Difference between revisions of "Introduction to Compensation Claims for Injured Workers (7:III)"

Of the 100,000 workers injured on the job in B.C. every year, about half suffer minor or inconvenient injuries and return to their pre-injury employment in quick order. Most of these claims are accepted by the Board for health care benefits only (medical treatment, medication, etc.). After a worker makes an application for temporary disability, the Board determines whether the worker is totally temporarily disabled (TTD) and if so, pays full wage loss benefits under Section 29 of the Act. If the worker is only partially temporary disabled (TPD) i.e. can work some hours or some duties, the Board will pay partial wages under Section 30 of the Act. If the worker is hurt but not disabled from work, the Board will pay no wage loss but may accept his claim for health care benefits only.  

Of those workers whose injuries are more serious, there are several common profiles of disability and recovery. The following examples are to illustrate common compensation benefits and scenarios for disability.  

*The worker suffers a broken wrist in his dominant hand and cannot perform his job duties as a result. His doctor recommends a certain number of weeks to recover after which he is cleared to return to work (RTW) full duties. The worker makes an application for compensation. If his claim is accepted, the Board sets a short-term wage rate (STWR) on his claim (based on his average earnings) and the worker is paid temporary wage loss benefits (TWL) at this rate for his days of lost work. The Board also covers any health care costs such as treatment or medication. If there are no permanent medical consequences to this injury and the worker returns to work full duties, the Board issues a decision that the injury is “resolved” and his claim is closed. The worker is not referred for any other benefits such as Disability Awards (DAs) or Vocational Rehabilitation (VR).

*The worker suffers a more serious injury to his hand (e.g. a crush injury). If his claim is accepted, he again receives TWL for his time away from work. However, after 10 weeks, the Board issues a new long-term wage rate (LTWR) based on a more complex formula in law and policy. At a discretionary point, the Board considers that the worker’s condition is no longer “temporary” and must make one of the following decisions about the worker’s medical condition. Either:  

**b. His injury is not fully resolved and he is left with some permanent functional impairment. In this case, the Board will issue a “plateau decision”, setting a date at which it considers that the worker’s condition is no longer temporary but it has reached a medical “plateau” (that is, the condition will not significantly change in the next year). This “plateau” decision also ends TWL benefits on the plateau date but will also refer the worker to DAs to assess the nature and severity of this permanent impairment. In a separate decision, the DA will rate his impairment according to a schedule and award the worker “permanent functional impairment” (PFI) pension (impairment % compared to a healthy person) in a “PFI decision”. The PFI pension is awarded regardless of whether the worker returns to work or not as it is compensation for the physical impairment, not for lost wages.   

 

However, if the Board considers that the worker cannot return to full duties with his impairment, the “plateau decision” will state this and the worker will be referred to VR for further help with employment.

The VR process is set out below and goes through five phases:

* '''Phase Two''': If unable to return to the same employer, works with worker andemployer to modify or identify job opportunities within the same company

* '''Phase Three''': If unable to return to the same company, tries to help identify suitable job options related to workers experience and skills.

* '''Phase Four''': If the worker is unable to return to the suitable work in the same or related industry, tries to help worker identify options in other injuries

* '''Phase Five''':If the worker needs additional skills in order to return to suitable work, they may cover the cost of training to help develop skills

The first phase is to see if the employer can or will accommodate the worker and his impairment. If there is no accommodation and the worker does not have a job to return to, VR goes through further phases to assess what VR assistance the Board should provide to help the worker become unemployable, given his permanent injury. VR benefits are discretionary but typically include a VR plan for the worker to retrain and/or have a job search and wage loss benefits for this period of VR time. If successful, VR results in the injured worker successfully adapting to employment with a permanent injury.

It is possible that VR is not successful or that a seriously injured worker is simply too disabled to ever be competitively employable. In these cases, the Case Manger must decide if the impact of the worker’s disability is “so exceptional” that a PFI pension is inadequate financial compensation for the worker’s loss of employability. In such cases, the worker may be entitled to be assessed for a wage replacement pension, known as a “loss of earnings” or LOE pension. The “LOE pension decision” is issued by the case manager, either as part of the plateau decision or after a VR process. If awarded, full LOE pension benefits are equivalent to ongoing TWL benefits. However, the criteria for having an LOE assessment are quite onerous under the new WCA and they are rarely awarded.