Initial entitlement decision - hearing loss

Review the information on the claim, get an understanding of the worker’s injury, their workplace environment and what they may need to assist them in their recovery. 

Refer to procedure 1-1 Step 1 for more information on what evidence should be reviewed to determine claim acceptance. 

In addition, for all hearing loss claims, consider: 

• Has the worker submitted a claim for ONIHL, occupational traumatic hearing loss or chemically induced hearing loss?
• Are they still working? If not, when did they stop working? If they are still working, are they performing regular or modified duties?
• Does the worker have a claim for hearing loss in another jurisdiction?
• Is the claim charged to the correct industry?
• Are audiograms on file? Were they completed by a registered hearing aid practitioner (RHAP) or audiologist?
• Were any employer audiograms done? Are these on file? 

For ONIHL claims, also consider:

• Have they worked as a self-employed farmer?
• Have they used firearms?
• Did they serve in the Armed Forces/military? If so, in what jobs did they work?
• Are they retired? If so, did they provide a retirement date?
• When was their last occupational exposure to noise?
• Do they have personal coverage? If so, what is the industry for which they have coverage and for what period did they have coverage? Does this match their employment history?
• What are/were the worker’s jobs? Are these jobs likely to involve exposure to excessive noise?
• Was any of the worker’s employment in Alberta or Saskatchewan? If so, did they work for at least two years in Alberta, Saskatchewan, or while entitled to WCB-Alberta coverage while working in a place other than Alberta or Saskatchewan?
• If information was provided by the employer regarding noise levels, was the document providing this information signed? Does this information support that the job involved exposure to excessive noise?

Determine what information may still be required to make the entitlement decision and anticipate questions that may arise during the initial conversations with the worker and employer (see step #2 for more details about this conversation).

Some claim-specific exceptions or special circumstances may require further consideration to make a decision, such as if:

• The accident or exposure that resulted in traumatic hearing loss or chemically induced hearing loss occurred outside of Alberta.
• The worker was injured in an accident that occurred in Alberta, but their permanent residence is in another province,
• The claim was not reported within 24 months of the accident or date of initial medical attention. See Step 4 for information about how the date of accident is determined for ONIHL and occupationally chemically induced hearing loss that developed over time.

Refer to the Claim-specific circumstances section in the 1-1 Initial entitlement decision procedure for additional information.

Make sure the claim is assigned (charged) to the correct employer account. See Supporting Information- Claims charging for hearing loss section.

Review previous claims history for any head traumas, ear trauma or hearing loss claims. If any are found, review the prior claims to determine if there are any previous audiogram readings, specialist reports or mention of skull fractures or ear problems. 

Contact the worker, employer and health care provider as needed. In some cases, communication with other parties, such as a union representative, worker or employer representative(s) and/or family members may be necessary. Arrange an interpreter to assist with communication, if required.

Before contacting the employer by phone, consider:

• If the worker is currently employed, contact by phone should be made with the current employer. However, if the worker is retired, contact with the employer by phone is not required.
• If the worker’s hearing loss may have been due to occupational noise exposure from employment with multiple employers, these employers do not have a direct interest in the claim and should not be informed of any claim information such as entitlement decisions, details about the hearing loss condition, etc. See the Supporting Information section- Determining if an employer has a direct interest in a hearing loss claim.

Refer to step 2 in the 1-1 Initial entitlement decision procedure for more general questions to ask the worker, employer and health care provider. Additionally, inform the worker and employer about the WCB Fact Sheets, which provide information about hearing loss claims. Refer to the General tab for links.

In addition to those general questions, when speaking with the worker discuss: 

