Earnings loss supplement (ELS) reviews

This step is completed by the case assistant.

Monitor the claim for scheduled and unscheduled reviews

Monitor the claim for new information, such as a change in salary, change in employment status, or work restrictions, or to apply a cost-of-living adjustment (COLA) to an existing ELS benefit. When new information is received that may impact the ELS benefit (unscheduled review), continue to step 5. 

Note: Cost-of-Living Adjustments for ELS benefits are applied yearly and the COLA is completed in the worker's birth month. For a COLA review, refer to the Cost-of-Living Adjustment (COLA) section. 

When new information is not received, start the review process upon receipt of the reminder task (task displays 60 days before the next scheduled review date). Scheduled reviews for ELS benefits occur yearly, with the exception of ELS's based on no post-accident earnings (zero-based) which are reviewed every three years to age 50 and every five years after age 50.

When new information is received, review the information and confirm if there is a change in:

• post-accident earnings,
• employment status, and/or
• work restrictions (i.e., confirmation of permanent work restrictions).

For ELS retirement reviews: Once a worker reaches age 64 or older, refer the claim to the Retirement Review Team to complete the review, with the exception of Special Care Services who complete their own ELS retirement reviews. Refer to the ELS retirement review section.

This step is completed by the case assistant.

Initiate the review by requesting information from the worker. 

Gather information from the worker

Call the worker to discuss the upcoming ELS review. Confirm if there have been any changes since the last review.

Confirm employment status and earnings. If the ELS is based on:

• Estimated earnings - Confirm the worker is still unemployed or underemployed. If employed, gather details about the job, including the position, start date, and salary.
• Actual earnings -Check that the worker's job, salary and employment status have not changed since the last review. If anything has changed, gather details about the change (e.g., new job, lay off, salary increase) and when it happened.  

Obtain proof of earnings. Explain to the worker that they are required to submit a confirmation of their earnings within the next three months. Discuss that acceptable proof of earnings may include:

• An official Canada Revenue Agency (CRA) Proof of Income Statement 'Option C' computer printout. This is the preferred document for verifying income, as it provides a comprehensive summary of all income sources, including dividends, self-employment and other earnings.
• Employer provided pay stubs, when income tax information is not available at the time of review. If the worker is working, ensure recent paystubs are submitted.
• Statement of Business activities if the worker is an owner/operator or self-employed.

Offer support

• If the worker needs assistance obtaining confirmation of their earnings from CRA, advise they can authorize a representative to request the information on their behalf by completing the Authorize a Representative for Offline Access (AUT-01) form and sending it directly to the CRA.
• Offer an in-person meeting to discuss the review. If they agree, inform them that they will receive a letter explaining the ELS review process, and that a case manager will contact them to schedule the meeting.
• Confirm if they will be able to submit the required information within three months. If they request additional time, find out why they need it and agree upon a date for the worker to submit the information. Note: If the worker requests additional time beyond the initial three-month period, the deadline (or due date or target date) for submission may be extended once, for a maximum of three additional months.
• If they advise they are unable to submit the required information, consider other options including:
  • Contacting their employer directly by phone or email to obtain their gross earnings information.
  • Asking the worker to have their employer provide a letter that confirms the worker's earnings.
  • Requesting the worker complete and sign a letter confirming their earnings when they indicate they did not file an income tax return. A signed letter alone may not be sufficient if a tax return has not been filed. The CRA Statement of Income helps confirm total employment income, which may include multiple sources such as other employment income, self-employment income, dividends or other income.
• Ask the worker to submit acceptable documentationAcceptable forms of documentation include an official Canada Revenue Agency (CRA) Proof of Income Statement 'Option C' computer printout, or employer provided pay stubs (when income tax information is not available at the time of review). of earnings or complete and sign the appropriate form when they live outside of Canada.
• If they have any concerns or need other assistance from WCB.

If no meeting is requested, continue monitoring the claim for incoming information. 

Determine if an extension on the timeline to submit the information is required

If the information is:

• likely to be received by the scheduled review date, continue to monitor for the information.
• not likely to be received by the scheduled review date, adjust the review date to the date the worker agreed to submit the information (up to a maximum of three months). If there are indications the worker is delaying the review process, discuss next steps with the supervisor and manager.

