1209]), but this remains a contentious area and one that the Board does not consider part of the “compensable” condition		:'''NOTE''': Many difficulties in this area arise from different concepts of disability and employability. The Board tends to assess a worker’s permanent disability in terms of impairment and to limit its assessment of impairment to “medical restrictions and limitations” (“R&Ls”),i.e., specific activities which the worker cannot do or should not do at all because of potential harm. R&Ls may or may not include other aspects of limited ability such as tolerance or endurance (such as an inability to sit for more than 10 minutes) which are key elements of work function. Also, disabled workers often face discrimination and other barriers to employment. Court decisions have been clear that vocational rehabilitation processes must address the whole worker, including any pre-existing disabilities or factors affecting employment (''[https://www.canlii.org/en/bc/bcsc/doc/2011/2011bcsc1209/2011bcsc1209.html?autocompleteStr=2011%2520BCSC%25201209&autocompletePos=1 Young v WCAT]'', 2011 BCSC 1209), but this remains a contentious area and one that the Board does not consider part of the “compensable” condition

	== G. Permanent Disability Pensions ==		== G. Permanent Disability Pensions ==

LSLAP: /* C. Temporary Wage-Loss Benefits */

2025-09-28T07:46:31Z

C. Temporary Wage-Loss Benefits

← Older revision		Revision as of 07:46, 28 September 2025
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	If a worker has an injury but can perform the full duties of the pre-injury job, the claim is accepted for health care benefits only (see below). If the injury is such that the worker cannot perform full duties, the Board makes an entitlement decision on an accepted claim regarding additional benefits, especially wage loss. For most claims, the Board finds that there is some type of temporary disability:		If a worker has an injury but can perform the full duties of the pre-injury job, the claim is accepted for health care benefits only (see below). If the injury is such that the worker cannot perform full duties, the Board makes an entitlement decision on an accepted claim regarding additional benefits, especially wage loss. For most claims, the Board finds that there is some type of temporary disability:

	* Temporary Total Disability: not working at all – temporary wage-loss benefits paid under s. 191 of the ''WCA'' [Former Act, s. 29] (see RSCM II, Policy #33.00);		* '''Temporary Total Disability''': not working at all – temporary wage-loss benefits paid under s. 191 of the ''WCA'' [Former Act, s. 29] (see RSCM II, Policy #33.00);
	* Temporary Partial Disability: working part-time at a suitable occupation or deemed suitable occupation, and paid partial temporary wage-loss benefits under s. 192 of the ''WCA'' [Former Act, s. 30] (See RSCM II, Policy #33.20); or		* '''Temporary Partial Disability''': working part-time at a suitable occupation or deemed suitable occupation, and paid partial temporary wage-loss benefits under s. 192 of the ''WCA'' [Former Act, s. 30] (See RSCM II, Policy #33.20); or
	* Temporary Disability with Light Duties: working full-time in suitable light duties as per RSCM II Policy #33.20. In this case, the Board usually does not pay the worker any temporary wage-loss benefits, but the worker’s other benefit entitlement (such as health care) is adjudicated under s. 192 of ''WCA''. Policy #33.20 applies to any adjudication of these light duties, including where the worker refuses light duties on the grounds that they are unreasonable.		* '''Temporary Disability with Light Duties''': working full-time in suitable light duties as per RSCM II Policy #33.20. In this case, the Board usually does not pay the worker any temporary wage-loss benefits, but the worker’s other benefit entitlement (such as health care) is adjudicated under s. 192 of ''WCA''. Policy #33.20 applies to any adjudication of these light duties, including where the worker refuses light duties on the grounds that they are unreasonable.

	:'''NOTE''': Light duties are meant to be a temporary arrangement during a period of temporary disability. Even though no temporary wage-loss benefit is paid to a worker, it is still an accepted period of “disability” under the ''WCA''. During this period, a worker is entitled not only to health care benefits, but also to a decision regarding the outcome of the accepted condition. All periods of “light duty” should conclude with a formal “resolve” or “plateau” decision.		:'''NOTE''': Light duties are meant to be a temporary arrangement during a period of temporary disability. Even though no temporary wage-loss benefit is paid to a worker, it is still an accepted period of “disability” under the ''WCA''. During this period, a worker is entitled not only to health care benefits, but also to a decision regarding the outcome of the accepted condition. All periods of “light duty” should conclude with a formal “resolve” or “plateau” decision.

