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To apply cost relief, cost transfer or cost reallocation on claims when the conditions of policy are met.
Description
The review for cost relief, cost transfer or cost reallocation may be triggered by a request from the employer or their representative or when the decision maker (for this procedure, decision maker refers to case manager) identifies a need based on the claim circumstances. To determine if a claim is eligible for cost relief, cost transfer or cost reallocation, the WCB decision maker first reviews the claim to assess whether there is enough information available to make a decision. If additional information – such as a medical opinion on the worker’s recovery – is required, the decision maker makes appropriate arrangements to obtain it.
The decision-maker evaluates the circumstances of the claim including the reason for considering cost relief, cost transfer or cost reallocation and determines if other factors apply to the claim such as whether the claim is or may be interjurisdictional, whether the claim occurred during the experience rating adjustment window and/or if the employer falls under the Industry Custom Pricing (ICP) program.
The decision maker then decides whether cost adjustment applies or refers the claim to the appropriate team to make and communicate the decision (applies to specific types of cost relief, cost transfer and cost reallocation).
The decision maker implements the cost relief or cost reallocation decision, if approved, and communicates the decision to the employer or their representative clearly explaining the basis for the decision.
Key information
Cost Relief
Under Policy 05-02, Cost Relief, costs resulting from unusual or exceptional circumstances of the accident may be entirely or partially removed from the employer's experience to provide a sharing of responsibility for costs that arise from these unusual circumstances.
Depending on the circumstances, cost relief may be available for:
Some cost relief is applied automatically but most requires a WCB decision maker review to make the decision.
Most employers are eligible for cost relief. However, there are some employers and/or circumstances where an employer is not eligible for cost relief. These are outlined in Policy 05-02, Part II – Application 1 - General. For example, elements of cost relief may be waived by employers participating in the ICP program. Except for overpayments, the Government of Canada is not eligible for cost relief.
Decision makers review for cost relief when the claim circumstances warrant a review or an employer or their representative requests one.
Cost reallocation and cost transfer
Costs may be reallocated or transferred under Policy 07-02, Experience Records. Depending on the circumstances, cost reallocation and/or cost transfer may apply when there is:
Disruption of modified work due to a state of emergency
1. Review the claim and determine if it may be eligible for cost relief, cost transfer or cost allocation
Review the claim for cost relief, cost transfer or cost reallocation when circumstances warrant a reviewSee Policy 05-02, Part I, Application 1 – General, Application 2 – Occupational Disease and Application 3 – Back Injuries. or a request is received from an employer or their representative.
Consider the entire cost relief policy (policy 05-02) and all policy on cost transfer/reallocation (under policy 07-02) in the review, not just the circumstance(s) prompting the review.
Figure out what policy criteria must be met to apply the type of cost relief or cost transfer/reallocation being considered and what further investigation or information is needed to make the decision. This could include paying benefits on a medical investigationA decision has been made to accept the injury on a medical investigation basis so wage replacement benefits (under s38(4) of the WC Act) can be paid to the worker during the investigation period. basis. The additional information section below also provides guidance on some types of cost relief and cost transfer/reallocation.
If the request or review is for:
A worker who was injured in a Canadian province or territory other than Alberta and there are no tasks or investigations by the Interjurisdictional Agreement (IJA) Case Manager on cost relief or cost transfer/reallocation, contact them to determine if cost relief or cost transfer/reallocation can be considered. If the IJA Case Manager determines cost relief or cost transfer/reallocation is not applicable, do not continue with this procedure. Refer to Interjurisdictional Agreement (IJA) claims section for more information.
Early cost relief or cost transfer/reallocation from the employer on a third-party recovery claim (for example, a claim for a motor vehicle accident), refer the claim via email to the Manager of Third-Party Recoveries (Legal Services) and they will determine if cost relief or cost transfer/ reallocation is applicable. Do not continue with this procedure. Refer to third-party recovery section for more information.
Negligence of another employer, ask the employer to complete and return the Claims Cost Transfer form and forward a request to the Underwriting team via email once the form is received. Refer to the Negligence of another employer section for more information. Do not continue with this procedure.