• The history of the worker’s hearing loss, medical assessment/treatment for hearing loss (such as audiograms, specialist appointments, etc.) and any past relevant history such as skull fractures or ear trauma. Discuss symptoms and concerns with the worker.
• If the worker was involved in an accident or was exposed to chemicals, the specific details about the accident or exposure (e.g., What occurred during the accident? What chemicals were they exposed to and for how long?).
• If the worker is still employed (that is, they are not retired), whether they are working regular or modified duties. If working modified duties, obtain details about the modified duties.
• Any missing information identified in Step 1.
• If an audiogram has not been completed in the last year, arrangements will be made for one to be completed.
• For traumatic hearing loss:
  • Details about their proximity and position in relation to the hazard. For example, if the accident involved a tire blowout, how far away were they from the blowout? What was the position of their body in relation to the tire (facing towards it, perpendicular to it, etc.)?
  • Whether they have issues with dizziness/balance. If so, complete a dizziness/balance questionnaire with the worker.
  • If the injury involved a skull fracture, ask if the worker had a CT scan of the temporal bone (if not already on file). If not, ask the worker to obtain a requisition so the CT scan can be expedited.
• For ONIHL or occupational chemically induced hearing loss that developed over time, their work history and whether the worker is retired. If the worker is not able to provide a complete history of their employment, discuss other sources of information that can confirm employment, such as paystubs, Records of Employment (ROEs), pension plan statements (a statement will have a record of any employment that led to pension contributions), or obtaining a copy of their employment history from Service Canada. See the Obtaining an employment history section.
• For ONIHL:
  • Their history of occupational and recreational exposure to noise.
  • Whether the worker has a history of gun handling. If they do, confirm which shoulder the worker shoots from.
  • If an audiogram is on file that shows a difference in hearing loss between the right and left ears (that is, the hearing loss is asymmetrical), whether they can think of an occupational or recreational reason for this. For example, if the worker drove a loud truck and often had the window down, it might explain hearing loss that is greater in the left ear.

If the worker is missing time from work and indicates they are experiencing financial difficulties as a result, ask additional questions to determine whether they meet the criteria for payment of benefits during a medical investigation. See Procedure 1-4 Benefits during a medical investigation.

If speaking with the employer, ask if any audiograms were completed as part of their employment (if not already on file) and, if so, request they submit copies of the audiograms. If the worker was involved in an accident or was exposed to chemicals, obtain details about the accident or exposure (e.g., What chemicals, and in what amount, was the worker exposed to? For how long? How do they know this?). A written request can also be sent to the employer to gather this information.

Send a letter to each of the worker’s employers from Alberta and/or Saskatchewan to confirm the worker's employment and obtain information about noise exposure. 

If the worker has been employed through a union, request a letter from the union to provide a history of employment. 

Request any other missing information identified in Step 1.

Determine whether additional information is needed to make the entitlement decision. 

Expedite any diagnostic testing, if applicable upon receipt of the requisition. 

Typically, an audiogram will already be on file. However, if the worker has never had an audiogram or has not had one in the past year, make arrangements for an audiogram. 

For ONIHL:

Determine the noise level the worker was exposed to for each of the jobs they worked in Alberta and/or Saskatchewan. Noise levels can be confirmed in various ways, such as:

• Noise level reports from employers,
• The internal noise level database or other internal documentation about noise levels.
• Online information about noise levels for various types of work.  

If the worker was not exposed to prolonged periods of excessive noise for two years cumulatively in Alberta or Saskatchewan or while the worker was entitled to WCB-Alberta coverage while working in a place other than Alberta, the worker does not meet the criteria for acceptance of ONIHL. Go to Step 6.

If the worker does have at least the minimum required period of prolonged exposure to excessive noise at work, review the audiogram(s) and chart it on the hearing loss calculator to determine whether the pattern of hearing loss shown on the audiogram(s) is consistent with NIHL. 

Review for findings that are/are not typical of NIHL. See the Noise-induced hearing loss (NIHL) section. If the audiogram(s) shows that there is a difference in loss of hearing between the right and left ear of over 20 dB, call the worker to explore why this might be (if not already completed in Step 2). For example, a truck driver might have a greater loss of hearing in their left ear because they drove for long periods with the window rolled down.

Determine whether an opinion from a medical consultant or audiology consultant is required. Consider:

• Are the results of the audiogram unclear or is the reporting complex?
• Is there an opinion from an audiologist or other specialist (e.g., ENT/ otolaryngologist) that does not seem consistent with the available information (such as the audiogram, the worker’s work history and occupational noise exposure)?
• For ONIHL claims, is the pattern on the audiogram consistent with NIHL?

If needed, obtain an opinion from a medical consultant or audiology consultant to establish:

• Whether there is other evidence that the worker has NIHL when the pattern on the audiogram is not consistent with NIHL.
• The relationship between NIHL or the traumatic or chemically-induced hearing loss and the work accident or occupational noise or chemical exposure.
• Whether a pre-existing hearing condition was aggravated by the work accident or occupational noise or chemical exposure.