LSLAP: /* 1. Recurrence or Deterioration and Wage Rates */

2025-09-28T07:45:54Z

1. Recurrence or Deterioration and Wage Rates

← Older revision		Revision as of 07:45, 28 September 2025
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	The re-opening provisions also have particular significance if the worker was injured prior to June 30, 2002, where the long-term wage rate was calculated as 75% of gross earnings and the definition of “average earnings” was different. This worker’s re-opening benefits would be calculated under the new policy provisions (90% of net average earnings).		The re-opening provisions also have particular significance if the worker was injured prior to June 30, 2002, where the long-term wage rate was calculated as 75% of gross earnings and the definition of “average earnings” was different. This worker’s re-opening benefits would be calculated under the new policy provisions (90% of net average earnings).

	It should be noted that a “recurrence” must be distinguished from a “deterioration.” In [https://www.canlii.org/en/bc/bcsc/doc/2006/2006bcsc722/2006bcsc722.html?autocompleteStr=Cowburn%2520v%2520Worker%25E2%2580%2599s%2520Compensation%2520Board%2520of%2520British%2520Columbia%252C%25202006%2520BCSC%2520722&autocompletePos=1 ''Cowburn v Worker’s Compensation Board of British Columbia'', 2006 BCSC 722], the court found that it was patently unreasonable to treat a deterioration of a worker’s disability as a recurrence of an injury. Accordingly, when a worker’s permanent disability that began before June 30, 2002 becomes worse, the increased benefits are based on the older provisions that were in force when the disability first arose (such as pension entitlement). However, a new applicable wage rate may still have to be determined under policy #70.20.		It should be noted that a “recurrence” must be distinguished from a “deterioration.” In ''[https://www.canlii.org/en/bc/bcsc/doc/2006/2006bcsc722/2006bcsc722.html?autocompleteStr=Cowburn%2520v%2520Worker%25E2%2580%2599s%2520Compensation%2520Board%2520of%2520British%2520Columbia%252C%25202006%2520BCSC%2520722&autocompletePos=1 Cowburn v Worker’s Compensation Board of British Columbia]'', 2006 BCSC 722, the court found that it was patently unreasonable to treat a deterioration of a worker’s disability as a recurrence of an injury. Accordingly, when a worker’s permanent disability that began before June 30, 2002 becomes worse, the increased benefits are based on the older provisions that were in force when the disability first arose (such as pension entitlement). However, a new applicable wage rate may still have to be determined under policy #70.20.

	== C. Temporary Wage-Loss Benefits ==		== C. Temporary Wage-Loss Benefits ==

LSLAP: /* C. Temporary Wage-Loss Benefits */

2025-09-28T07:43:17Z

C. Temporary Wage-Loss Benefits

← Older revision		Revision as of 07:43, 28 September 2025
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	* Temporary Total Disability: not working at all – temporary wage-loss benefits paid under s. 191 of the ''WCA'' [Former Act, s. 29] (see RSCM II, Policy #33.00);		* Temporary Total Disability: not working at all – temporary wage-loss benefits paid under s. 191 of the ''WCA'' [Former Act, s. 29] (see RSCM II, Policy #33.00);
	* Temporary Partial Disability: working part-time at a suitable occupation or deemed suitable occupation, and paid partial temporary wage-loss benefits under s. 192 of the ''WCA'' [Former Act, s. 30] (See RSCM II, Policy #33.20); or		* Temporary Partial Disability: working part-time at a suitable occupation or deemed suitable occupation, and paid partial temporary wage-loss benefits under s. 192 of the ''WCA'' [Former Act, s. 30] (See RSCM II, Policy #33.20); or
	* Temporary Disability with Light Duties: working full-time in suitable light duties as per RSCM II Policy #33.20. In this case, the Board usually does not pay the worker any temporary wage-loss benefits, but the worker’s other benefit entitlement (such as health care) is adjudicated under s. 192 of ~~the Act~~. Policy #33.20 applies to any adjudication of these light duties, including where the worker refuses light duties on the grounds that they are unreasonable.		* Temporary Disability with Light Duties: working full-time in suitable light duties as per RSCM II Policy #33.20. In this case, the Board usually does not pay the worker any temporary wage-loss benefits, but the worker’s other benefit entitlement (such as health care) is adjudicated under s. 192 of ''WCA''. Policy #33.20 applies to any adjudication of these light duties, including where the worker refuses light duties on the grounds that they are unreasonable.

