Economic loss payment (ELP) 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, 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).

When the information will impact the ELP 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). 

For ELP retirement reviews, refer the claim to the Retirement Review team who will complete the review, with the exception of Special Care Services who complete their own ELP retirement reviews. Refer to the ELP 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 ELP review. Confirm if there have been any changes since the last review.

Confirm employment status and earnings. If the ELP 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, layoff, 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 pay stubs 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 them that 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 ELP 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 that they are unable to submit the required information, consider other options. This may include:
  • 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 their 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.

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 ELP 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 ELP 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 on 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 ELP benefit.

This step is completed by the case assistant.

Temporary suspension of ELP benefits

Send a recommendation to place a temporary stop on the ELP benefits.

When the supervisor:

• does not approve a temporary stop in ELP benefits, action any recommendations provided.
• approves a temporary stop in ELP benefits, call the work to explain that their ELP 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 ELP 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 ELP benefit payments. Then continue to next step.
• Not received, consider placing a permanent stop on the worker's ELP benefit payments.

Permanent suspension of ELP benefits

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

When the supervisor:

• does not approve a permanent stop in ELP benefits, action any recommendations provided.
• approves a permanent stop in ELP benefits, request they be 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 ELP 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 at the ELP36 review, complete the review based on the original ELP plan. Once the full benefits have come to an end, complete the ELP review and adjust accordingly.
• The Case Planning Line Details tab for the position that was used for the existing ELP benefit 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.
• 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 ELP 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. 

This step is completed by the case assistant.

Proceed with the claim actions based on the review outcomes outlined below. 

If ELP benefits were permanently suspended while awaiting required information for a review, and the claim is subsequently transferred, ensure the case manager is notified. The benefit may need to be reinstated depending on the outcome of the review.

Note: For any worker aged 50 or older whose retirement date has not been confirmed, transfer the claim to the case manager to discuss the worker's plans for retirement.

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 changes 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 ELP review

When there is an increase in the legislated minimum wage, the ELP is not adjustment immediately (i.e., unscheduled review). The adjustment for the increase is completed at the next scheduled review date. 

At the scheduled review date (whether the legislated minimum wage has increased or not), recalculate the reduction plan by adding maximum salary percentage increase to the last approved post-accident earnings. Confirm the recalculated amount is not higher than the current minimum wage. If it is, use the current minimum wage for the reduction plan. 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 minimum wage. Refer to 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-based ELP reviews section. 

After updating the file with the reduction plan, determine next steps:

• If the ELP will continue, continue to step 9 to communicate the extension.
• If the recommendation is to discontinue the minimum wage-based ELP, transfer the claim to the case manager for review and decision.

Once the file has been updated with the reduction plan, continue to step 9 to communicate the decision to extend the minimum wage-based ELP, unless information supports the ELP should be discontinued. In those circumstances, transfer the claim to the case manager to review and determine if it should be discontinued.

Note: Approval is not required to extend the minimum wage-based ELP, unless the total wage loss liability increases by $10,000. 

Estimated earnings, no change in post-accident earnings or ELP estimated on minimum wage

When the ELP is based on estimated earnings and there is no change in post-accident earnings or the case plan, continue to step 8 to send a recommendation to the supervisor to extend the ELP based on reduction plan outlined. 

In some circumstances, WCB may decide that yearly reviews are not required, such as when a worker is severely disabled and it is clear their impairment in earnings capacity will not change. The case manager sets the review frequency based on individual circumstances. For example, when a no-post-accident earnings (zero-based) ELP was implemented because:

• the medical evidence confirms the worker is not capable of working because of compensable work restrictions, reviews may occur every three years until age 50 and every five years after age 50.
• there was no job lead, yearly reviews may be required to confirm if the worker found a job. 

For a permanently totally disabled worker, the ELP is reviewed after 36 months to set the ELP 36 rate. Following this, scheduled reviews do not occur since the ELP benefits are paid for the worker's lifetime. Refer to Policy 04-04, Part I, Permanent Disability. In all cases, if unclear, discuss with the case manager or the supervisor when the next scheduled review should take place.