In some cases, the medical consultant may request additional testing, such as an auditory brain stem response test or an MRI, to determine when it will be appropriate to review for permanent clinical impairment. Expedite the testing, when possible, and/or follow up with the worker’s doctor to request they initiate a referral for the testing.

Medical consultants provide opinions on hearing loss claims when medical doctors (e.g., ENTs/otolaryngologists) have provided opinions and when the claim is complex. 

Audiology consultants generally provide opinions in all other cases.

Review all information on the file and determine if the claim is compensable, based on related policy and legislation.

When:

• There is not enough information to make an entitlement decision, repeat steps 1 through 3 until there is enough information to make the decision. If the worker is missing time from work, consider if a medical investigation is required. See Procedure 1-4 Benefits during a medical investigation.
• A decision cannot be made because contact with the worker and/or employer has not been possible and information from them is needed, send a letter explaining what information is needed and why a decision cannot be made. Request contact with the worker and/or employer. The claim may be inactivated until the information is received. Note: If a decision can be made without contact, proceed with making the decision after making two attempts to reach the worker and/or employer.
• The medical evidence supports the worker has a pre-existing condition in the same body part involved in the accident, and it is unclear if the accident affected the pre-existing condition, refer to the 1-6 Aggravation of a pre-existing condition decision procedure. Return to this step once a decision is made.
• The claim is for traumatic or chemically induced hearing loss, but the evidence supports the worker instead has ONIHL, deny the claim and create a new claim for ONIHL. Once the claim for ONIHL is created, go to Step 1 to make the initial entitlement decision on the new claim.

To accept a claim for occupational traumatic hearing loss or occupational chemically induced hearing loss, the worker must have confirmed hearing loss (as shown on an audiogram) and the weight of evidence must support that the work accident or exposure was a necessary factor for the development of the hearing loss.

To accept a claim for ONIHL, the weight of evidence must support that:

• The worker had  prolonged exposureOccupational exposure is prolonged if the worker has a clear history of exposure to excessive levels in the workplace for a minimum cumulative duration of two years in Alberta, Saskatchewan or while the worker was entitled to WCB-Alberta coverage while working in a place other than Alberta or Saskatchewan. to excessive noiseOccupational exposure is excessive if the exposure is higher than the occupational exposure limit (or equivalent) set out in the Alberta Occupational Health and Safety code. in Alberta or Saskatchewan or while the worker was entitled to WCB-Alberta coverage while working in a place other than Alberta for at least two years confirmed,
• The worker has NIHL. Consider:
  • Does the audiogram show a pattern that is characteristic of NIHL? See the NIHL section for more information about this characteristic pattern.
  • If the audiogram does not show a pattern that is characteristic of NIHL, does the medical evidence support that the characteristic pattern is masked by other factors such as hearing loss due to aging (presbycusis)? If so, consider whether the weight of evidence supports that prolonged exposure to excessive noise was a factor in the development of NIHL.
  • Is the hearing loss greater in one ear than the other (that is, is the hearing loss asymmetrical)? If so, see the Asymmetry in hearing loss section for information on how asymmetry impacts entitlement decisions.
• The NIHL was caused by exposure to prolonged exposure to excessive noise. Consider if the worker reported their hearing loss issues (related to the diagnosis of NIHL) within 12 months of their last occupational noise exposure? If the worker:
  • Reported this within 12 months of their last occupational exposure, the NIHL is presumed to be caused by the occupational exposure (unless there is evidence to the contrary).
  • Did not report this within 12 months of their last occupational exposure, determine if the occupational exposure was a necessary factor for the development of NIHL.  

See Policy 03-01, Part II, Application 5.

If the claim is accepted:

• Complete the Audiometric reading worksheet (Form C416) based on the audiogram used for decision.
• Ensure the date of accident (DOA) on the claim is correct. If not, correct the DOA.
• Approve medical aid and device payments, such as hearing aids, batteries, etc. and authorize any necessary medical treatment and appliances. For further details, refer to the internal Procedure Resource Library.
• Determine if a permanent clinical impairment (PCI) review is required. If the medical consultant or audiology consultant already rated the worker’s PCI, go to step 8 to determine if the worker is eligible for a non-economic payment (NELP) or permanent partial disability (PPD) then proceed to the next step (Step 5).

