Document name

Benefits – Customers in Transition from WCB to SGI Benefits

Document number

POL 06/2009

1. Occasionally, workers receiving benefits from the WCB are involved in non-work-related motor vehicle incidents that result in injury. This situation may result in the worker being caught between the compensation systems of the WCB and SGI.
2. Section 202(7) of The Automobile Accident Insurance Act (the “AAIA”) outlines the responsibilities of both the WCB and SGI for the payment of benefits to workers.
3. Although there are no provisions in The Workers’ Compensation Act, 2013 (the “Act”), the WCB has the implied authority as a public corporation to enter into a Memorandum of Agreement for the Benefit Determination Process with SGI.

Where WCB is First Payer

1. According to the Memorandum of Agreement for the Benefit Determination Process between SGI and the WCB, where a worker is receiving WCB benefits and sustains another injury as a result of a non-work-related motor vehicle incident, and due to that latter injury the worker becomes entitled to SGI benefits:
   1. SGI and the WCB will:
      1. Make a joint decision based on all medical information available regarding which injury is the primary disabling factor and, as a result, which agency will be responsible for issuing benefits; and
      2. Pay compensation in proportion to the attribution of the worker’s injuries.
   2. Where the WCB has issued benefits to the worker as a result of the non-work-related injury, the WCB will request a refund from SGI where appropriate.
2. When required, the WCB will continue to be the first payer of benefits until a joint decision with SGI can be made.

Where SGI is First Payer

3. Where the worker sustains a work injury after being injured in a non-work-related motor vehicle incident, the worker’s claim for WCB benefits shall be adjudicated in accordance with POL 12/2017, Pre-Existing Conditions – Aggravation or Acceleration.