Temporary economic loss (TEL) benefit 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 permanent work restrictions. When new information is received that may impact the TEL benefit (unscheduled review), continue to step 5.

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). 

Sixty (60) days before the scheduled review date

Review information related to the initial TEL benefit approval including: 

• The initial TEL approval file note.
• Start and end date TEL benefits.
• The reduction plan for each year the TEL will be paid.
• The basis of the TEL and the information that needs to be gather (e.g., earning information such as paystubs, medical information to confirm work restrictions).

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 review of their TEL benefit. Confirm if there have been any changes since the last review. 

Confirm employment status and earnings - If the TEL 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.
• Employer provided pay stubs when income tax information is not available at the time of review.
• Statement of Business activities if the worker is an owner/operator or self-employed.

Offer Support 

• If 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 TEL 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.
• 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.

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 TEL 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.

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 TEL benefit review. If the worker could not be reached, include a request for them to call as soon as possible. 

Continue to monitor for the required information.

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

If the information has been received, continue to step 5.

If the information has not been received, continue to the next step to obtain approval to temporarily suspend the TEL benefit.

This step is completed by the case assistant.

Temporary suspension of TEL benefits

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

When the supervisor:

• does not approve a temporary stop in TEL benefits, action any recommendations provided.
• approves a temporary stop in TEL benefits, call the work to explain that their TEL 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 TEL benefit payments. If the worker could not be reached, include a request for them to call as soon as possible. 

Review for the required information in four weeks

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

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

Permanent suspension of TEL benefits

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

When the supervisor:

• does not approve a permanent stop in TEL benefits, action any recommendations provided.
• approves a permanent stop in TEL benefits, request they be permanently stopped. Do not continue with this procedure.

When the worker provides the required information, reinstate the TEL benefit payment and continue the review. 

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). 

Include the following in the review:

• The initial proposal file note and/or the last review file note including any changes made to the original plan.
• The Case Planning Line Details tab for the position that was used for the existing TEL benefit and whether actual or estimated earnings were used.
• The Case Planning Line Details tab for the position and earnings (i.e., actual or estimated) used for the TEL benefit.
• The new earnings information, whether the worker is working, and if the actual earnings are higher than the estimated earnings.
• Whether the date of retirement was discussed and confirmed with the worker.
• 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 TEL 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.

Action the claim based on the outcome of the review

When there is:

• No Change in earnings or the latest plan: Continue to Step 7 to send a recommendation to the supervisor, including a summary of the review.
• A change in earnings or the latest plan (e.g., earnings increase or decrease, job change, work restrictions, one-year TEL or TEL is not expected to end in 6 years and may need to be converted): Transfer the claim to a case manager.

This step is completed by the case manager. 

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

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 as permanent work restrictions were previously confirmed for the initial TEL.

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 TEL benefit estimation. When the job:

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

Change in Earnings or Employment Status 

Consider if the post-accident earnings have increased or decreased and assess how this change impacts the TEL benefit. Refer to Policy 04-04, Part II, Application 1 - Determining Impairment of Earning Capacity.

If the TEL benefit is based on

• Actual earnings and the earnings increased since the last review, adjust the TEL to reflect the actual increase in post-accident earnings. If there is no loss of earnings (i.e., worker reaches pre-accident earnings), discontinue the TEL.
• 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. Adjust the TEL based on the reduction plan for same position, if appropriate.  When a new position is required, review re-employment plan and identify another suitable job to re-estimate the earnings and follow the 8-1 Wage loss supplement (WLS) final approval procedure.  
• Estimated earnings and the worker is working, and their actual earnings are higher, adjust the TEL benefit to reflect their actual earnings.

Consider converting the TEL to an ELP when the worker is not expected to reach their date-of-accident earnings within six (6) years (e.g. due to applied cost of living increases, change in earnings or position). 

If a one-year TEL was approved, evaluate salary projections to determine if the worker is likely to reach pre-accident earnings within six years. If the worker did not receive any salary increases or none are known, consider converting the TEL benefit to an ELP.

Continue to the next step to request approval to convert the TEL benefit to an ELP.

This step is completed by the case assistant (for extensions-no change in the original plan) and case manager.

Send a recommendation to the supervisor requesting approval to extend, adjust or convert the TEL benefit. Include the rationale to support the decision and the next review date. Complete the Case Planning Line as appropriate for the TEL recommendation.

The supervisor reviews the information and approves or does not approve the recommendation. For TEL extensions exceeding one year for the same plan, the supervisor forwards the recommendation to the manager and director for approval. TEL conversions an ELP are also sent to the appropriate level of authority, as required. Refer to the Levels of Authority (LOA) for initial approval of ELPs, TELs, TPDs and ELSs in the Resource Library.

If at the TEL 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 TEL plan. Once the full benefits have come to an end, review the TEL 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 TEL moving forward. Note: An overpayment is not created, unless the circumstance warrants a recovery as outlined in policy. When recovery is warranted, adjust the TEL retroactively to create the overpayment and start the recovery process. Refer to Policy 05-01, Part II, Application 1 - Compensation Overpayments.
• There are special circumstances (e.g. DRDRB decision, Appeals Commission decision) that result in the TEL being discontinued or adjusted after the first day of the month contact a payments specialist to discuss options for the adjustment of the payment.

The supervisor, manager, and/or director reviews the recommended and approve or does not approve the recommendation.

Note: If earnings are entered in the case plan incorrectly or are altered in a yearly plan, causing the system to recalculate the TEL benefits incorrectly (e.g., the TEL payments were inflated because earnings were changed and the system incorrectly recalculated the COLA), notify the Payment Unit to fix the error. Correcting or changing the information in the CPL will not correct the error; it has to be corrected by the Payment Unit. If the error is identified after the supervisor has reviewed and approved the initial change, the claim must be sent to the supervisor for approval again once the line has been corrected. 

This step is completed by the case assistant (for TEL extensions) and the case manager.

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

If the TEL is not approved, action any recommendations and return to step 5 to re-evaluate the TEL benefits.

If the TEL is 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). If the worker disagrees with the decision, consider whether their concerns require further review. If not, explain why the decision is unchanged. 

If the TEL is being converted to an ELP, review the reduction plan and discuss the review schedule (i.e., when the 36-month review will take place). Confirm the worker's plans for retirement, if the worker is over age 50 and retirement has not previously been discussed with them.

Communicate the decision in writing. Case manager, transfer the claim to the case assistant for continued monitoring, if appropriate. 

Note: Ensure the worker is aware that the considers TEL benefits to be reportable income for T-5007 purposed. 

If the TEL is no longer payable, action any outstanding items. If no further action is required, inactivate the claim.

This step is completed by the case assistant.

Review the monitoring recommendations from the case manager. Ensure the retirement date has been confirmed, if required when the TEL was converted to an ELP or the TEL benefit is scheduled to end before the date of retirement. If the retirement date has not been confirmed, return the claim to the case manager.

Note:  If there was a delay in completing the review (e.g., late submission of earnings), set the next review date to one year from the current review date rather than the originally scheduled date.

Return to step 1 to monitor the claim.