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To determine if a worker has a Permanent Clinical Impairment (PCI) resulting from their compensable injury, and if they do, to implement a non-economic loss payment (NELP), permanent partial disability (PPD) award or a permanent injury award (PIA).
Description
The decision maker identifies if the worker is likely to have any remaining permanent impairmentA worker is considered to have a permanent disability
when a work injury results in a permanent measurable clinical impairment. Refer to Policy 04-04, Part I. and, if applicable, refers the claim for a possible PCI assessment rating. The decision maker requests additional medical documentation and/or refers the worker for medical assessment(s) if required.
PCI may be evaluated through a documentary review or an in-person medical assessment. A documentary review is completed by a PCI medical consultant who determines the PCI rating based on the medical information on file. PCI evaluated through an in-person medical assessment involves an examination with a specially trained clinician (e.g., physician, physical therapist, psychologist, etc.) who provides the findings needed for PCI rating. The PCI medical consultant reviews the findings from the examination and the available medical information on the claim file, if required to determine the PCI rating. The PCI medical consultant uses the Alberta Permanent Clinical Impairment Guidelines or The American Medical Association Guidelines when the Alberta Permanent Clinical Impairment Guidelines does not adequately address PCI.
The decision maker assesses the worker's eligibility for a PCI award based on the opinion of the PCI medical consultant and informs the worker of the assessment outcome. Should the worker be eligible for a PCI award, the decision maker assists in deciding whether a monthly payment or a lump sum would best suit their situation and then proceeds to process and administer the award. The procedure explains other circumstances related to PCI payments such as affirmations and requests for early release of pension payments. Refer to the Affirmations and Early pension cheque release sections.
Key information
When a worker suffers a work injury or illness that has a permanent impact on their function, they may be eligible for PCI. PCI is meant to recognize loss of a body part; loss or use of a body part, system or function; or a measurable change or disfigurement to a body part, system or function. Refer to Policy 04-04, Part I - Permanent Disability.
PCI evaluation is considered once all medical treatment and rehabilitation are complete (i.e. the medical condition or illness has reached a medical plateauA medical plateau is normally reached when the worker's medical condition has stabilized, further significant medical improvement is unlikely, and permanent work restrictions can be confirmed.), typically two years after the accident or last surgery, unless the injury qualifies for a scheduled PCI review. Refer to thePCI evaluation methods section. Complex injuries, like brain or psychological injuries, may need more time to reach maximum medical improvement. For deteriorating conditions, PCI is assessed when the condition first stabilizes, with possible reassessment later. If a worker has multiple injuries, the assessment is usually delayed until all injuries are ready for assessment, unless there is a reason to schedule more than one evaluation (e.g., a prolonged recovery is expected for some of the injuries). Refer to theTiming of PCI reviews section for more details.
Types of PCI reviews
A new PCI review sets the initial PCI rate. If the worker's condition changes, a reassessment can be done later, which may result in an increasePCI reassessment determines that the worker's condition has deteriorated resulting in an increase in the PPD or NELP award. or a decreasePCI reassessment determines the worker's condition has improved resulting in a decrease in the PPD or NELP awardPCI reassessment determines the worker's condition has improved resulting in a decrease in the PPD or NELP awardin the PCI rating. Refer to thePCI reassessmentand theIncrease in PPD sections for more information.
PCI rating is determined through a medical assessment or by documentary review. The medical department determines whether an in-person evaluation is required or whether a documentary review can be completed to determine the PCI percentage. There are five ways that a PCI may be evaluated. Refer to the PCI evaluation methods section. The medical consultant uses the Alberta Permanent Clinical Impairment Guidelines to assess the PCI rating, expressed as a percentage of the whole person, which determines the payment amount. If the Alberta Permanent Clinical Impairment Guidelines do not adequately address the PCI, the PCI medical consultant may use the American Medical Association Guidelines to determine the PCI rating.
In some circumstances, when a worker's disability involves parts of the body with identical functions, (e.g., both arms, both legs, both eyes, etc.), the PCI review will include an enhancement factor. This review assesses if the combined effect of two or more disabilities exceeds the sum of the individual impairments, when appropriate. For example, immobility of the ankle joint is rated at a 12% impairment, according to the Alberta Permanent Clinical Impairment Guide. However, if both ankle joints are immobile, the overall effect might surpass 24%, and the Workers' Compensation Board (WCB) might increase the permanent clinical impairment award (NELP or PPD) beyond this figure. This additional percentage is referred to as an "enhancement factor." Refer to Policy 04-04, Part II, Application 7; Enhancement Factor or see Enhancement factor section for more information.
Types of Permanent Clinical Impairment payments/awards
Once the PCI rating is established, there are three types of payments/awards payable for permanent clinical impairment:
Non-economic loss payment (NELP) - payable for PCI when the date of accident is on or after January 1, 1995. In addition to the NELP award, the worker may be eligible for a wage loss supplement (i.e., TEL, ELP). Refer to the 8-1 wage loss supplement final approval procedure.
Permanent partial disability (PPD) pension- payable for PCI when the date of accident is before January 1, 1995. In addition to a PPD award, a worker may be eligible for an earning loss supplement.Refer to the 8-1 wage loss supplement final approval procedure.