	:'''NOTE''': Light duties are meant to be a temporary arrangement during a period of temporary disability. Even though no temporary wage-loss benefit is paid to a worker, it is still an accepted period of “disability” under the ''WCA''. During this period, a worker is entitled not only to health care benefits, but also to a decision regarding the outcome of the accepted condition. All periods of “light duty” should conclude with a formal “resolve” or “plateau” decision.		:'''NOTE''': Light duties are meant to be a temporary arrangement during a period of temporary disability. Even though no temporary wage-loss benefit is paid to a worker, it is still an accepted period of “disability” under the ''WCA''. During this period, a worker is entitled not only to health care benefits, but also to a decision regarding the outcome of the accepted condition. All periods of “light duty” should conclude with a formal “resolve” or “plateau” decision.

LSLAP at 07:42, 28 September 2025

2025-09-28T07:42:40Z

LSLAP: /* 1. Recurrence or Deterioration and Wage Rates */

2025-09-28T07:40:00Z

1. Recurrence or Deterioration and Wage Rates

← Older revision		Revision as of 07:40, 28 September 2025
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	A claim may be “re-opened” if a worker suffers a new period of temporary disability and/or an increased degree of permanent disability from a recurrence or deterioration of a previously accepted condition.		A claim may be “re-opened” if a worker suffers a new period of temporary disability and/or an increased degree of permanent disability from a recurrence or deterioration of a previously accepted condition.

	Under s. 229(1) of the ''~~Act~~'' [Former Act, s. 35.1(8), a recurrence of an injury is treated as a new injury for any new period of temporary disability. In addition, if the re-opening is more than 3 years after the initial injury, the Board may reset the long-term wage rate for the purpose of calculating additional benefits under the re-opening.		Under s. 229(1) of the ''WCA'' [Former Act, s. 35.1(8), a recurrence of an injury is treated as a new injury for any new period of temporary disability. In addition, if the re-opening is more than 3 years after the initial injury, the Board may reset the long-term wage rate for the purpose of calculating additional benefits under the re-opening.

	The applicable policy on re-setting long-term wage rates for re-openings over 3 years is Policy #70.20 of the RSCM II. This policy is complex, and it is best to consult this policy in light of the particular facts of each case. This policy affects all workers with long-term disabilities, where their condition recurs or deteriorates.		The applicable policy on re-setting long-term wage rates for re-openings over 3 years is Policy #70.20 of the RSCM II. This policy is complex, and it is best to consult this policy in light of the particular facts of each case. This policy affects all workers with long-term disabilities, where their condition recurs or deteriorates.

LSLAP at 07:39, 28 September 2025

2025-09-28T07:39:23Z

← Older revision		Revision as of 07:39, 28 September 2025
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	Another example is a “new” worker, defined as when the worker was permanently employed by the employer for less than 12 months before the injury. For this type of worker, section 217 of the ''WCA'' [Former Act, s. 33.3] allows the average earnings to be calculated based on what a person of similar status employed in the same type and classification of employment would earn in 12 months. However, section 217 is not applicable where the worker’s employment is deemed casual or temporary.		Another example is a “new” worker, defined as when the worker was permanently employed by the employer for less than 12 months before the injury. For this type of worker, section 217 of the ''WCA'' [Former Act, s. 33.3] allows the average earnings to be calculated based on what a person of similar status employed in the same type and classification of employment would earn in 12 months. However, section 217 is not applicable where the worker’s employment is deemed casual or temporary.

