Workers' Compensation: Part 2 - COHS208 Module 5 PDF

**Workers\' Compensation: Part 2** introduces the continuation of the Workplace Safety and Insurance Act (WSIA), focusing on Parts VI through XIII. In the previous module (Module 4), key concepts such as who is covered, prevention, insurance, claims, benefits, rights of action, and return-to-work pl...

**Workers\' Compensation: Part 2** introduces the continuation of the Workplace Safety and Insurance Act (WSIA), focusing on Parts VI through XIII. In the previous module (Module 4), key concepts such as who is covered, prevention, insurance, claims, benefits, rights of action, and return-to-work plans were discussed. Now, in this module, the coverage expands to: - - - - - - - - The module focuses on various benefits (disability compensation, death benefits, pensions), and administrative details. Students are encouraged to use the WSIA from the e-Laws website as a reference for these sections. Many of the theoretical concepts from earlier modules will now be applied practically. **Insured Payments** Workers who experience a loss of earnings due to a workplace injury covered by insurance are entitled to several types of payments under the WSIA. These include: - - - - If a worker dies on the job, survivors receive wage replacement, a lump-sum death benefit, and funeral expenses (WSIA sections 43-48). **Payment Details:** - - - - - - - **Points of Clarifications:** - - **Change-over Benefits:** - **Review of Payments:** - **Examples:** - **Loss of Retirement Income (WSIA Section 45)** When workers are injured and receive loss of earnings payments for over 12 consecutive months, the WSIB sets aside 5% of each payment for retirement. Workers under 64 can also choose to contribute an additional 5%, but this decision is final and must be made in writing. The contribution is deducted from their payments. At age 65, workers receive a pension based on the total amount set aside, plus interest. If the total is over \$3,000, they can convert it to an annuity or other payment form; smaller amounts are paid as a lump sum. Survivors may receive benefits, but typically not from both section 45 (retirement income) and section 48 (death benefits). The WSIB provides annual statements showing contributions, investment income, and other relevant details. **Non-Economic Loss (NEL)** When a worker suffers a permanent impairment, they are entitled to compensation for the **loss of enjoyment of life**, unrelated to income. This compensation is determined through a two-step process: 1. 2. - - - Examples Let us calculate the non-economic loss (NEL) entitlement of a 55-year-old worker who is 15% impaired. 55 - 45 = 10 years greater than 45 \$1,313.71 x 10 = \$13,137.10 \$59,095.26 - \$13,137.10 = \$45,958.16 (for 100% impaired) Since the worker is 15% impaired, \$45,958.16 x 0.15 = \$6,893.72 Let us calculate the NEL for a worker who is 30 years of age, and who is 80% impaired. 45 - 30 = 15 years less than 45 \$1,313.71 x 15 = \$19,705.65 \$59,095.26 + \$19,705.65 = \$78,800.91 (for 100% impaired) Since the worker is 80% impaired, \$78,800.91 x 0.80 = \$63,040.73 **Survivor Benefits (WSIA)** Survivor benefits, referred to as \"death benefits\" under the Workplace Safety and Insurance Act (WSIA), are paid to the survivors of a worker who dies due to a work-related injury. ### **Surviving Spouse** - - - - - - - ### **Spouse with Children** - - ### **No Surviving Spouse** - - ### **Additional Provisions** - - ### **Lump-Sum Payment for Surviving Spouse:** 1. 2. - - 3. ### **Periodic Payments:** 1. - - - - - 2. - ### **Example Calculations:** - - - - - - - - ### **Administration Summary (Sections 49--66)** The WSIA addresses various administrative issues from sections 49 to 66. Here\'s a simplified overview: - - - - - ### **Employer Obligations Summary** Sections 67 to 87 of the WSIA outline the obligations of employers regarding the insurance plan. All Schedule 1 and Schedule 2 employers must register with the Board within 10 days of hiring and report their estimated wages. Schedule 1 employers are required to provide annual wage summaries to help determine premium amounts. The Board sets premium rates based on accident records and safety precautions taken by employers and can adjust premiums based on injury frequency. Employers can apply for cost transfers if a worker's injury is caused by another employer. While Schedule 1 employers do not pay benefits directly to workers, Schedule 2 employers are responsible for their own costs and must pay benefits to injured workers. Additionally, Schedule 2 firms may be required to deposit funds with the Board for future claims and obtain insurance coverage for accident costs. ### **Compensation and Prevention Summary** The WSIA allows the Board to adjust premium rates for Schedule 1 firms based on their safety practices, accident records, compliance with first aid requirements, and workplace injury costs compared to industry standards (Section 82). Section 83 enables the Board to