Document name
Benefits – Customers in Transition from WCB to SGI Benefits
Document number
PRO 06/2009

Effective date: September 1, 2009

Application: All workers who are attempting to establish entitlement to SGI benefits as a result of a non-work-related motor vehicle incident.

Policy subject: Benefits - General

Purpose:

To ensure workers continue to receive benefits from the Workers’ Compensation Board (WCB) after a non-work-related motor vehicle incident, until the worker can establish benefits with Saskatchewan Government Insurance (SGI).

BACKGROUND

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Section detail
  1. POL 06/2009, Benefits – Customers in Transition from WCB to SGI Benefits outlines the responsibilities for SGI and the WCB, under the Memorandum of Agreement for the Benefit Determination Process, with respect to payment of benefits to workers who have been injured in a non-work-related motor vehicle incident either prior, or subsequent, to sustaining a work-related injury.
  2. This procedure provides guidelines to ensure compliance with the Memorandum of Agreement for the Benefit Determination Process between SGI and the WCB.

PROCEDURE

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  1. Where notification is received that a worker has been involved in a motor vehicle incident, and Operations staff determine that the worker qualifies for benefits under Injuries – Travelling for or Attending Medical Aid or Return-to-Work Programming (POL 04/2011), benefits for any injuries sustained as result of the motor vehicle incident will be the responsibility of the WCB as the first payer.
  2. Where the worker is currently receiving benefits from the WCB and is involved in a non-work-related motor vehicle incident, the WCB will continue to be the first payer of benefits. Operations staff will contact SGI to make a joint decision as to which injury is the primary disabling factor and, as a result, which agency will be responsible for issuing benefits.
  3. Operations staff will obtain and review all relevant medical records in order to determine whether the injuries sustained in the motor vehicle incident will prolong recovery from the work injury (POL 12/2017, Pre-Existing Conditions – Aggravation or Acceleration).
  4. Once a joint decision has been made between SGI and the WCB distinguishing between work-related and motor vehicle injuries, the WCB will notify SGI where any benefits have been paid in regards to the non-work-related injury. Payments received from SGI in recognition of this are to be handled by Finance and are to be credited to the work injury claim to ensure the employer’s cost experience rating is not negatively affected.
  5. Where payment is not received by SGI, costs will be charged to the Second Injury and Re-Employment Fund and a determination of ongoing benefit entitlement will be made.
  6. If WCB and SGI staff cannot agree on which injury is the intervening cause preventing the worker from returning to employment, the issue will be decided in accordance with the escalation process outlined in the agreement between SGI and the WCB.

Policy references

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Act Sec #

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n/a

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Amended

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01 January 2014. References updated in accordance with The Worker’s Compensation Act, 2013

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Supersedes

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n/a

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Complements

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