	Under section 218 of ~~the Act~~ [Former Act, s. 33.4], the Board may also determine average earnings differently in “exceptional” circumstances, if the one-year average would be “inequitable.” This provision does not apply to cases of “casual” workers or to “new” permanent workers as described above. Practice Directive #C9-12 states that an exceptional case is one that is “truly extraordinary,” “unusual,” or “irregular,” such that “the worker’s circumstances in the year prior to the injury fail to provide any meaningful measure of their employment history.” Examples might include a non-compensable illness or injury, or maternity/paternity obligations. Under this exception, an officer has discretion to seek a long-term average earnings figure that better reflects the worker’s real income loss, possibly by excluding a significant atypical disruption (i.e., one lasting more than six weeks) or basing the worker’s “average earnings” on a longer or shorter period of time.		Under section 218 of ''WCA'' [Former Act, s. 33.4], the Board may also determine average earnings differently in “exceptional” circumstances, if the one-year average would be “inequitable.” This provision does not apply to cases of “casual” workers or to “new” permanent workers as described above. Practice Directive #C9-12 states that an exceptional case is one that is “truly extraordinary,” “unusual,” or “irregular,” such that “the worker’s circumstances in the year prior to the injury fail to provide any meaningful measure of their employment history.” Examples might include a non-compensable illness or injury, or maternity/paternity obligations. Under this exception, an officer has discretion to seek a long-term average earnings figure that better reflects the worker’s real income loss, possibly by excluding a significant atypical disruption (i.e., one lasting more than six weeks) or basing the worker’s “average earnings” on a longer or shorter period of time.

	Under ''WCA'' s. 208(4) [Former Act, s. 33(3.2)], EI benefits are included in the calculation of the worker’s earnings for the year if the worker was, in the Board’s opinion, employed in “an occupation or industry that results in recurring seasonal or recurring temporary interruptions of work.” For a seasonal worker, this is an important distinction. For example, consider a worker injured at work in their first week after returning from a six-month layoff. If this worker were designated as a “casual worker,” the Board would simply calculate their earnings over the last year (including the period of the long layoff, but ''without'' counting EI payments) to arrive at the “average earnings” over the oneyear period before the injury. This figure would set both their short-term wage rate and long-term wage rate, and the only argument for a higher rate would be through the exceptional circumstances covered by section 218 of the ''Act''. However, if the worker is found to be in a “highly seasonal” occupation, their EI benefits would add to the calculations of their “average earnings,” and greatly increase their long-term wage rate. In addition, their short-term wage rate (for the first 10 weeks) would be set in the usual manner as being their wages at the time of injury.		Under ''WCA'' s. 208(4) [Former Act, s. 33(3.2)], EI benefits are included in the calculation of the worker’s earnings for the year if the worker was, in the Board’s opinion, employed in “an occupation or industry that results in recurring seasonal or recurring temporary interruptions of work.” For a seasonal worker, this is an important distinction. For example, consider a worker injured at work in their first week after returning from a six-month layoff. If this worker were designated as a “casual worker,” the Board would simply calculate their earnings over the last year (including the period of the long layoff, but ''without'' counting EI payments) to arrive at the “average earnings” over the oneyear period before the injury. This figure would set both their short-term wage rate and long-term wage rate, and the only argument for a higher rate would be through the exceptional circumstances covered by section 218 of the ''Act''. However, if the worker is found to be in a “highly seasonal” occupation, their EI benefits would add to the calculations of their “average earnings,” and greatly increase their long-term wage rate. In addition, their short-term wage rate (for the first 10 weeks) would be set in the usual manner as being their wages at the time of injury.
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	== C. Temporary Wage-Loss Benefits ==		== C. Temporary Wage-Loss Benefits ==

	The ''WCA'' does not define “disability,” although it uses this term throughout the ''~~Act~~''. Section 191(1) of ~~the Act~~ [Former Act, s. 29(1)] states that if a worker has a temporary total disability (“'''TTD'''”), the Board must pay full temporary wage-loss benefits (calculated according to the steps above). Section 192 of the ''Act'' [Former Act, s. 30] states that if a worker has a temporary partial disability (“'''TPD'''”), the Board must pay the difference between the worker’s average net earnings before the injury and either their average net earnings after the injury or the average net earnings in some deemed “suitable” occupation.		The ''WCA'' does not define “disability,” although it uses this term throughout the ''WCA''. Section 191(1) of ''WCA'' [Former Act, s. 29(1)] states that if a worker has a temporary total disability (“'''TTD'''”), the Board must pay full temporary wage-loss benefits (calculated according to the steps above). Section 192 of the ''Act'' [Former Act, s. 30] states that if a worker has a temporary partial disability (“'''TPD'''”), the Board must pay the difference between the worker’s average net earnings before the injury and either their average net earnings after the injury or the average net earnings in some deemed “suitable” occupation.