Modified work being unavailable during a state of emergency, determine whether there has been a local or provincial state of emergency and if the worker’s modified work was unavailable due to that emergency. Refer to the Cost Reallocation during a state of emergency section for guidance. If cost reallocation may apply, send an email to the Underwriting team (supervisor) for a decision on whether to apply it. Do not continue with this procedure.
If the claim is not eligible for cost relief or cost transfer/reallocation, proceed to step 6.
Administrative tasks
Check the task list to determine if the claim has been deferred for an IJA claim investigation or if claim costs have been reimbursed from another workers' compensation board (WCB) and therefore cost relief does not apply.
Send an email to the Underwriting team when the completed Claims Cost Transfer (A638) form[PDF, 0.19MB] is received. Refer to the Underwriting team’s site on the internal electronic workplace, Section 95(2) option.
Send an email to the Underwriting supervisor for consideration of cost reallocation, when applicable.
2. Determine if the date of accident is outside the window for cost adjustments on the employer's account
Consider how long it has been since the date of accident. Most cost adjustments affecting an employer’s experience rating will only be available for a maximum of four years following the year in which the accident occurred. There are some exceptions where premium adjustments may be recalculated up to six prior calendar years.
Supervisor approval is needed to apply cost relief or cost transfer/reallocation outside of the cost adjustment window. Continue with this procedure.
If the date of accident is outside the cost adjustment window proceed to Step 6.
Administrative tasks
Refer to the Cost Adjustment window document in the Procedure Resource Library for guidance in determining whether eligibility for cost relief or cost transfer or reallocation is impacted.
3. Notify the employer and obtain any additional information required
Call the employer or their representative to advise them that an investigation for cost relief, cost transfer/reallocation will be completed. Obtain any additional information required from the employer to make the decision.
If the reason for the cost relief or cost transfer/reallocation review is for:
A pre-existing conditionA pre-existing condition refers to an injury, illness or medical condition that an injured worker had before their date of accident. (aggravation or separate factor) has prolonged the period of recovery, go to the next step.
A concurrentA concurrent condition refers to a non-compensable injury, illness or medical condition that occurs at the same time as the compensable work injury. Its onset can either be before or after the compensable accident. condition, go to step 5.
Add a file note (Contact/Employer Contact) documenting the discussion.
4. Determine if the recovery period has been prolonged
When the cost relief decision relates to the worker’s period of recovery being prolongedThis means the worker’s recovery has gone beyond the expected period. because of a pre-existing or concurrent condition or one of the other factors outlined in policy, determine if the worker’s recovery was impacted, and if so, for what period. For information on prolonged period of disablement and the differences between concurrent conditions and aggravation of a pre-existing condition, seeProlonged period of disablement in Supporting Information.
For physical injuries, identify the injury the worker would have most likely sustained had they not had a pre-existing or concurrent condition. Determine the expected period of recovery for that injury based on the maximum recovery timeframe outlined in the Disability Duration Reference The Disability Duration Reference documents (formerly known as the Alberta Disability Duration Guidelines) can be used to assist in estimating durations of disability. They are a tool, and only one piece of all the information to be considered. Recommended use of the reference documents require:
Early initial contact between the claim owner and the injured worker (i.e. well before the stated maximum disability duration(s)).
Early discussion with and/or referral to medical consultant/clinical consultant. . For example, the worker’s claim was accepted for a right rotator cuff tear. Medical reporting confirms the worker has pre-existing right shoulder osteoarthritis. The Disability Duration Reference indicates the maximum recovery time for a rotator cuff tear is 12 weeks. The recovery time is only prolonged if it took longer than 12 weeks for the worker to recover.
If the Disability Duration Reference does not address the physical injury or if the injury is for a psychological condition, obtain an opinion from a medical and/or psychological consultant, as appropriate. Ask for an opinion on the expected period of recovery for the compensable injury had the worker not had a pre-existing or concurrent condition.
For a psychiatric/psychological condition, refer the claim as follows:
For medical reporting (including reports from psychiatrist), send the referral to a medical consultant for an opinion.
