Wednesday, April 16, 2008

Loss of Retirement Income Benefit Changes

The Workplace Safety and Insurance Board sets aside funds to replace a worker's lost retirement income if a worker has received loss of earnings (LOE) payments for 12 continuous months. The funds equal 5% of the amount of every subsequent LOE payment. You can also contribute an additional 5% of your benefits to the fund.

When you reach the age of 65, you are to receive the Loss of Retirement Income (LRI) benefit. The amount of the LRI benefit is the sum of the mandatory contributions, the voluntary contributions and the accumulated investment income.

The Board has increased the monetary threshold of when they pay a lump sum amount. If the Loss of Retirement Benefit equals a payment amount of less than $3000 per year, your benefit will be paid as a lump sum. If the amount of the benefit is more than $3000 per year you cannot take the money out as a lump sum. You will be given a choice of 3 payment schemes and different investment options. You should carefully consider the consequences of the choices and their impact on your estate.

Wednesday, April 09, 2008

WSIB Required to Provide Explanation of Benefits Calculations

IAVGO made a complaint to the Fair Practices Commission regarding the Board's lack of co-operation in providing an explanation of benefits calculations, particularly in complex retroactive awards. Many worker representatives have battled with the Board over the years, trying to get individual claims adjudicators to provide an explanation for benefits in cases where the injured worker received retroactive benefits on appeal. As a result of the Fair Practices Commission's intervention, a protocol has been established within the Board for dealing with such explanations.
In a letter dated January 31, 2008 to Judy Kondrat of IAVGO, Fair Practices Specialist Janice Sandomirsky outlined the following:

" Claims Adjudicators have been reminded that they are expected to be proactive in providing payment explanations in all cases. All verbal payment explanations are to be followed up in writing. A detailed written explanation should always be provided in cases involving a complex payment. Examples of complex payments include:
  • Retroactive payments

  • Reviews/adjustments of benefit payments

  • Minimum or maximum benefit payments

  • Partial benefit payments

  • Recalculations of average earnings

  • CPP/QPP offsets

The written explanation will identify the type of benefit included in the payment(e.g. loss of earnings, interest, arrears, diversion for assignments, court orders), the average earnings basis and the payment period of each benefit paid.

Where there is a request for clarification of the benefit payment calculation, the Claims Adjudicator is expected to contact the Payment Specialist who will place a memo on the file outlining the calculation of the benefit payment in question. It is anticipated that the Claims Adjudicator will respond to the clarification request within three days. In exceptional cases, such as pre-1990 or non-imaged claims, it may take up to two weeks for the Payment Specialist to produce the memo. The Claims Adjudicator will advise the requester in writing about the delay and provide a time frame for a response.

If there are questions that require additional assistance/clarification, the Claims Adjudicator is expected to obtain guidance from his/her Manager, and , if necessary, the Payment Specialist Manager. "

The complex payment review also involved the creation of documents on payment terms and definitions, some sample letters, suggested payment criteria paragraphs, effective writing tips, plain language advice, grammar and spelling tips, and clear language reference tools.

This article has been reproduced with permission from Judy Kondrat of the Industrial Accident Victim's Group of Ontario (IAVGO). Kudos go out to Judy and IAVGO for their great work!

Thursday, April 03, 2008

ODSP and Interest on Payments for Pain and Suffering

A recent case the Ontario Superior Court of Justice held that damages or compensation for pain and suffering including interest is considered to be exempt income for the purpose of calculating a person's entitlement to disability benefits.

The case is Mule v. Ontario Disability Support Program 88 O.R. (3d) 326. ODSP initially decided that the part of the settlement representing prejudgement interest did not constitute "damages or compensation for pain and suffering as a result of injury" and therefore it was to be included in applicant's income in their application for disability benefits. The applicant appealed this decision. In making their decision the court looked at the meaning of the word "for".

They stated that the most appropriate meaning to give to the word"for" in this context was "having a reason or cause". The court indicated that the interest was dependent on the entitlement to damages. The interest paid could not exist independently it formed part and parcel of the award for damages or compensation. Therefore, the interest was to be exempted from income.

This case is also relevant in the WSIB context. It applies to those individuals who are receiving ODSP benefits and who receive a non economic loss award together with interest.

Help for your return to work

If you, as a worker, are concerned that the modified work offered is not consistent with your functional abilities you can request an ergonomic assessment to see if the work is in fact suitable. An ergonomist is someone who has studied human capabilities in relationship to work demands. Information derived from ergonomists contributes to the design and evaluation of tasks, jobs, products, environments and systems in order to make them compatible with the needs, abilities and limitations of people. They examine the workplace with the goal of reducing worker fatigue, discomfort and injury.

An ergonomist will be able to objectively assess the proposed working conditions and determine if they are consistent with the your restrictions and relay their findings and recommendations to you, as the worker, the employer and the WSIB . It is important for you to be present with a representative at the assessment, so that the ergonomist can view how you, not a co-worker, performs the tasks. Having a representative present allows you to voice your concerns or correct any misinformation provided. Factors such as posture and stature can be very relevant to the final recommendations.

An ergonomic assessment can be particularly helpful in cases where the relationship between the worker and employer have become strained, creating difficulties in the return to work process.

Wednesday, April 02, 2008

Canada Pension Disability Changes

One of the requirements to qualify for Canada Pension disability benefits is to have made enough contributions into the plan while you were working. You need to have made enough contributions in at least 4 of the last 6 years.

Canada Pension Plan recently introduced a change to this rule that will benefit individuals who made contributions for more than 25 years. Applicants with 25 or more years of contributions into the plan now only need to have made contributions in 3 of the last 6 years. This change applies to all applications received on or after March 3rd, 2008.

All applicants must still meet the second criteria which is: that they suffer from a severe and prolonged disability.

This change will benefit those that have been seriously injured or suffer from a serious illness or disease later in life causing them to lose time off work.