	If a worker has an injury but can perform the full duties of the pre-injury job, the claim is accepted for health care benefits only (see below). If the injury is such that the worker cannot perform full duties, the Board makes an entitlement decision on an accepted claim regarding additional benefits, especially wage loss. For most claims, the Board finds that there is some type of temporary disability:		If a worker has an injury but can perform the full duties of the pre-injury job, the claim is accepted for health care benefits only (see below). If the injury is such that the worker cannot perform full duties, the Board makes an entitlement decision on an accepted claim regarding additional benefits, especially wage loss. For most claims, the Board finds that there is some type of temporary disability:

LSLAP at 07:37, 28 September 2025

2025-09-28T07:37:22Z

Show changes

← Older revision		Revision as of 07:42, 28 September 2025
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	Under section 218 of ''WCA'' [Former Act, s. 33.4], the Board may also determine average earnings differently in “exceptional” circumstances, if the one-year average would be “inequitable.” This provision does not apply to cases of “casual” workers or to “new” permanent workers as described above. Practice Directive #C9-12 states that an exceptional case is one that is “truly extraordinary,” “unusual,” or “irregular,” such that “the worker’s circumstances in the year prior to the injury fail to provide any meaningful measure of their employment history.” Examples might include a non-compensable illness or injury, or maternity/paternity obligations. Under this exception, an officer has discretion to seek a long-term average earnings figure that better reflects the worker’s real income loss, possibly by excluding a significant atypical disruption (i.e., one lasting more than six weeks) or basing the worker’s “average earnings” on a longer or shorter period of time.		Under section 218 of ''WCA'' [Former Act, s. 33.4], the Board may also determine average earnings differently in “exceptional” circumstances, if the one-year average would be “inequitable.” This provision does not apply to cases of “casual” workers or to “new” permanent workers as described above. Practice Directive #C9-12 states that an exceptional case is one that is “truly extraordinary,” “unusual,” or “irregular,” such that “the worker’s circumstances in the year prior to the injury fail to provide any meaningful measure of their employment history.” Examples might include a non-compensable illness or injury, or maternity/paternity obligations. Under this exception, an officer has discretion to seek a long-term average earnings figure that better reflects the worker’s real income loss, possibly by excluding a significant atypical disruption (i.e., one lasting more than six weeks) or basing the worker’s “average earnings” on a longer or shorter period of time.

	Under ''WCA'' s. 208(4) [Former Act, s. 33(3.2)], EI benefits are included in the calculation of the worker’s earnings for the year if the worker was, in the Board’s opinion, employed in “an occupation or industry that results in recurring seasonal or recurring temporary interruptions of work.” For a seasonal worker, this is an important distinction. For example, consider a worker injured at work in their first week after returning from a six-month layoff. If this worker were designated as a “casual worker,” the Board would simply calculate their earnings over the last year (including the period of the long layoff, but ''without'' counting EI payments) to arrive at the “average earnings” over the oneyear period before the injury. This figure would set both their short-term wage rate and long-term wage rate, and the only argument for a higher rate would be through the exceptional circumstances covered by section 218 of the ''~~Act~~''. However, if the worker is found to be in a “highly seasonal” occupation, their EI benefits would add to the calculations of their “average earnings,” and greatly increase their long-term wage rate. In addition, their short-term wage rate (for the first 10 weeks) would be set in the usual manner as being their wages at the time of injury.		Under ''WCA'' s. 208(4) [Former Act, s. 33(3.2)], EI benefits are included in the calculation of the worker’s earnings for the year if the worker was, in the Board’s opinion, employed in “an occupation or industry that results in recurring seasonal or recurring temporary interruptions of work.” For a seasonal worker, this is an important distinction. For example, consider a worker injured at work in their first week after returning from a six-month layoff. If this worker were designated as a “casual worker,” the Board would simply calculate their earnings over the last year (including the period of the long layoff, but ''without'' counting EI payments) to arrive at the “average earnings” over the oneyear period before the injury. This figure would set both their short-term wage rate and long-term wage rate, and the only argument for a higher rate would be through the exceptional circumstances covered by section 218 of the ''WCA''. However, if the worker is found to be in a “highly seasonal” occupation, their EI benefits would add to the calculations of their “average earnings,” and greatly increase their long-term wage rate. In addition, their short-term wage rate (for the first 10 weeks) would be set in the usual manner as being their wages at the time of injury.