For psychological reporting only, send the referral to a psychological consultant.
Review and action the consultant’s opinion or recommendation; obtain any additional information that may be required to provide an opinion.
If the worker’s pre-existing condition or concurrent condition delayed their recovery, refer to the section that applies to the claim circumstance to determine the effective date for cost relief – Aggravation of a pre-existing condition or Concurrent condition(s).
Administrative tasks
Refer to eCO Help for the Disability Duration References.
5. Review the claim file to determine if the employer’s industry is in the ICP program
Review the claim file to determine if the employer’s industry is(or was) in the ICP program during the relevant time period. Check the Cost Relief Table indicating which employers are entitled to full or partial cost relief for any year, regardless of whether the ICP flag is displayed in eCO.
ICP is a flexible pricing program available at the industry level; industries in the ICP program vote whether or not to waive cost relief when an aggravation of a pre-existing condition (back and non-back) results in a prolonged period of disability. Such claims are not eligible for cost relief for the time the employer’s industry is participating in the ICP programSee Industry Custom Pricing - Employer Fact Sheet [PDF, 0.07MB] for more details.and has waived cost relief for prolonged disability due to an aggravation of a pre-existing condition.
For the years that the industry participates in ICP and has waived cost relief, costs for prolonged disability due to an aggravation of a pre-existing condition are not eligible for cost relied.
If the claim is not eligible for cost relief, proceed to step 6.
Administrative tasks
To determine if an employer falls under ICP:
Find the industry code of the employer in eCO.
Access the cost relief table on the internal Electronic Workplace (EW) > Departments > Underwriting. Select Core Business, Industry Custom Pricing, and the tab Resources/Tools. Open the Cost Relief table.
Look up the industry code and date of accident year to determine if the employer is eligible for cost relief (N = not eligible).
6. Make and communicate the decision and implement cost relief, cost transfer or reallocation, if applicable
Determine if cost relief or cost transfer/reallocation applies, and the dates that it starts and ends (if applicable) based on the claim circumstances and applicable policy.
If cost relief or cost transfer/reallocation is:
Approved and falls within the window for cost adjustments, communicate the decision in writing. If the cost relief or cost transfer/reallocation is for:
A simple, non-ICP prolonged period of disablement because of a concurrent condition or aggravation of a pre-existing condition, update the eCO Injury Detail screen and the system will automatically send the approval letter and apply cost relief. The cost relief applied is based on the Disability Duration Reference or the medical consultant’s review (if the information is not available in the reference).
Any other reason, send a request to Cost Distribution to apply cost relief.
Recommended and does not fall within the window for cost adjustment but may be a valid exception, request supervisor approval. The supervisor will make a decision to approve or not approve and document their decision in a file note. Action the claim based on the supervisor’s response.
Not approved, contact the employer to discuss the decision and then communicate the decision in writing clearly explaining the basis for the decision.
Note: Any claim can be reviewed again if new information and/or evidence is submitted.
When cost relief is only applicable for a specific period and the end date is unknown, continue to monitor for the end date. Once the end date is identified, send a file note to the Cost Distribution, Working Desk requesting that the cost relief end.
Administrative tasks
To request approval to extend the cost adjustment window, send a file note (Cost Distribution/Cost Relief Required) to the supervisor describing the basis for the request.
Add a file note (Contact/Employer Contact) documenting the discussion and the decision to deny cost relief or cost transfer/reallocation.
Send the appropriate decision letter in the IN022 series. Do not send a copy to the worker.
Send a file note (Cost Distribution / Cost Relief Required) to the Cost Distribution, Working Desk including the following:
Basis for the request
The section of cost relief or cost transfer/reallocation policy that applies
Medical opinion (if applicable)
Effective date and end date (if applicable)
Any relevant information specific to the cost relief circumstance (back injury, including that TD01 costs are being reallocated due to the state of emergency, etc.)
To add an end date to an active cost relief or cost transfer/reallocation claim, add a file note (Cost Distribution/Cost Relief Required) stating the end date and send it to the Cost Distribution, Working Desk.
