WCB Procedures

Lump sum retirement (pre-retirement) benefit approval

Procedure summary

Published On

May 20, 2025

Purpose

To determine a worker's entitlement to a lump sum retirement benefit, also referred to as a pre-retirement benefit or (PRB), based on criteria set in policy and any cost adjustments to an existing or new PRB that may be required.

Description

PRB payments are processed by the Medical Aid team when the criteria for payment (as identified in Policy 04-02, Part II, Application 1 and/or Policy 04-04, Part II, Application 3, Questions 11-18) are met.

The decision maker reviews and acts on PRB requests and adjustments in the following situations:

When a worker or their representative requests a PRB payment, the decision maker assesses eligibility and communicates the decision.
When the Medical Aid team adjusts an already issued PRB payment, the decision maker communicates the decision to adjust the PRB payment. If the adjustment results in an overpayment, the decision maker determines whether the overpaymentAn overpayment happens when a worker is paid more compensation benefits than they are entitled to receive. This may occur due to factors, such as changes in the worker's earnings, compensation rate, return-to-work date, or other benefits. An overpayment occurs when a worker received more compensation benefits than they were eligible. An overpayment may occur due to various reasons such as changees in the worker's earnings or compensation rate, return to work date, or other benefits.will be recoveredOverpayment recovery means reclaiming extra benefits paid to a worker. WCB reviews each overpayment and decides whether to recover or cancel it. Recovery usually happens due to duplicate earnings, deliberate misrepresentation, or errors is identified within two weeks of the payment. Overpayments may be cancelled if they result from administrative errors or a reconsideration of a decision. a Overpayment recovery means reclaiming excess benefits paid to a worker. WCB reviews each overpayment and decides whether to recover or cancel it. Recovery typically occurs when there is a duplication of earnings, deliberate misrepresentation, or an error is identified within two weeks of the excess payment. An overpayment may be cancelled if it resulted from a an administrative error or a reconsideration of a decision.nd communicates the overpayment decision.
When the Medical Aid team recovers an overpayment from a new PRB payment, the decision maker reviews whether it is appropriate to recover the overpayment from the PRB payments. They will then communicate the decision about the overpayment recoveryOverpayment recovery means reclaiming extra benefits paid to a worker. WCB reviews each overpayment and decides whether to recover or cancel it. Recovery usually happens due to duplicate earnings, deliberate misrepresentation, or errors is identified within two weeks of the payment. Overpayments may be cancelled if they result from administrative errors or a reconsideration of a decision..

Key information

A PRB is a lump sum retirement payment to compensate a worker for reduced opportunity to contribute to retirement plans as a result of their injury. The payment is equivalent to two percent of the total wage loss benefits paid on a worker's claim from the date of accident up to the month in which the wage loss benefits ended. Refer to Policy 04-02, Part II, Application 1, Question #14 for further details.

The earliest PRB benefit is paid 45 days after wage loss benefits end.

A worker is eligible for a PRB payment when:

The date of accident was on or after January 1, 2018.
The worker's wage loss benefits ended before the worker's normal retirement age, and
The worker was in receipt of temporary wage loss benefits continuously for a minimum of 24 months (two years) before their wage loss benefits ended.

The type of wage loss benefit includes all periodic rate-based payments:

Temporary total disabilityTemporary total disability benefits are payable when there is medical evidence that a worker's work-related injury has resulted in temporary work restrictions which prevent them from resuming pre-accident employment or other suitable employment. (TD01, TD04),
Temporary partial disabilityTemporary partial disability benefits are payable when the weight of medical evidence indicates a worker has compensable temporary work restrictions but is physically and medically capable of returning to a modified version of their pre-accident job or another suitable job. Temporary partial disability benefits are payable when the weight of medical evidence indicates a worker has compensable temporary work restrictions but is physically and medically capable of returning to a modified version of their pre-accident job or another suitable job.(TD02),
Re-employment (vocational) wage loss benefitsRe-employment or vocational benefits are payable when a worker's compensable work restrictions prevent them from returning to their date-of-accident job and re-employment services are provided to help them return to the workforce. The type of benefit payable depends on the type of re-employment support provided (e.g., supported job search, retraining). (VR01, VR02, VR04, VR05), and
Wage loss supplementsWhen a worker's compensable work restrictions result in an impairment of their earnings capacity, they may be eligible for a wage loss supplement, which provides a top-up between their estimated or actual earnings and their earnings at the time of their injury. When a worker's compensable work restrictions result in an impairment of their earnings capacity, they may be eligible for a wage loss supplement, which provides a top-up between their estimated or actual earnings and their earnings at the time of their injury.including temporary partial disability (TPD), and temporary economic loss (TEL) and economic loss payment (ELP), as long as the TEL and/or ELP ended before the worker reached their normal retirement ageAge 65 is considered normal retirement age. However, if the date of accident is on or after January 1, 2018, and the worker is 60 or older at the time of accident, WCB considers normal retirement age to be 65 or 5 years after, whichever is later.. Refer to Policy 04-04, Part II, Application 3.
If a worker is in receipt of a TEL or ELP at normal retirement age, refer to step 3.