	Where a worker has two jobs and is unable to work at either due to an injury at one, the worker’s benefits will be calculated based on their '''combined''' earnings at both jobs, up to the statutory maximum. This applies even if the worker’s other job is not otherwise protected by the ''WCA'' (RSCM II Policy #65.02).		Where a worker has two jobs and is unable to work at either due to an injury at one, the worker’s benefits will be calculated based on their '''combined''' earnings at both jobs, up to the statutory maximum. This applies even if the worker’s other job is not otherwise protected by the ''WCA'' (RSCM II Policy #65.02).
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	== C. Temporary Wage-Loss Benefits ==		== C. Temporary Wage-Loss Benefits ==

	The ''WCA'' does not define “disability,” although it uses this term throughout the ''WCA''. Section 191(1) of ''WCA'' [Former Act, s. 29(1)] states that if a worker has a temporary total disability (“'''TTD'''”), the Board must pay full temporary wage-loss benefits (calculated according to the steps above). Section 192 of the ''~~Act~~'' [Former Act, s. 30] states that if a worker has a temporary partial disability (“'''TPD'''”), the Board must pay the difference between the worker’s average net earnings before the injury and either their average net earnings after the injury or the average net earnings in some deemed “suitable” occupation.		The ''WCA'' does not define “disability,” although it uses this term throughout the ''WCA''. Section 191(1) of ''WCA'' [Former Act, s. 29(1)] states that if a worker has a temporary total disability (“'''TTD'''”), the Board must pay full temporary wage-loss benefits (calculated according to the steps above). Section 192 of the ''WCA'' [Former Act, s. 30] states that if a worker has a temporary partial disability (“'''TPD'''”), the Board must pay the difference between the worker’s average net earnings before the injury and either their average net earnings after the injury or the average net earnings in some deemed “suitable” occupation.

	If a worker has an injury but can perform the full duties of the pre-injury job, the claim is accepted for health care benefits only (see below). If the injury is such that the worker cannot perform full duties, the Board makes an entitlement decision on an accepted claim regarding additional benefits, especially wage loss. For most claims, the Board finds that there is some type of temporary disability:		If a worker has an injury but can perform the full duties of the pre-injury job, the claim is accepted for health care benefits only (see below). If the injury is such that the worker cannot perform full duties, the Board makes an entitlement decision on an accepted claim regarding additional benefits, especially wage loss. For most claims, the Board finds that there is some type of temporary disability:
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	* Temporary Disability with Light Duties: working full-time in suitable light duties as per RSCM II Policy #33.20. In this case, the Board usually does not pay the worker any temporary wage-loss benefits, but the worker’s other benefit entitlement (such as health care) is adjudicated under s. 192 of the Act. Policy #33.20 applies to any adjudication of these light duties, including where the worker refuses light duties on the grounds that they are unreasonable.		* Temporary Disability with Light Duties: working full-time in suitable light duties as per RSCM II Policy #33.20. In this case, the Board usually does not pay the worker any temporary wage-loss benefits, but the worker’s other benefit entitlement (such as health care) is adjudicated under s. 192 of the Act. Policy #33.20 applies to any adjudication of these light duties, including where the worker refuses light duties on the grounds that they are unreasonable.

	:'''NOTE''': Light duties are meant to be a temporary arrangement during a period of temporary disability. Even though no temporary wage-loss benefit is paid to a worker, it is still an accepted period of “disability” under the ''~~Act~~''. During this period, a worker is entitled not only to health care benefits, but also to a decision regarding the outcome of the accepted condition. All periods of “light duty” should conclude with a formal “resolve” or “plateau” decision.		:'''NOTE''': Light duties are meant to be a temporary arrangement during a period of temporary disability. Even though no temporary wage-loss benefit is paid to a worker, it is still an accepted period of “disability” under the ''WCA''. During this period, a worker is entitled not only to health care benefits, but also to a decision regarding the outcome of the accepted condition. All periods of “light duty” should conclude with a formal “resolve” or “plateau” decision.