Supporting information
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Aggravation of a pre-existing condition
An employer may be eligible for cost relief when:
a worker has a pre-existing conditionA pre-existing condition is a physical or mental condition which pre-dates a work-related injury.,
the pre-existing condition has been aggravated by the compensable injury, and
the aggravation prolonged the period of recovery for the compensable injury beyond the expected recovery period for that injury.
This includes physical injuries (both back injuries and non back injuries), occupational diseases, psychological and psychiatric conditions. The pre-existing condition may have been a separate factorA separate factor means the pre-existing condition was not affected by the compensable injury. or aggravated by the accident. If it is a separate factor, it may be eligible for cost relief for prolonged disablement due to a concurrent condition. For differences between concurrent conditions and aggravation of a pre-existing condition, see Prolonged period of disablement below.
Employers that are part of the IICP program may not qualify for cost relief for aggravation of a pre-existing condition that results in a prolonged period for disability. Refer to the ICP section for more information.
Note: A neck (cervical) injury is not considered to be a back injury, so cost relief for neck injuries are not administered under the back cost relief policy. An aggravation involving the neck is considered under Policy 05-02 Part II, Application 1 - General.
When cost relief is effective and how costs are calculated
If the injury is not a back injury or a cardiac claim, cost relief may be applied to all costs beyond the expected recovery for the compensable condition or injury. The effective date can be from the onset of the prolonged period of recovery or the date of accident. When the prolonged period of recovery only lasts for a certain period, cost relief is applied only for that period.
In some cases, the entire period of recovery may be due to the pre-existing condition (for example, a worker inhales dust which aggravates their pre-existing cystic fibrosis condition causing the entire period of disability). In these cases, the decision maker determines if a worker without a pre-existing condition would have developed an injury based on the same accident or exposure and, if so, what the expected period of recovery would be for the injury. If not, cost relief is applied the day after the date of accident.
For back injuries (excluding neck injuries) and cardiac claims with dates of accident:
On or after September 1, 2018, cost relief is applied for all claim costs exceeding eight times the worker’s weekly compensation rate. The dollar value will differ for all workers as the amount is based on the worker’s individual earnings.
This is calculated using the rate in effect at eight weeks post-date of accident. This includes using the base rate (if the worker is seasonal) in effect at that time (that is, eight weeks post-date of accident).
Before August 31, 2018, claim costs exceeding the dollar value of eight times the weekly maximum compensation rate in effect on the date of accident are relieved. Refer to Policy 05-02, Part II, Addendum A for a list of maximum claims costs. The dollar value is the same for all workers, regardless of the worker's individual earnings at date of accident.
Considerations for when there is one or more compensable injury and/or pre-existing condition
When it is determined that the worker has:
More than one compensable aggravation of a pre-existing condition it must be determined if the period of recovery has gone beyond the expected period of recovery for each of the compensable aggravations. If two or more compensable aggravations resulted in a prolonged period of disability, cost relief is applied based on the latest date the worker would have recovered had it not been for the pre-existing condition.
Example: A worker has an aggravation of pre-existing knee tear (medial collateral ligament) and an aggravation of pre-existing major depressive disorder. The Disability Duration Reference indicates that the worker would have recovered from a knee tear within twelve weeks. The Medical Consultant indicates that, had it not been for the pre-existing depression, the worker likely would have recovered within six months from depressed mood. Cost relief should be applied six months from the date of accident because the worker's period of recovery for the first six months of the claim is reasonably related to at least one of their compensable conditions. If cost relief is applied at twelve weeks based on the anticipated period of recovery for the knee, the costs related to the compensable depression would not be reflected on the employer's experience account.
One (or more) compensable aggravation and one (or more) condition that has not been aggravated, it must be determined if the period of recovery has gone beyond the expected period of recovery for the condition that has been aggravated.
Determine the date the worker would have recovered from the pre-existing condition that was aggravated as if the worker had not sustained any other injuries. Next, determine if the worker has recoveredRecovery means the date that no further improvement of the condition(s) is expected. from the compensable condition that was not aggravated and, if so, on what date they recovered from the condition. Cost relief is applied based on the latest of the two dates. If the worker has not yet recovered from their compensable condition, cost relief is not applied until they have recovered.
