Loss of Earnings: WSIB Claims

August 15, 2017 at 12:07pm

Workers Comp Claims & Appeals: Loss of Earnings

Information adopted from the Ontario Worker Adviser (OWA) website. Used with permission.

What Are Loss of Earnings (LOE) Benefits?

Loss of Earnings benefits are paid by the WSIB in place of your lost income due to your work-related injury.

When Am I Eligible for LOE Benefits?

You are eligible for LOE benefits if you have a loss of earnings as a result of a work-related injury beyond the day of the injury. If you have suffered a wage loss due to a work-related injury then you, your employer and/or your doctor should file a claim with WSIB.

How Much Are LOE Benefits?

Full Loss of Earnings benefits are 85% of your net average earnings (NAE) before your injury. WSIB also pays partial LOE benefits that may be any part of the full benefits. Your LOE benefits may change if WSIB recalculates your NAE after 12 weeks of benefits. If you receive a disability pension from the Canada Pension Plan, some or all of this income may be deducted from your LOE benefits.

What Do I Have to Do to Continue Receiving Full LOE Benefits?

To continue receiving full LOE benefits, you must experience a full loss of earnings and cooperate in:

  • early and safe return to work activities
  • health care and treatment prescribed by your treating doctor (or other health care professional) and approved by WSIB
  • work transition (formerly, labour market re-entry) assessments or plans

WSIB can reduce or take away your benefits if you do not cooperate.

What Happens If My Medical or Work Situation Changes?

You must notify WSIB within ten days of any changes in your medical condition, your treatment, your income from any source, or your status at work. These types of changes are called Material Change in Circumstances. WSIB may reduce or take away your LOE benefits if these material changes are not reported on time. If you are unsure whether something is a material change in circumstances, you should inform WSIB anyway.

What Happens to My LOE Benefits If I Return to Work?

If you:

  • Return to work while you are still suffering a work-related impairment
  • are paid less than what you earned before your injury

then the amount of LOE benefits will be 85% of the difference between what you earned before your injury and what you are earning after your injury.

You will receive LOE benefits until the earliest of, the day you:

  • Recover from your work related injury.
  • No longer suffer a wage loss due to your injury,.
  • Turn 65, or 2 years after the date of injury if you were injured at age 63 or older.

If you return to work and suffer a recurrence of your work-related injury, are laid off or fired because of the injury, you may be entitled to full LOE benefits again.

How Does Work Transition Affect My LOE Benefits?

If you participate in a work transition (WT) assessment or plan, you will get full LOE benefits as long you continue to cooperate.

After the WT plan has ended or if no WT plan was required, LOE benefits will be based on the earnings that WSIB determines you are able to earn in the jobs that are suitable and available for you.

How Often May WSIB Review My LOE Benefits?

The WSIB may review your LOE benefits once each year, or whenever there is a material change in circumstances. Prior to a review, the WSIB will contact you. You should provide any information requested about your income and medical condition. WSIB will only change your LOE benefits when there is a significant change in your earnings or the earnings that WSIB has determined you are able to earn, usually a 10% change or more, up or down. WSIB usually cannot review your LOE benefits after 72 months (six years) following the injury.

There are some exceptional circumstances where WSIB may conduct a further LOE review beyond 72 months (six years).

Election for Older Workers

If WSIB decides you are entitled to LOE benefits when you are age 55 or older, you may be entitled to have your LOE benefits stay the same until age 65 without further WSIB reviews. To be entitled to elect the option of no further WSIB reviews, you must have completed your WT plan and have reached your maximum medical recovery, which means your medical condition is not likely to change. WSIB should advise you in writing of the option to choose whether your LOE benefits will be reviewed each year. You must notify WSIB within 30 days if you choose not to have your LOE benefits reviewed each year.

If WSIB does not send you written notice of this election, you can notify WSIB in writing that you do not want your LOE benefits reviewed each year.

  • You must do this within 30 days from the date on which you reach maximum medical recovery or complete your WT plan, whichever is later.
  • Your LOE benefits will then continue at the same rate until age 65.
  • You cannot change your mind once you choose not to have your LOE benefits reviewed yearly and advise WSIB of your decision.

Interested in this option? You should get help from a qualified representative.

Can I Appeal a WSIB Decision on LOE Benefits?

Yes. You can object to any decision that affects your LOE benefits. Generally, you must object within six months of the date of the decision. If a decision about your early and safe return to work or work transition affects your LOE benefits, then you must object within 30 days of the date of the decision.

If you wish to get help with your appeal contact the UFCW Locals 175 & 633 Workers’ Compensation Department (1-800-267-1977).