If the worker has not missed any time from work proceed to Step 6. 

If the worker has missed time from work set the compensation rate. 

Rates are based on the workers: 

• Employment status (permanent, non-permanent, personal coverage, owner-operator, subcontractor)
• Date of hire and history with the employer for the past 12 months
• Shift cycle
• Hourly rate of pay
• Overtime, vacation pay and shift premiums
• Additional income from other employers, if applicable

Refer to Procedure 2-1 Rate Setting for additional information on how to set a compensation rate. 

If the employer does not provide earnings information in a timely manner, set a provisional compensation rateA provisional rate is a temporary rate that is set to ensure benefits are paid in a timely manner. Once the worker's earnings are verified, using their T1 tax return, the rate is adjusted as required. using the information the worker submitted about their earnings.

Once the rate is set, communicate with the worker and confirm how and when they would like to receive wage replacement benefits. If the employer continues to pay the worker wages/salary the wage replacement benefits may be paid on assignmentWhen an employer keeps a worker on pay while they are missing time from work, WCB issues benefits to the employer instead of the worker. See policy 04-09, Part II, Application 1. to the employer. 

Call the worker to communicate the decision and next steps. 

If the hearing loss was caused trauma, chemical exposure or noise exposure while working for only one employer, also call the employer to communicate the decision and next steps. See Supporting Information- Determining if an employer has a direct interest in a hearing loss claim.

Clearly express the rationale used to reach the decision (citing policy, medical information on the file, any important background information). If the worker or employer disagrees with the decision, consider whether their concerns require further review. If not, explain why the decision is unchanged.  

 When the claim is: 

• Accepted, outline their eligibility for hearing aids, hearing aid supplies, etc. and next steps for treatment (if any), return-to-work-details (if applicable) and plans for follow-up conversations. Offer additional services if eligible. 
  
  If the worker has missed time from work, explain how their rate has been set and when wage replacement benefits will be paid. Include the option to receive payment through direct deposit. 
  
  If the worker has concerns about how their rate was set, request that they submit any evidence they may have, such as paystubs, tax returns, etc. or follow up with the employer about these concerns.

  If the worker has been diagnosed with tinnitus, explain that a decision on the acceptance of tinnitus cannot be made yet. WCB policy indicates that a worker must use hearing aids provided by WCB for one year before tinnitus may be accepted.

  If the claim is accepted for occupational traumatic hearing loss or occupational chemically-induced hearing loss, explain that hearing loss sometimes resolves with time. For this reason, arrangements will be made for the worker to have another audiogram in 6-12 months from the DOA to determine if the hearing loss has resolved. If the hearing loss has not resolved, PCI will be assessed at that time.

• Denied, clearly express the rationale used to reach the decision (citing policy, medical information on the file, any important background information, etc.). Discuss additional resources that may be available to the worker as they recover such as Employment Insurance benefits, long-term sick leave through Canada Pension Plan or sick benefits through an employer plan as well as organizations that help pay for hearing aids. When appropriate, offer assistance from WCB’s Community Support Program, which can connect workers with various agencies and organizations across the province for additional support outside of the workers’ compensation system.

Send the appropriate letter explaining the decision and confirming the details of the discussions as outlined above. If the medical consultant or audiology consultant already rated the worker’s PCI, include the decision about the worker’s entitlement to a NELP or PPD in the letter. See Step 8.

Review the claim for any applicable cost relief. For:

• ONIHL claims, see Policy 05-02, Part II, Application 2 for cost relief provisions that apply to ONIHL claims.
• Occupational traumatic hearing loss and occupational chemically induced hearing loss, see Policy 05-02, Part II, Application 1.

Note: ONIHL is a type of occupational disease under the Workers’ Compensation Regulation.

Upon receipt of a task to:

• Arrange for another audiogram 6-12 months after the DOA when the claim is for occupational traumatic or chemically induced hearing loss, go back to Step 3 to arrange for another audiogram. If the audiogram indicates that the hearing loss is:
  • Resolved, close the claim.
  • Not resolved, go to the next step.
• Review for acceptance of tinnitus after the worker has been using a hearing aid provided by WCB for at least one year, see the Tinnitus section for information.