Example: A worker aggravates a pre-existing knee tear (medial collateral ligament) and has sustained a femur fracture. The Disability Duration Reference indicates that the worker would have recovered from a knee tear within twelve weeks. The worker recovers from their femur fracture at 29 weeks after the DOA. Cost relief should be applied at 29 weeks from the date of accident. If we apply cost relief at twelve weeks based on the anticipated period of recovery for the knee, the costs related to the compensable femur fracture will not be reflected on the employer's experience account.
Automatic application of cost relief
The system automatically applies cost relief on the following policies and circumstances:
Cost relief may be provided when the worker's inability to work is prolonged due to the unavailability of a hospital bed or other facility through no fault of the worker. Refer to Policy 05-02, Part II, Application 1 - General(Question 5).
Assess if the length of the worker's inability to work is prolonged by a delay in hospital admission and the anticipated duration of this delay.
Determine the worker's eligibility for benefits while awaiting hospital admission. Consider a referral to an appropriate internal consultant to confirm the worker's current fitness for work, if needed.
The worker's actions (e.g., the worker has repeatedly cancelled the appointment), review the worker's entitlement to benefits under duty to cooperate. Discuss concerns with the worker and follow the 3-3 Duty to cooperate procedure.
If the delay is through no fault of the worker and a private or semi-private accommodation is unavailable, then continue benefits and request cost relief be applied under 12A -Compensation Pending Hospital Admission. Refer to Policy 05-02, Part II, Application 1-General(Question 5) to determine the period that cost relief can be applied.
Maintain regular contact with the worker and monitor the claim for a hospital admission date.
Upon the worker's admission to the hospital, request cost relief be updated to 12B Compensation Day Of & After Hosp Admission. The employer is not entitled to cost relief effective the date the worker is admitted to the hospital.
Concurrent condition(s)
An employer is eligible for cost relief when there is a concurrent conditionA concurrent condition is a separate, non-compensable condition that exists at the same time as the compensable disability. that has prolonged recovery from the compensable injury.
The onset of the concurrent condition can be either before or after the date of accident except when the date of accident is before June 1, 2017. In this case, the concurrent condition must have existed before the date of accident. . For the differences between concurrent conditions and aggravation of a pre-existing condition, refer to Prolonged period of disablement section for more information.
When the concurrent condition impacts the worker’s treatment or healing of the compensable injury and prolongs their recovery, (i.e., period of disablement) from the compensable injury, the employer may be eligible for cost relief for that period. For example, the worker has a non-compensable wrist surgery that delays their treatment for a back injury prolonging their recovery or the worker has diabetes which delays their healing from an ankle fracture prolonging their recovery.
Personal risk factors such as smoking, obesity, addictions, etc. are not considered concurrent conditions and cost relief cannot be applied unless the personal risk factors cause a delay in medical treatment or return-to-work services. However, diseases arising out of personal risk factors that result in a prolonged period of recovery (for example, Type 2 diabetes, lung cancer, cirrhosis of the liver, etc.) are considered concurrent conditions.
When cost relief is effective
When the worker’s recovery is prolonged because of a concurrent condition, costs that are attributable to the prolonged period may be relieved. The effective date can be from the onset of the prolonged period of recovery, the onset of the concurrent condition if it occurs after the date of accident or the date of accident when the concurrent condition pre-dates the date of accident.
Concurrent earnings
The cost of benefits paid due to concurrent earningsThese are earnings from an additional job(s) held by the worker at the date of accident, which the worker cannot perform due to the injury. Concurrent earnings are included in the worker’s compensation rate. are automatically relieved from the claim without any action required from the decision maker (except in the case of a wage loss supplement).
In wage loss supplement cases, the decision maker first identifies the worker’s compensation rate in effect (that is, section 56, 61, 67 or 68) when the wage loss supplement was approved. They then calculate the portion of that rate that comes from concurrent earnings and request cost relief be applied for the same proportion of the wage loss supplement benefit.