A deceased worker's estate is entitled to the pre-retirement benefit, if the policy criteria are met.

Detailed business procedure

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1. Review the request and assign to the triage team Decision maker (non-triage team) When a request for a PRB or an adjustment to an existing PRB benefit is received from a worker or representative, notify the Triage team supervisor. Note: The Medical Aid team processes new PRB benefits or adjustments to existing PRB benefits. that meet the policy criteria. They manage and/or assign claims to the Triage team, as appropriate. They will outline the action that is required in a file note.	Administrative tasks If the claim is not assigned to the Triage team, send a task (TCM to assess for PRB) to the Assign E31, Team Desk. The supervisor assigns the claim to a triage decision maker. Call the Triage team supervisor if there are any questions.
2. Review the request for PRB and assign the claim, if needed. Triage team supervisor Review the request for review for a new PRB or an adjustment to an existing PRB. The request may originate from the Medical Aid team, a non-triage decision maker, worker or their representative. When the claim is: Not assigned to a decision maker, assign it to a triage team decision maker. Assigned to a decision maker in Client Services, notify the triage team decision maker to review the request for PRB benefits. The claim will remain assigned to the original decision maker and the triage decision maker will determine eligibility for the PRB benefit.	Administrative tasks If the claim is not assigned to the Triage team, send a task (TCM to assess for PRB) to the Assign E31, Team Desk. The supervisor assigns the claim to a triage decision maker. If the claim is already assigned, send a task (TCM - PRB review required) to a triage decision maker.
3. Review the request and determine eligibility for a PRB benefit Determine why the PRB benefit requires review and action, as appropriate. PRB request received from Medical Aid When the Medical Aid team: Adjusts a previously paid PRB, resulting in a: higher PRB payment owing to the worker, continue to the next step to communicate the decision. lower PRB payment owing to the worker, determine if the resulting overpayment should be recovered or cancelled (cost corrected/forgiven) and action the overpayment as appropriate. Continue to the next step to communicate the decision. Recovers an existing overpayment from a new PRB payment owed to the worker, determine if it was reasonable to recover the overpayment from the PRB payment. If it is not reasonable, take the appropriate action regarding the overpayment. Continue to the next step to communicate the decision. PRB request received from the worker or their representative When a request for review for PRB benefits is received from a worker or their representative, confirm the worker meets eligibility criteria for a PRB benefit. Refer to the eligibility criteria in the Key information section. If the worker does not meet the eligibility criteria, consider if any special circumstances apply: It has been 45 days since the wage loss benefits ended. Eligibility for PRB benefit will not show up on the report until 45 days have passed, at which time a review for PRB benefits will be completed by the Medical Aid team. If there is a gap in wage loss benefits, the wage loss benefit duration period ends. When wage loss benefits restart, a new duration period also starts. If wage loss benefits were paid for less than 24 months, review the reason why the benefits ended and decide if it was appropriate to stop the benefit. For example, if there is a short gap of one or two days of benefits, consider if all the days were not captured in the payment for this period but should have been, or if benefits were suspended but should have been reinstated retroactively. If the reason the benefits ended was Appropriate, the worker is not eligible for a PRB benefit. Was not appropriate and/or due to an error, issue the wage loss benefits retroactively to resolve the gap. Once there is no gap, determine if the worker received 24 months of continuous wage loss benefits. If they did, the worker is eligible for a PRB benefit. The worker has any other claims where wage loss payment benefits were issued. If so, check whether the total duration of continuous payments is at least 24 months across all claims. If this condition, along with other criteria for the payment is met, the worker is eligible for a PRB payment. The worker was in receipt of an ELP or TEL, but their benefits ended before normal retirement age. If they did, the worker is eligible for the PRB benefit as long as the other criteria are met. The worker was in receipt of a TEL to their normal retirement age. If they were, the worker is not eligible for a PRB payment. Ensure that the TEL is converted to an ELP. The worker is in receipt of an ELP to normal retirement age. If they were, the worker is not eligible for the PRB payment as their ELP is adjusted to reflect retirement income and the adjusted ELP is payable for life. Following the review, go to the next step to communicate the decision. If following the review, it appears that a PRB payment should have been issued by the Medical Aid team (i.e., the claim meets the criteria for a PRB payment and there was no error that needed to be corrected to eliminate a gap in wage loss benefits), notify the Medical Aid team of the issue. Calculate the amount of the PRB payment and request that of the issue the payment. To calculate the PRB payment or for additional information, refer to the Pre-retirement benefit frequently asked questions section.	Administrative tasks Follow the internal Procedure 5.2 Diagnose a Cost Adjustment and Cost Correct/Forgive it or Collect it as an Overpayment. Contact the Medical Aid team, if questions or concerns with the report or their review. Calculate the PRB payment as outlined in the the Pre-retirement benefit frequently asked questions section. Send a file note to Medical aid with the calculations of the PRB to have it processed.
4. Communicate the decision Call the worker or worker representative to discuss the decision to approve or not approve the PRB benefit, to adjust the PRB benefit, and/or to recover or cancel (cost correct/forgive) an overpayment. Clearly explain the rationale used to reach the decision (citing policy, any important background information) during the discussion and in the decision letter. When a review for PRB benefit was requested but it has not been 45 days since the wage loss benefits ended, advise the worker and/or their representative that the review will be completed when 45 days has passed. When the Medical Aid team: Adjusts a previously paid PRB, resulting in a: higher PRB payment owing to the worker, discuss the increased amount. lower PRB payment owing to the worker, discuss whether the decision is to recover or cancel (forgive/cost correct) the overpayment and any remaining PRB payable, if applicable. Recovers an existing overpayment from a new PRB payment owed to the worker, discuss the overpayment amount and the decision to: recover the overpayment and the amount that was recovered from the PRB payment, and whether there is any remaining PRB payment and if so, the amount. cancel the overpayment and the amount cancelled (forgive/cost corrected) and the PRB benefit amount payable. Send the appropriate letter to communicate the decision in writing.	Administrative tasks Document the decision in a file note (Entitlement Decision). Send the appropriate letter: PRB - Denied (CL067B) letter. PRB- Approve/Adjust (CL067A) letter. Follow the internal Procedure 5.2 Diagnose a Cost Adjustment and Cost Correct/Forgive it or Collect it as an Overpayment.