In both cases, send the appropriate review letter outlining the information needed. If the worker is self-employed, ask the Payment Unit to send a letter to obtain self-employment income and expenses

In-person meeting required (case manager)

Call the worker to book a meeting. During the meeting, discuss the ELS review, and together, agree on a plan to address the worker's concerns and set a new date for the worker to provide the information, if required.

This step is completed by the case assistant.

Upon receipt of the reminder task, review the claim to determine if the required information is on file.

When the required information has been received, continue to step 5 to complete the review.  

If the required information has not been received or has been received but cannot be used, call the worker to clarify the information needed. If the information submitted cannot be used, explain why. Let the worker know the information must be provided within four weeks (or by an agreed-upon date) to avoid disruption in benefits.

If an in-person meeting has not yet been completed, offer to arrange one. If the worker agrees to an in-person meeting, return to step 2. 

Send a second letter outlining the information required to complete the ELS benefit review. If the worker could not be reached, include a request for them to call as soon as possible. 

Continue to monitor the claim for the required information. 

Review for the required information in four weeks (or the agreed-upon date) 

When the information is:

• received, continue to step 5.
• not received, continue to the next step to obtain approval to temporarily suspend the ELS benefit.

This step is completed by the case assistant.

Temporary suspension of benefits

Send a recommendation to the supervisor to place a temporary stop on the ELS benefits.

When the supervisor:

• does not approve a temporary stop in ELS benefits, action any recommendations provided.
• approves a temporary stop in ELS benefits, call the worker to explain that their ELS benefit payments will be suspended because the required earnings information has not been provided. Confirm that benefits will be reinstated once the necessary documentation is received. If an in-person meeting has not already been completed, offer to schedule one.  If the worker agrees to an in-person meeting, return to step 2. 

Send a letter outlining the decision and specifying the information required to review the worker's ELS benefit payments. If the worker could not be reached, include a request for them to call as soon as possible. 

Review the claim in four weeks

Review the claim in four weeks for the required earnings information or a response from the worker. When the information is 

• Received, request removal of the temporary stop on the ELS benefit payments. Then continue to next step.
• Not received, consider placing a permanent stop on the worker's ELS benefit payments.

Permanent suspension of benefits

Send a recommendation to the supervisor to permanently stop the ELS benefits.

When the supervisor:

• does not approve a permanent stop in ELS benefits, action any recommendations provided.
• approves a permanent stop in ELS benefits, adjust the payments so they are permanently stopped. Do not continue with this procedure.

When the worker provides the required information, continue to the next step to determine if the worker remains eligible for ELS benefits and whether the benefit will be adjusted.

This step is completed by the case assistant.

Assess the information

Review the claim for changes in earnings or the original plan (e.g., work restrictions or employment status). 

Consider the following information:

• The initial proposal file note and/or the last review file note including any changes made to the original plan. Note: If the worker is in receipt of full compensation benefits (e.g., recurrence of disability, academic sponsorship, etc.) at the ELS review, set the rate based on the original ELS plan. Once the full benefits have come to an end, complete the ELS review and adjust accordingly.
• The Earnings loss supplement line -Line Details tab for the position that was used for the existing ELS and whether actual or estimated earnings were used.
• The new earnings information, whether the worker is working, and if the actual earnings are higher than the estimated earnings.
• If benefits were suspended, determine the effective date for any rate adjustments. The rate should be adjusted for the next effective payment date and then reinstate benefits. For example, if the review was scheduled for June but the information is provided in October, the adjustment takes effect in October. If actual earnings are higher than estimated, the rate is still adjusted for the next effective payment date and no overpayment is created for prior benefits. The only exception is if deliberate misrepresentation was made by the worker at the time of estimating
• Whether the date of retirement was discussed and confirmed with the worker.  Once a worker reaches age 64 or older, refer the claim to the Retirement Review Team to complete the review, with the exception of Special Care Services who complete their own ELS retirement reviews.
• Recent medical reporting for any changes in the worker's medical status or work restrictions.
• Dispute Resolution and Decision Review Body (DRDRB) and Appeals Commission (AC) decision memos which may affect the ELS benefit entitlement.
• Worker's claims history to check for subsequent claims with potential earnings and job position information.

Contact the worker to gather any additional information, if needed. If the worker is age 50 or older and their retirement date has never been confirmed, ask them to confirm it.

This step is completed by the case assistant.