Example: A worker's compensation rate is $90,000. One third of that ($30,000) is from concurrent earnings. An Economic Loss Payment (ELP) is approved on the claim. The worker's compensation rate was in effect at the time the ELP was approved. This means two thirds of the worker's ELP comes from earnings with the date-of-accident employer and one third comes from earnings with the concurrent employer. Based on this, the decision marker would request cost relief for one third of the cost of the ELP.
Cost reallocation during a state of emergency
Costs may be reallocated by moving individual employer costs to the Accident fund for wage replacement (TD-01) benefits paid when modified work becomes unavailable during a provincial or local state of emergency that occurs on or after May 1, 2016. Only wage replacement (TD-01) benefit costs are reallocated; other costs (for example, those related to the unavailability of local medical treatment or lodgings) are not reallocated. Refer to Policy 07-02, Part II, Application 2- Experience Rating (Question 14) for further information.
Costs may be reallocated from the date the state of emergency was declared or the date the event occurred if there was a delay in declaring the state of emergency. Cost reallocation ends when the state of emergency ends, the worker returns to modified duties, or the worker becomes fit for pre-accident duties, whichever occurs first.
When there is a delay in declaring a state of emergency, yet it is clear the event would have impacted an employer's ability to provide modified duties, cost reallocation may begin prior to the date the state of emergency was declared. For example, a state of emergency was declared in Fort McMurray on May 4, 2016, yet the evacuation of Fort McMurray began on May 3, 2016. In this example an employer may be eligible for cost reallocation as of May 3, 2016.
A request from an employer or representative is not required to initiate cost reallocation. It is considered for any claims where the worker was performing modified duties in the affected area at the time the state of emergency was declared, and modified duties were disrupted due to the state of emergency.
Cost relief for occupational diseases when more than one employer contributed to the compensable condition
For some occupational diseases, costs may be charged to the industries to which the employers who contributed to the compensable condition belong, rather than to the date-of-accident employer alone (for example hearing loss and respiratory diseases). For these claims the injury most often occurs from working with more than one employer over time and not solely due to employment with the date-of accident employer. See Policy 05-02, Part II, Application 2 for additional information.
WCB decision makers obtain a detailed history of the worker’s employment to determine whether the occupational illness or disease is attributable to only one employer or multiple employers. If the occupational illness or disease is attributable to only one employer; cost relief is not applied.
All other types of injuries (including progressive injuries such as carpal tunnel syndrome) are not eligible to have costs distributed among multiple employers even when other employers may have contributed to the injury.
When the initial entitlement decision is made and it is confirmed that more than one employer or industry contributed to the occupational illness or disease, they share the claims costs. If there is more than one industry, the decision maker determines the percentage of claim costs to be charged to each industry and class based on the amount of time the worker was employed in that industry and class (for example, the worker was employed in four companies whose industries should share the claim costs). The percentage totals 100 and the costs are distributed in whole numbers.
For example:
Industry and Class A - employed for 24 months = 34%
Industry and Class B - employed for 6 months = 8%
Industry and Class C - employed for 24 months = 33%
Industry and Class D - employed for 18 months = 25%
eCO Injury Details screen for automated cost relief (concurrent conditions or aggravation of pre-existing conditions)
The eCO Injury Details screen automatically triggers the application of cost relief for prolonged disablement due to concurrent and pre-existing conditions when it is completed as outlined below. The cost relief applied is based on the Disability Duration Reference (refer to eCO help) or the medical consultant’s review (if the information is not available in the reference).
Cost relief is automatically applied for:
Aggravation of a simple pre-existing condition (back and non-back claims) that resulted in a prolonged period of disability (back and non-back).
Concurrent condition or pre-existing condition that was a separate factor that resulted in a prolonged period of disability.
To enable cost relief automation, complete the Injury Details in eCO screen as follows:
For the pre-existing or concurrent condition, update the Injury Decision field to “not accepted.”
Choose the injury decision type (that is, pre-existing or concurrent). This displays the relevant policy for cost relief application. When a pre-existing condition has not been aggravated but cost relief is to be applied (separate factor), select “concurrent condition.”
