Document name
Second Injury and Re-employment Reserve
Document number
POL 11/2017

Effective date: October 1, 2017

Application: All injuries on or after the effective date.

Policy subject: Employer accounts – Claims costs adjustments and cost relief

Purpose:

To establish guidelines for charging claim costs to the Second Injury and Re-Employment Reserve.

BACKGROUND

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Section detail
  1. The Workers’ Compensation Act, 2013 (the “Act”) allows the Workers’ Compensation Board (WCB) to establish the Second Injury and Re-Employment Reserve. This is consistent with the WCB’s authority to set up a reserve(s) to meet losses from any disaster or other circumstance the liability for which would, in the opinion of the WCB, unfairly burden the employers in any class (Section 145).
  2. The purpose of the Second Injury and Re-Employment Reserve (the “reserve”) is to:
    1. Provide employers with cost relief on claims attributed to an earlier work-related injury.
    2. Provide employers cost relief on compensable claims that may involve a worker’s pre-existing condition.
  3. The reserve is set at one per cent of benefit liabilities (POL 14/2017, Funding).

POLICY

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Section detail

Cost Relief

  1. Cost relief eligibility will be considered on claims for all workers and throughout the life of a claim.
  2. If a claim is eligible for cost relief the employer will be provided total or partial cost relief and costs are charged to the reserve.
  3. If an employer is provided cost relief a credit is applied to their account (POL 27/2016, Experience Rating Program – Discounts or Surcharges will apply).

Pre-Existing Conditions and Second Injuries

  1. A non-work related pre-existing injury, disease, degenerative condition or psychological condition is a risk to a worker in and out of employment (POL 03/2017, Arising Out of and In the Course of Employment). The WCB will charge total claim costs to the reserve if conditions of a worker’s employment increased the risk of an injury occurring or the severity of the injury.
  2. The WCB will charge total claims costs to the reserve if a worker’s prosthetic device, prescribed for a previous work injury, fails and causes an injury. Costs to repair damage to the prosthetic device will not be charged to the reserve.
  3. The WCB will charge partial claim costs to the reserve in the following situations:
    1. If recovery from a work injury is prolonged because a worker’s non-work related pre-existing condition (POL 12/2017, Pre-Existing Conditions – Aggravation or Acceleration) is:
      1. Aggravated by the work injury.
      2. Accelerated by the work injury.
    2. If a prior work injury with another employer:
      1. Prolongs the recovery of a new work injury because a prior work injury is aggravated or accelerated.
      2. Causes a new work injury.
  4. An employer will be eligible for partial cost relief if a workplace exposure contributes to a respiratory disease (e.g., asthma, emphysema, lung cancer) and smoking is partially responsible. The WCB will charge 50 per cent of claims costs to the reserve.

Injury Following a Return-to-Work

  1. If a worker sustains a new injury, the WCB will charge total claims costs for that injury to the reserve if it arises out of and in the course of:
    1. A return-to-work (RTW) plan (POL 08/96, Return-to-Work Plans).
    2. Alternate or accommodated employment, with either the pre-injury or a new employer:
      1. Within one year of starting alternate or accommodated employment., and
      2.  To the same area of injury as the work-related injury.

Other

  1. The WCB will charge partial claim costs to the reserve in the following situations:
    1. The worker or dependent spouse has a good reason for not participating in health care or an individualized vocational plan (IVP) (POL 15/2016, Suspension of Benefits; POL 01/2008, Suspension of Benefits – Pregnancy).
    2. The worker is incarcerated and benefits are redirected to a dependent spouse (POL 10/2016, Suspension – While Incarcerated). Costs redirected to the dependent spouse during a notice period will be charged to the reserve.
    3. The worker sustains an injury while travelling to or from treatment or RTW program and the WCB is paying for travel (POL 04/2011, Injuries – Travelling for or Attending Medical Aid or Return-to-Work Programming).
    4. The worker is entitled to benefits (i.e., medical or wage loss benefits) for a claim involving serious and wilful misconduct (POL 08/2017, Serious and Wilful Misconduct).
    5. The worker sustains an injury because of an imported personal hazard of another worker (POL 03/2017, Arising Out of and In the Course of Employment).
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