Decrease in post-accident earnings or changes in the latest case plan

When there is a decrease in the worker's post-accident earnings or a change to the original (or latest) case plan, transfer the claim to a case manager to determine the impact on the case plan and benefits. 

Minimum wage-based ELS review

If there is no change in the legislated minimum wage, ensure the retirement date has been confirmed. If the retirement date:

• has been confirmed, continue to step 9 to communicate the decision.
• has not been confirmed, transfer the claim to the case manager to confirm the retirement date.  

If the legislated minimum wage has increased, ask the Payment Unit to calculate the monthly ELS amount using the approved maximum salary percentage increase that was in place at the time the ELS was approved. Continue to add the maximum salary percentage increase to the post-accident salary at yearly reviews until earnings are equivalent to the legislated minimum wage ensuring not to exceed the legislated. See the Library Resource 8-1D CPL - New WLS based on estimated earnings, Question 4, for the approved maximum salary percentage increases and the Scheduled minimum wage ELS review section. Adjust the ELS to reflect the minimum wage at the next scheduled review date.

Note: Adjustments to ELS for legislated minimum wage increases are only completed at the next scheduled review date. Unscheduled reviews are not completed at the time of the minimum wage increase.

No change in post-accident earnings or the latest plan or minimum wage 

When there is no change to the worker's post-accident earnings, the original plan or the legislated minimum wage (if the ELS was estimated on minimum wage), document the outcome of the review. 

Ensure the retirement date has been confirmed. If the retirement date:

• has been confirmed, continue to step 9 to communicate the decision.
• has not been confirmed, transfer the claim to the case manager to confirm the retirement date.  

Increase in actual post-accident earnings

When there is an increase in actual post-accident earnings, document the outcome of the review and ask that the Payment Unit to calculate the new amount. 

Ensure the retirement date has been confirmed. If the retirement date:

• has been confirmed, continue to step 9 to communicate the decision.
• has not been confirmed, transfer the claim to the case manager to confirm the retirement date.  

ELS to be discontinue

 Discontinue ELS benefits when the:

• Loss of earnings ends (i.e., the worker reaches pre-accident earnings),
• Worker no longer has compensable work restrictions, or
• Worker has reached normal retirement age, whichever comes first. Refer to the ELS retirement review section to complete a retirement review. Note: If a worker decides to retire early, they remain eligible for their full ELS benefit until they reach normal retirement age of 65. Continue to schedule reviews until the worker reaches normal retirement age, at which time the ELS is discontinued.

If the decision is to discontinue the ELS, update the claim to stop the ELS benefits. Document the outcome of the review including the reason the ELS is ending and transfer the claim to the case manager to communicate the decision. 

This step is completed by the case manager, except when the case assistant is involved to continue ELS payments based on minimum wage.

Review the case assistant's recommendation and the information received and determine how it impacts the ELS benefits. 

No change, confirm retirement

When there is no change to the worker's post-accident earnings or the original reduction plan, but retirement needs to be confirmed, call the worker to discuss their retirement plans and confirm a retirement date, if not already completed. Document the outcome of the discussion and continue to continue to step 9 to communicate the decision. 

Change in permanent work restrictions

When the medical evidence suggests or supports there has been a change in the worker's permanent work restrictions, determine if a decision can be made on the available reporting or if a referral for a consultant opinion or an assessment is needed to confirm work restrictions (e.g., medical consultant opinion, Functional Capacity Evaluation). Note: An independent medical examination (IME) is typically not required if permanent work restrictions were previously confirmed for the initial ELS.

Call the worker to obtain additional information, if needed and/or to discuss the assessment referral and the reason for it. Obtain their agreement to attend.

Review the assessment reporting once it is available. When there is a confirmed change in permanent work restrictions, reassess the suitability of job used for the ELS benefit estimation. When the job:

• Remains suitable, continue with the reduction plan outlined in the latest ELS plan.
• Is no longer suitable, review re-employment plan and identify another suitable job to re-estimate the earnings.

Ensure any change in the worker’s permanent work restrictions is communicated in writing.

Change in Earnings or Employment Status

Consider if the post-accident earnings have increased or decreased and the impact to the ELS benefit. Refer to Policy 04-04, Part II, Application 1 - Determining Impairment of Earning Capacity.