For pre-existing conditions:
Indicate whether the injury/condition has been aggravated. (Yes for a pre-existing condition and No for a concurrent condition).
For a pre-existing condition, indicate whether the aggravation is temporary or permanent.
For a concurrent condition, indicate whether the injury is temporary or permanent.
For both pre-existing and concurrent conditions, indicate whether the recovery for the compensable condition has been prolonged.
For both pre-existing and concurrent conditions, indicate the expected recovery date by adding the anticipated recovery date for the compensable injury based on the Disability Duration Reference or the medical consultant’s opinion (if not available in the reference). For back injuries and cardiac claims, input the date of accident in the expected recovery date field.
Indicate whether the recovery for the compensable condition has been prolonged.
Indicate the expected recovery date by adding the anticipated recovery date for the compensable injury based on the Disability Duration Reference or the medical consultant’s opinion (if not available in the reference). For back injuries and cardiac claims, input the date of accident in the expected recovery date field.
When the update is saved, the system automatically applies cost relief and sends the appropriate letter.
Industries in ICP vote on whether they want to waive cost relief for prolonged recovery due to an aggravation of a pre-existing condition. Not all industries in ICP may have chosen to waive cost relief, so it is important to determine how the industry voted on cost relief to know which types of cost relief they are eligible for.
Industries in the ICP programIndustries may be in ICP and not have chosen the cost relief option. They vote on whether or not to be part of the cost relief option when they vote to be in ICP. So, just because an employer is in ICP, doesn't mean they waive cost relief for aggravation of a pre-existing condition. They probably have, but it depends on whether or not the industry waived the cost relief option or not. that have chosen to waive cost relief have voted to waive cost relief when an aggravation of a pre-existing condition results in a prolonged period of disability. As such, cost relief is not granted for prolonged periods of recovery due to an aggravation of a pre-existing condition for the time the employer's industry is participating in the ICP program and has voted to waive cost relief. This includes aggravation of pre-existing back and non back injuries. Cost relief can be reviewed for ICP employers for any other reason (such as concurrent condition(s) that prolonged the worker’s recovery, delay in hospital admission, etc.).
An employer who is participating in ICP as of the date of accident may be identified by the ICP flag beside the policy number in eCO. However, there are circumstances in which the ICP flag is displayed but the employer is eligible for partial cost relief. In addition, the ICP flag is removed from a claim when it is more than four years after the date of accident year even if the employer is still participating in ICP. To ensure the employer is eligible for the cost relief, the decision maker checks the Cost Relief Table before applying cost relief regardless of whether an ICP flag is displayed in eCO.
Interjurisdictional Agreement (IJA) claims
Employers operating in Canadian jurisdictions are subject to the Interjurisdictional AgreementSee Policy 06-01, Part 2, Application 5, Coverage Outside Alberta [PDF, 0.25MB] for more details. on Workers’ Compensation (IJA). The IJA is intended to avoid duplicate payment of premiums and to aid injured workers in claiming and receiving compensation when two or more jurisdictions are involved.
Per the IJA, WCB-Alberta staff review claims to determine if they should be charged to another Canadian workers’ compensation (WCB); cost relief requests on IJA claims are deferred until the claim can be reviewed by the IJA Unit.
When the IJA Case Manager sends a request to another WCB under the IJA, an eCO system task (High priority, Cost Relief Deferred) is sent to the decision maker telling them to defer cost relief requests until they are notified by the IJA Unit. This task must remain on the decision maker’s task list until that happens; the date may be adjusted into the future if appropriate.
When reimbursement has been received from the other WCB and the employer is changed to reflect that other Board, another eCO system task (High priority, IJA – Cost Relief N/A) is sent to the decision maker advising them that cost relief is not applicable.
All costs of the claim will be removed from the date-of-accident employer’s Alberta account once the other WCB accepts responsibility and reimbursement is received. As a result, cost relief must be considered by the WCB where the employer’s costs reside.