	There are a number of RSCM II policies that apply to temporary wage-loss benefits as set out in Chapter 5 – Wage-Loss Benefits. Some key issues covered by those policies include:		There are a number of RSCM II policies that apply to temporary wage-loss benefits as set out in Chapter 5 – Wage-Loss Benefits. Some key issues covered by those policies include:
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	Health care benefits are payable under ss. 156–161 of the ''WCA'' [Former Act, s. 21] for the period of the worker’s disability, and thereafter to “cure and relieve from the effects of the injury or alleviate those effects.” Chapter 10 of the RSCM II greatly expands the Board’s regulation and control of particular health care benefits including all forms of treatment, medical investigation with specialists, medical aids, and medications. As noted above, if a worker has an impairment but can perform their full pre-injury job, the claim is accepted for health care benefits only (as long as there is a short episode of disability: see RSCM II, Policy #33.00).		Health care benefits are payable under ss. 156–161 of the ''WCA'' [Former Act, s. 21] for the period of the worker’s disability, and thereafter to “cure and relieve from the effects of the injury or alleviate those effects.” Chapter 10 of the RSCM II greatly expands the Board’s regulation and control of particular health care benefits including all forms of treatment, medical investigation with specialists, medical aids, and medications. As noted above, if a worker has an impairment but can perform their full pre-injury job, the claim is accepted for health care benefits only (as long as there is a short episode of disability: see RSCM II, Policy #33.00).

	Once an injured worker has reached the “resolve/plateau” point of their injury, they then receive a permanent disability assessment. This may be an issue for workers who are able to return to work with permanent injuries, especially in accommodated positions. Such a worker may be suffering from the effects of their injury but are not considered “disabled.” They are entitled to ongoing treatment under ss. 156–161 of the ''~~Act~~''. Where a worker is denied but disagrees with the result, they may appeal to obtain such benefits.		Once an injured worker has reached the “resolve/plateau” point of their injury, they then receive a permanent disability assessment. This may be an issue for workers who are able to return to work with permanent injuries, especially in accommodated positions. Such a worker may be suffering from the effects of their injury but are not considered “disabled.” They are entitled to ongoing treatment under ss. 156–161 of the ''WCA''. Where a worker is denied but disagrees with the result, they may appeal to obtain such benefits.

	The Board must pay for necessary medical treatment, including physicians and hospital bills, physiotherapy, drugs, artificial limbs, hearing aids, and special transportation. Allowances for personal care and for structural alterations to the home may also be paid to paraplegics and other severely disabled workers. Practice directive #C10-1 addresses pain medication, sedatives, and hypnotics. Compensation for prescribed opioids and other potentially addictive medications are generally limited to four weeks coverage		The Board must pay for necessary medical treatment, including physicians and hospital bills, physiotherapy, drugs, artificial limbs, hearing aids, and special transportation. Allowances for personal care and for structural alterations to the home may also be paid to paraplegics and other severely disabled workers. Practice directive #C10-1 addresses pain medication, sedatives, and hypnotics. Compensation for prescribed opioids and other potentially addictive medications are generally limited to four weeks coverage
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	If a worker is struggling or unsafe near the end of the period of wage loss, an advocate should review the file to ensure a referral to vocational rehabilitation is made. If there is no referral, the advocate may make a direct request to the Case Manager and/or appeal the “resolve” or “plateau” decision on the basis that these decisions do not contain a vocational rehabilitation referral, when one is needed. Items C11-85.00 and C11-86.00 of the RSCM II set out the principles, goals, and eligibility criteria for vocational rehabilitation benefits.		If a worker is struggling or unsafe near the end of the period of wage loss, an advocate should review the file to ensure a referral to vocational rehabilitation is made. If there is no referral, the advocate may make a direct request to the Case Manager and/or appeal the “resolve” or “plateau” decision on the basis that these decisions do not contain a vocational rehabilitation referral, when one is needed. Items C11-85.00 and C11-86.00 of the RSCM II set out the principles, goals, and eligibility criteria for vocational rehabilitation benefits.

	Once a vocational rehabilitation referral is made, the Board may provide a large variety of vocational rehabilitation services to injured workers. These are discretionary benefits under s. 155 of the ''~~Act~~'' [Former Act, s. 16], governed by the policy set out in Chapter 11 of the RSCM II. Generally, the extent of vocational rehabilitation services depends on the nature of the worker’s disability.		Once a vocational rehabilitation referral is made, the Board may provide a large variety of vocational rehabilitation services to injured workers. These are discretionary benefits under s. 155 of the ''WCA'' [Former Act, s. 16], governed by the policy set out in Chapter 11 of the RSCM II. Generally, the extent of vocational rehabilitation services depends on the nature of the worker’s disability.

