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
- 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).
- The purpose of the Second Injury and Re-Employment Reserve (the “reserve”) is to:
- Provide employers with cost relief on claims attributed to an earlier work-related injury.
- Provide employers cost relief on compensable claims that may involve a worker’s pre-existing condition.
- The reserve is set at one per cent of benefit liabilities (POL 14/2017, Funding).
POLICY
Cost Relief
- Cost relief eligibility will be considered on claims for all workers and throughout the life of a claim.
- 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.
- 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
- 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.
- 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.
- The WCB will charge partial claim costs to the reserve in the following situations:
- 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:
- Aggravated by the work injury.
- Accelerated by the work injury.
- If a prior work injury with another employer:
- Prolongs the recovery of a new work injury because a prior work injury is aggravated or accelerated.
- Causes a new work injury.
- 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:
- 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
- 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:
- A return-to-work (RTW) plan (POL 08/96, Return-to-Work Plans).
- Alternate or accommodated employment, with either the pre-injury or a new employer:
- Within one year of starting alternate or accommodated employment., and
- To the same area of injury as the work-related injury.
Other
- The WCB will charge partial claim costs to the reserve in the following situations:
- 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).
- 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.
- 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).
- 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).
- 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).
Policy references
Section heading
Act Sec #
Act Sec #
145
Section heading
Supersedes
Supersedes
POL 21/2010 Second Injury and Re-Employment Reserve
POL 25/2010 Administrative Error – Cost Relief
Section heading
Complements
Complements