Supporting Information

Pre-retirement benefits - frequently asked questions

Question	Answer
How is the PRB payment calculated?	The calculation is 2% of all wage loss benefits (see above) paid on the claim, from the date of accident to the month that wage loss benefits stopped. Calculation example: PRB calculation based on a combination of eligible benefits paid at $500 per week for 100 consecutive weeks. $500 x 100 weeks x 2% - $1000 pre-retirement benefit paid.
Are workers who receive an ELP or TEL eligible for a PRB benefit?	Refer to step 3 for the answer.
Can a worker request payment once 24 months have passed but before benefits have ended?	No. Benefits must be discontinued before WCB will consider if a worker is eligible for a PRB.
Are workers whose benefits are paid on assignment eligible?	A worker is eligible for a PRB payment when WCB benefits are paid to the employer (i.e., paid on assignment) because they kept the worker on full pay during the worker's layoff. Refer to Policy 04-09, Part II, Application 1 - General Question #5.
What happens if there is a gap in wage loss benefits?	Refer to step 3 for the answer.
What happens when a worker is entitled to an additional period of wage loss benefits or a retroactive rate increase after receiving the PRB payment?	The Medical Aid team reviews claims with changes to wage loss benefits after a PRB payment has been made. If the policy criteria are met, they recalculate the PRB payment to account for the retroactive increase in wage loss benefits. The difference between the original and recalculated PRB payment is then issued. The claim is assigned to a decision maker to communicate the decision in writing.
What happens if benefits are reduced retroactively after a worker received the PRB payment?	The usual process for management of overpayments should be followed in the event of reduced entitlement. If an overpayment results, the Medical Aid team will send a file note to the decision maker to communicate the decision about the overpayment. The overpayment is created at 25% recovery. The decision maker determines if the overpayment should be recovered or cancelled (forgiven/cost corrected). Refer to step 3.
What if my worker received some of their wage loss benefits on one claim and some on another?	If the total duration of continuous periodic rate-based benefits across all claims is 24 months, the worker is eligible for the pre-retirement benefit. The payment will be split between the claims on which the worker received the continuous benefits for 24 months or more, based on the proportion of benefits paid on each claim. Refer to step 3.
Does the 24-month count stop if benefits are suspended due to non-compliance, even when the worker is not able to work due to their injury?	Any gap in benefits stops the 24-month count. However, if WCB decides to reinstate benefits and pay them retroactively (meaning the gap in benefits is eliminated as a result of the retroactive payment), the 24-month count would resume.

Supporting references

Policies

Procedures

1-7 Reconsider a previous decision (new evidence)

Workers’ Compensation Act

Applicable sections

Section 60.1 (1-4) - Retirement benefit
Section 17 (3) - Jurisdiction of Board
Section 142 - Overpayments

General Regulation

Applicable sections

Related Legislation

Applicable sections

Compatibility Warning

WCB Procedures

Lump sum retirement (pre-retirement) benefit approval

Procedure summary

Detailed business procedure

Decision maker (non-triage team)

Administrative tasks

Triage team supervisor

Administrative tasks

PRB request received from Medical Aid

PRB request received from the worker or their representative

Administrative tasks

Administrative tasks

Supporting Information

Supporting references

Policies

Procedures

Workers’ Compensation Act

General Regulation

Related Legislation