Manage the claim:

If the worker is missing time from work or performing modified duties, continue to keep in contact with the worker every two weeks and the employer every six weeks, or as soon as the worker has achieved the ability to return to either modified or full work in order to assist with facilitating their return to work. Together, discuss the worker’s progress, evaluate their fitness for work, and modified work opportunities. Also, issue the appropriate benefits and arrange services as required.

If the claim will be transferred to a case assistant for ongoing monitoring, then contact the worker and explain the reason for the transfer.

Transfer the claim:
If the worker is missing time from work or performing modified duties, the claim may need to be transferred to another staff member for longer term or complex care cases.

Call the worker and employer and explain the reason for the transfer and discuss any related referrals, if applicable.

Ask the worker how they’re recovering and assess whether they require additional referrals or support. Confirm with them that all of the information on their file is up to date.

Provide the worker and employer with the name and telephone number of their new contact and send a follow-up letter. Confirm with the worker that they will hear from their new contact within five business days.

Inactivate the claim:
If the worker did not miss any time from work or has already returned to their job, the claim can be inactivated.

Call the worker and employer to communicate the closure of the claim and ensure all benefits have been paid. Confirm what ongoing benefits are approved (e.g., hearing aid replacements, batteries, supplies, etc.) and if any additional assessments or treatment (e.g., repeat audiogram in 6-12 months, review for tinnitus or PCI) are planned or anticipated. Let the worker know that their file can also be re-opened at any time in the future if there are any concerns or additional information related to their claim.

A compensable hearing loss may or may not result in a permanent disability. It is possible that a worker with a compensable hearing loss claim will not have a measurable PCI and therefore may not be entitled to a NELP. 

For:

• ONIHL claims, PCI can be rated as soon as the claim is accepted.
• Occupational traumatic and chemically-induced hearing loss claims, PCI can be assessed if hearing loss persists beyond 6-12 months or when a medical consultant/audiology consultant advises it is reasonable to assess PCI.

The Alberta Clinical Impairment Guide is used to rate PCI. See Policy 04-04, Part II, Application 2. This guide indicates that hearing loss must be at least 140dB to have a ratable PCI. If, based on the most recent audiogram, the worker has: 

• Compensable hearing loss of at least 140 dB in one or both ears, make a referral to the audiology consultant to rate PCI. Go to Step 3 to make the referral then return to this step.
• Compensable hearing loss of less than 140 decibels in both ears, PCI for hearing loss is not ratable. No further action is required.

Note: Before deciding whether a referral to the audiology consultant is required, consider how any asymmetry impacts the level of compensable hearing loss in each ear. See the Asymmetry in hearing loss section for more information.

Review the audiology consultant’s memo. If the claim is for ONIHL and the audiology consultant provided a PCI rating, determine if the PCI should be prorated. See the Prorating PCI section for more information.

If the worker has a PCI rating of 0.4% or more (once any prorating has been applied, when applicable) and their DOA was on of after January 1, 1995, they are eligible for a NELP. Refer to the internal procedure 7.1-3.

If the worker has a PCI rating (once any prorating has been applied, when applicable) and their DOA was prior to the January 1, 1995, they are eligible for a PPD benefit. To pay a PPD:

• Set the compensation rate if a rate was not already set in step 5. Refer to the Rate setting procedure for information on how to set the compensation rate. 

Note: Rates are typically set based on the worker’s earnings in the year prior to the DOA. However, given that hearing loss is often not diagnosed until after a worker retires, the worker may not have been working in the year prior to the DOA. In that case, use the worker’s earnings for the year prior to the date of retirement.

• See internal procedure 7.1-4 and follow steps 1-3 to have the PPD amount calculated, and the payment set up.

Note: When the worker has a hearing loss claim including a physical injury, PCI for the physical injury follows the regular PCI assessment process 24 months from the date of accident or date of the last surgery. See internal procedure 7.1-1.

Once the PCI has been implemented, contact the worker to notify them and the amount of the payment. Advise them that this does not affect their coverage for medical aid and devices. Send a letter explaining the decision. The claim may be closed if no other action is required.