If ELS is based on:

• Actual earnings and the earnings increased: Continue to the next step to obtain approval to adjust the ELS to reflect the actual increase in post-accident earnings.
• Actual earnings and the earnings decreased: Assess the reason for the decrease in earnings and whether the job the worker was employed in was suitable. If the job was:
  • suitable, continue with the reduction plan outlined in original (or latest) ELS plan. Proceed to step 9 to communicate the decision.
  • not suitable, review re-employment plan and identify another suitable job to re-estimate the earnings. Continue to the next step to request approval for the new wage loss, if applicable.
• Estimated earnings, the worker is working, and their actual earnings are higher, continue to the next step to obtain approval to adjust the ELS to reflect their actual earnings.
• Estimated earnings of minimum wage and there has been a legislated increase, determine if the ELS should be adjusted for the legislated minimum wage increase. When the ELS
  • will continue to be based on minimum wage, document the decision and ask the case assistant to action accordingly. Case assistant: Update the claim and continue to step to step 9 to communicate the decision.
  • will not continue to be based on minimum wage, determine the next steps needed to determine if the worker is experiencing a loss in income and re-estimate earnings, if appropriate (i.e., identify another suitable job to estimate earnings, use actual earnings, etc.). Continue to the next step to request approval for the new wage loss, if applicable.

ELS to be discontinued

If the recommendation is to discontinue the ELS benefit, confirm the reason the benefits will end and ensure ELS benefits have stopped. Continue to step 9 to communicate the decision.

Send a recommendation to the supervisor to adjust ELS benefit payments.  Include a reference to the case assistant's recommendations, the rationale to support the decision and the next review date (i.e. annual or 5 years, etc.).

If at the ELS review:

• The worker is in receipt of full compensation benefits (e.g., recurrence of disability, academic sponsorship, etc.), set the rate based on the original ELS plan. Once the full benefits have come to an end, review the ELS and adjust accordingly.
• The worker's earnings capacity is higher than estimated or they had an increase in actual earnings in the past, adjust the rate for the next effective payment date. An overpayment is not created for prior benefits. The only exception is if deliberate misrepresentation was made by the worker at the time of estimating.

The supervisor, manager, and/or director reviews the information and approves or does not approve the recommendation. Refer to the 8-3A Levels of Authority (LOA) for initial approval of ELPs, TELs, TPDs and ELSs in the Resource Library.

This step is completed by the case manager or the case assistant (for ELS extensions, including minimum wage extensions).

When there are no changes to the ELS, call the worker to discuss the outcome of the review. Explain that the ELS benefits will be extended and confirm the reduction plan and next review date. Ensure the worker understands that the ELS ends at normal retirement age (age 65), unless there is satisfactory evidence to support an extension of their retirement age. Refer to the Satisfactory evidence to extend retirement age section.

Changes to the ELS

Review the supervisor's, manager's and/or director's decision to approve or not approve the recommendation to adjust the ELS benefits.

If the ELS adjustment is

• not approved, action any recommendations and return to step 8 to resubmit for approval.
• approved, call the worker to discuss the decision. Clearly express the rationale used to reach the decision (citing policy and information used to make the decision). Confirm the worker's date of retirement, if not already completed. Ensure the worker is aware that Canada Revenue Agency (CRA) considers ELSs to be reportable income for T-5007 purposes.  
• no longer payable, call the worker to discuss the decision and the reason the ELS benefit is ending. Action any outstanding items. If no further action is required, inactivate the claim.

If the worker's ELS benefits were permanently stopped, reinstate the benefits and ensure any adjustment to the rate is adjusted for the next effective payment date. An overpayment is not created for benefits previously paid. The exception is if there is deliberate misrepresentation from the worker at the time of estimating.

If the worker disagrees with the decision, consider whether their concerns require further review. If not, explain why the decision is unchanged. Communicate the decision in writing and include the date of the next review and the worker's retirement date. Case manager, transfer for the claim to the case assistant for continued monitoring, if appropriate.

Case assistant

Review the monitoring recommendations from the case manager.  Ensure the retirement date has been confirmed.  If not confirmed, return the claim to the case manager.

Continue to monitor the claim until the next scheduled review date or sooner if there is a change in the case plan (e.g., earnings, employment, or work restrictions). Return to step 1 to repeat the procedure.

Note:  When there was a delay in completing the review (e.g. the worker's earnings were submitted late), adjust the next review date to be one year from the current review.