	The policy requires that the assigned Vocational Rehabilitation Consultant consult with the worker and issue a written vocational rehabilitation plan identifying a suitable occupational goal and the vocational rehabilitation services required.		The policy requires that the assigned Vocational Rehabilitation Consultant consult with the worker and issue a written vocational rehabilitation plan identifying a suitable occupational goal and the vocational rehabilitation services required.
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	=== 1. Permanent or Partial Total Disability Benefits ===		=== 1. Permanent or Partial Total Disability Benefits ===

	When the Board determines that a worker has a permanent functional impairment, the Board must determine whether the functional impairment is a Permanent Total Disability (“'''PTD'''”) or aPermanentPartial Disability (“'''PPD'''”). Sometimes, this will be obvious, such as in cases of paraplegia or blindness. In other cases, the Board must conduct an assessment to determine the degree of impairment. If the impairment is 100%, the worker has a PTD. If it is anything less than 100%, the worker has a PPD. This is an important distinction, as PTD and PPD benefits are calculated under different sections of the ''~~Act~~'' and have different minimum payable amounts.		When the Board determines that a worker has a permanent functional impairment, the Board must determine whether the functional impairment is a Permanent Total Disability (“'''PTD'''”) or aPermanentPartial Disability (“'''PPD'''”). Sometimes, this will be obvious, such as in cases of paraplegia or blindness. In other cases, the Board must conduct an assessment to determine the degree of impairment. If the impairment is 100%, the worker has a PTD. If it is anything less than 100%, the worker has a PPD. This is an important distinction, as PTD and PPD benefits are calculated under different sections of the ''WCA'' and have different minimum payable amounts.

	There are two methods used to calculate a worker’s degree of impairment: the functional impairment method – often referred to as the loss of function method (“'''LOF'''”) – or, the loss of earnings method (“'''LOE'''”).		There are two methods used to calculate a worker’s degree of impairment: the functional impairment method – often referred to as the loss of function method (“'''LOF'''”) – or, the loss of earnings method (“'''LOE'''”).
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	Note that loss of function awards for chronic pain are capped at 2.5% per area of pain (RSCM II, Item C6-39.10).		Note that loss of function awards for chronic pain are capped at 2.5% per area of pain (RSCM II, Item C6-39.10).

	As stated above, if the LOF method leads to a finding that the worker is 100% disabled, they will be paid PTD benefits pursuant to s. 194 of the ''~~Act~~'' [Former Act, s. 22]. If the LOF method leads to a finding that the worker is less than 100% disabled, they will be paid PPD benefits pursuant to s. 195–196 of the ''~~Act~~'' [Former Act, s. 23].		As stated above, if the LOF method leads to a finding that the worker is 100% disabled, they will be paid PTD benefits pursuant to s. 194 of the ''WCA'' [Former Act, s. 22]. If the LOF method leads to a finding that the worker is less than 100% disabled, they will be paid PPD benefits pursuant to s. 195–196 of the ''WCA'' [Former Act, s. 23].

	Note that even if a worker is found to be 100% unemployable pursuant to the LOE method described below (i.e., their loss of earnings is complete), it does not necessarily make them 100% functionally disabled, because the LOE method may incorporate personal information about the worker (such as a criminal history) that makes the worker unemployable even though the injury did not cause a 100% functional impairment. As such, a 100% unemployable worker will still be paid benefits pursuant to s. 192 of the ''~~Act~~'' [Former Act, s. 30(2)].		Note that even if a worker is found to be 100% unemployable pursuant to the LOE method described below (i.e., their loss of earnings is complete), it does not necessarily make them 100% functionally disabled, because the LOE method may incorporate personal information about the worker (such as a criminal history) that makes the worker unemployable even though the injury did not cause a 100% functional impairment. As such, a 100% unemployable worker will still be paid benefits pursuant to s. 192 of the ''WCA'' [Former Act, s. 30(2)].

	=== 3. Loss of Earnings Method ===		=== 3. Loss of Earnings Method ===