Actual earnings review occurs before the ELP 36 review date

If the post-accident actual earnings increased by:

• less than 6%, document the change in earnings on the claim and call the worker to explain that their ELP will not be adjusted because their increase in earnings is less than 6%. Notify the worker of the date for their scheduled review date.
• 6% or more, send a recommendation to the case manager to adjust the ELP to reflect the increase in post-accident earnings.

Actual earnings review occurs on or after the ELP 36 review date

Send a recommendation to the case manager to adjust the ELP based on the increase in post-accident earnings or continue with the reduction plan from the original case plan when there is no change in the worker's post-accident earnings.

This step is completed by the case manager.

Review the case assistant's recommendation and the information received and determine how it impacts the ELP benefits. Confirm the worker's plans for retirement if they are age 50 or older if there is no confirmed retirement date.

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 ELP.

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 the job used for the ELP benefit estimation. When the job:

• Remains suitable, continue with the reduction plan outlined in the latest ELP case planning line.
• Is no longer suitable, review the 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 ELP benefit. Refer to Policy 04-04, Part II, Application 1 - Determining Impairment of Earning Capacity.

If the ELP benefit is based on:

• Actual earnings and the earnings increased since the last review, adjust ELP 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 ELP.
• 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 ELP case plan.
  • not suitable, review the re-employment plan and identify another suitable job to re-estimate the earnings.
• Estimated earnings and the worker is working, and their actual earnings are higher, adjust the ELP to reflect their actual earnings.
• Estimated earnings of minimum wage and the case assistant's recommendation is to discontinue the ELP benefit, consider the information on file and the rationale provided. Decide if the minimum wage- based ELP will continue or be discontinued. If it:
  • will continue, ask the case assistant to action accordingly.
  • will not continue to be based on minimum wage, determine the basis for the ELP based on the claim circumstances (i.e., identify another suitable job to estimate earnings, use actual earnings, etc.).

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

Send a recommendation to the supervisor to extend or adjust the ELP.  Include the rationale to support the decision and the next review date (i.e., yearly, 3 years, 5 years, etc.). Complete the case planning line as appropriate for the ELP recommendation.

If at the ELP 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 ELP plan. Once the full benefits have come to an end, review the ELP 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 ELP moving forward. Note: An overpayment is not created, unless the circumstance warrants a recovery as outlined in the policy. When recovery is warranted, adjust the ELP retroactively to create the overpayment and start the recovery process. Refer to Policy 05-01, Part II, Application 1 - Compensation Overpayments. Any adjustments must be done for the first of the month.
• There are special circumstances (e.g., DRDRB decision, Appeals Commission decision) that result in the ELP 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 information and approves or does not approve the recommendation. Refer to the Levels of Authority (LOA) for initial approval of ELPs, TELs, TPDs and ELSs in the Resource Library.

Note: If earnings are entered in the case plan incorrectly or are altered in a yearly plan, causing the system to recalculate the ELP benefits incorrectly (e.g., the ELP 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 extensions when there is no change in the original plan) and the case manager.

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

If the ELP 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). Review the reduction plan and confirm the worker's date of retirement, if not already completed. Ensure the worker is aware that Canada Revenue Agency (CRA) considers ELPs to be reportable income for T-5007 purposes. Note: If the ELP benefits were permanently discontinued while awaiting required information, notify the Payment Unit to remove the permanent suspension and reinstate the ELP benefits.
• no longer payable, call the worker to discuss the decision and the reason the ELP benefit is ending. Action any outstanding items. If no further action is required, inactivate the claim.

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. 

For case assistants: After communicating the ELP extension decision, if the worker is age 50 or older and their retirement date has not been confirmed, assign the claim to the case manager to confirm it. Alternatively, if no active case management is required, follow the case assistant monitoring details outlined below.

For case managers: After communicating the decision, transfer for the claim to the case assistant for continued monitoring, if appropriate.

Case assistant monitoring

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.