Negligence of another employer
A date-of-accident employer may request a transfer of claim costs on the basis that the injury was the result of negligence of another employer or the employee of another employer. The employer must clearly identify the alleged negligent employer(s) and provide sufficient information that sets out the negligent conduct or action when requesting a transfer of claim costs. See Policy 07-02, Part II, Application 5 and Policy 05-02, Part II, Application 1 (question 13).
The cost transfer decision on these claims is determined and communicated by the WCB Underwriting team once the employer sends in the Claims Cost Transfer (A638) form.
Note: Cost transfer (due to the negligence of another employer) and cost relief are separate decisions. When costs have been transferred from a date-of-accident employer to a negligent employer, it is possible that cost relief may also be applied if policy criteria are met (see policy 05-02). The decision on cost relief happens after costs are transferred to the negligent employer and are subject to the pricing program of the negligent employer. For example, if the negligent employer participated in ICP and their industry waived cost relief for aggravation of pre-existing conditions for the date-of-accident year, they would not be eligible for cost relief if an aggravation of a pre-existing condition resulted in a prolonged period of disability. See industry custom pricing.
No time loss (NTL) claims
A no time-lost claim (NTL) is when there is a compensable injury but the worker can continue working without losing time from work beyond the day of injury and does not have a permanent disability resulting from that work injury.
Claim costs on NTL claims are not applied to the employer’s experience account until costs reach the applicable threshold described in the table below. Cost relief is not considered or applied on NTL claims until the claim’s costs reach the applicable amount specified. The costs on all lost time claims are charged immediately to the employer’s experience account.
Prolonged period of disablement (concurrent condition versus aggravation of a pre-existing condition)
Aggravation of a pre-existing condition is when a compensable accident causes a pre-existing condition or disease to worsen to the point where a worker has temporary or permanent clinical impairment and/or loss of earning capacity (seePolicy 03-02, Part II, Application 1). A concurrent condition is a non-compensable condition that exists at the same time as a compensable disability that may or may not impact the worker’s recovery from the compensable condition (see Policy 04-02, Application 2). A pre-existing condition that was not aggravated can be a concurrent condition.
In both cases, cost relief may be available. For aggravation of a pre-existing condition, costs from the prolonged period of disability are relieved (different criteria applies to backs). For more information, seeAggravation of a pre-existing condition. For concurrent conditions, if the worker’s period of disablement is prolonged because of the condition, WCB may relieve costs attributable to the prolonged period. SeeConcurrent condition(s)for more information.
Administrative tasks
Refer to the Pre-existing condition versus concurrent condition document in the Procedure Resource Library.
Third party recoveries
When a third party causes or contributes to a worker's injury (for example, motor vehicle accident), WCB may pursue recovery of the claim costsSee Policy 07-02, Part II, Application 6, Third Party Recoveries. if the other party was at fault and is not covered under the Workers’ Compensation Act. If the action for recovery results in a settlement or judgment, the employer will have costs of the claim relieved from their record, either in the amount of the settlement or the percentage of liability.
When WCB is unable to recover the costs from a third party (for example, the third party is uninsured or is unknown), cost relief may be approved if WCB is satisfied that costs would have likely been recovered had the third party been identified or insured. See Policy 07-02, Part II, Application 6.
Cost relief under Third Party Recovery is initiated and recommended by Legal Services. Legal Services is notified of possible third-party action on a claim when the initial entitlement decision is made. If a request is received before the third-party recovery has reached a settlement, refer to Legal Services as outlined in step 1.
Triggers for cost relief review
A cost relief review may be triggered by requests from an employer or their representative, or initiated by a WCB industry specialist, supervisor, or decision maker.
A review can occur at any time. WCB decision makers review for cost relief as soon as:
A claim is reviewed for initial entitlement.
A claim is reviewed after assignment.
A non-economic loss payment or permanent partial disability award is implemented.
An entitlement decision is updated which changes the level of responsibility.
An economic loss payment or permanent partial disability award is implemented.
The worker’s recovery is prolonged relative to the diagnosis.
Costs should be split between industries or employers.
Claims costs exceed the rate as outlined in policy for back claims.