create programs that incentivize employers to reduce workplace injuries. The overarching goal of the WSIA is to promote health and safety in workplaces through various methods, including education and economic sanctions. Increasing premiums for firms with poor safety records serves as a financial motivator to encourage safer workplace practices, thus ensuring adequate funding for the insurance pool. In contrast, Schedule 2 firms, which are self-insured, do not face similar economic incentives to enhance safety, as they bear the full costs of accidents without the pressure of fluctuating premiums. ### **Insurance Fund Summary** The WSIA mandates that the Board maintains an insurance fund for Schedule 1 employers to ensure that sufficient funds are available to pay for benefits and operational costs when needed. Section 96 requires the Board to monitor the fund\'s sufficiency and prevent any individual class from being unfairly burdened by past accident costs. The Lieutenant Governor of Council has the authority to direct the Board to increase premiums to meet funding standards. Additionally, the Board can establish reserve funds for future accident costs, with these funds invested according to the Pension Benefits Act. If deficiencies arise, the Board can require additional premiums from all employers. Section 100 allows the Lieutenant Governor to make regulations under specific circumstances. **Sections Not Covered** Part IX of the Act deals with transitional rules. These rules are not within the scope of this course and hence, not covered. Part X deals with uninsured employment, and this area was briefly discussed earlier in this course. ### **Decisions and Appeals Summary** The WSIA grants the Board exclusive authority to make decisions on matters related to the Act, including classification of industries, determining injuries caused by accidents, and assessing compliance with return-to-work programs (Section 118). The Board\'s decisions **are final and cannot be challenged in court, as outlined in the finality and privative clauses.** If parties disagree with a decision, they can file a written notice of objection within specific timeframes, and the Board may reconsider its decision or offer mediation. **Judicial Review:** This is the process through which a court reviews decisions made by the Board under the WSIA. The Board makes its decisions based on case specifics rather than legal precedents. If the evidence for and against a claim is roughly equal, the decision favors the worker. If a party believes the Board made an error, they can file a written notice of objection within six months (or 30 days for certain decisions). The Board can reconsider its decision and may offer mediation. **Appeals Tribunal:** Established in section 123, the Appeals Tribunal hears appeals of final Board decisions regarding health care, benefits, and classifications. It can uphold, modify, or reverse these decisions based on case merits, not legal precedents. The Tribunal issues written decisions within 120 days and may refer policies back to the Board for review if inconsistent with the WSIA. Both the Board and the Tribunal have the authority to summon witnesses and require documents, and they cover witness expenses. ### **Enforcement Summary** Starting with section 135, the WSIA outlines the Board\'s enforcement powers, allowing it to examine employers\' records and conduct investigations to verify: - - - - The Board can inspect premises to ensure the safety of machinery and worker precautions. Part XII details the Board\'s rights to enforce premium payments and addresses issues related to contractors and subcontractors in construction. Offences include making false statements, failing to report changes in circumstances, and non-compliance with registration and reporting requirements. If a corporation commits an offence, responsible directors or officers may also be charged. Prosecutions must occur within two years of the offence being known, except for false statements, which have no time limit. Penalties for convictions include: - - All fines contribute to the insurance fund. ### **Administration of the Act Summary** This section outlines administrative aspects of the WSIA, confirming that the Workers\' Compensation Board is now called the Workplace Safety and Insurance Board (WSIB). The WSIB has various powers, including: - - - - - - The governing Board includes a chair and president, both appointed by the Lieutenant Governor, along with at least nine members representing workers and employers. Every five years, the WSIB develops an annual strategic plan in agreement with the Minister of Labour. Section 168 mandates a value-for-money audit of one program each year. The Workplace Safety and Insurance Appeals Tribunal and the Offices of Worker and Employer Advisors continue to operate. The Office of the Worker Advisor assists non-unionized workers and their survivors, while the Office of the Employer Advisor helps employers with fewer than 100 employees.