Permanent Injury award (PIA)- may be applicable for compensable accidents that occur between January 1, 1985, through December 31, 1994.
Note: PPD percentages are rounded to 1 decimal point and NELPs are rounded to 2 decimal points.
WCB also recognizes permanent total disability (PTD)When PTD status is awarded, the worker’s economic loss payments (ELP) are not adjusted or terminated at retirement age, the ELP is not offset by any post-accident earnings (i.e., they receive “full”/unreduced benefits), and the worker will receive the maximum non-economic loss payment (NELP). for workers who suffer catastrophic injury. Workers who receive a PCI rating of 100% are presumed to have a permanent total disability (PTD)insert definition, or link to policy. As of January 1, 2025, a worker may also be eligible for PTD when:
the date of accident is on or after January 1, 2025 and,
the worker has a compensable injury or combination of injuries with a PCI rating greater than or equal to 75% and less than 100% and,
the worker is permanently incapable of participating in employment as a direct result of the compensable injuries.
Determine if the worker's injury will or is likely to result in a permanent clinical impairment (PCI) that will require a new (i.e. initial PCI rate) or increased Non-economic Loss Payment (NELP) or Permanent Partial Disability (PPD) award.
Note: To consider a PPD award, all rate-based benefits (e.g., TD, VR, ELS, etc.) must be at completion. For NELP awards, rate-based benefits do not need to be at an end.
Consider when the PCI evaluation will take place (e.g., two years after the date of accident or last surgery or a longer time frame). In some circumstances, depending on the injury type, a scheduled award PCI review may take place before the usual two-year mark. This is because the loss of function for the compensable injury is known. A scheduled award is a designated percentage for a specific loss of function resulting from surgery, amputation or a body part being removed, etc. Refer to the Timing of PCI reviews and PCI evaluation methods section for more details.
For PPD awards, ensure the following are available on the file:
A signed Worker's Report of Accident or Occupational Disease (C-060) form.
The compensation rate is set, and any increases/adjustments have been implemented (e.g., learner or apprentice). Follow the 2-1 Rate setting procedure.
Proof of age. If the worker has another PPD award claim, the worker's proof of age may be already available and may be copied from that claim file to the current one.
Ensure the claim file is current with the following details:
All benefits as per the Workers' Compensation Act have been granted, and the worker, employer and their representatives have been notified of the WCB benefits in writing.
All necessary medical reports that are pertinent to the injury for PCI evaluation are on file, such as operative reports, CT scans, MRIs, bone scans, specialist/consultant reports, and the initial and most recent x-rays for fractures.
There is medical documentation on file for any part of the body not covered by compensationNon-compensable that is being considered for an enhancement factor.
There are medical reports showing a worsening of the condition that is directly related to the injury covered by compensation, for the purpose of reassessment evaluation.
Cost relief has been applied where it is applicable.
Administrative tasks
Consult the Disability Duration Reference to assist in assessing if the worker's injury may lead to a permanent clinical impairment and to determine the appropriate timing for evaluation.
Review the worker's previous claims via the View Claimant's Claims link. Expand All to determine if the worker has a PPD claim. In the claim, look for PPDs on the Permanent Clinical Impairment screen (Summary section), Injury List, Injury History tab and Claim Folder - Participant (for Claimant) screen.
Documents acceptable for proof of age include: birth certificate, driver's license with photo (not temporary), government-issued photo ID, citizenship card or papers and baptism certificate.
Update the relevant eCO screens:
Injury Details for all accepted and not accepted injuries. PCI cannot be assessed if the decision is in pending status.
Treatment Details for compensable surgeries and any surgeries/treatment not accepted.
2. Call the worker to discuss the PCI review process
If PCI is anticipated, discuss the PCI review process with the worker. Explain:
That the purpose of the PCI review is to determine if the compensable injury has resulted in permanent clinical impairment.Should this be the case, the worker may be eligible for a PIA (permanent injury award)A Permanent Injury Awards applies to compensable accidents from January 1, 1985 through December 31, 1994. , NELP or PPD award for PCI.
When the PCI review will take place. Refer to the Timing of PCI reviews section for more details.
That the worker will be contacted before the review to gather any outstanding medical reports or information.
The PCI review could be completed as a documentary reviewA documentary review is completed by a Medical Consultant and the percentage of PCI is based on the medical information on file and the Alberta Permanent Clinical Impairment Guidelines., or the worker might need to attend a PCI evaluation exam. Refer to the PCI evaluation methods section for more details.
A PCI medical consultant will examine the medical report(s) to assign a percentage of loss relative to the whole body. For instance, a quadriplegia injury equates to a 100% loss of function, whereas 0% indicates no loss. The minimum for a NELP is 2% and 0.5% for a PPD.
Ask the worker to provide updated or missing information, including a signed Worker's Report (C-060) and proof of age for new PPD awards.
If a scheduled award review can be completed, proceed to step 4 to prepare the file for a documentary review.
If the PCI review will be done at a future date, set a reminder for one month before the PCI review date, if applicable, and transfer the claim to the case assistant to arrange for the PCI review for the designated timeframe.
Administrative tasks
Document the discussion in a file note (Contact/Claimant Contact).
Transfer the claim to the case assistant and add a reminder task for 30 days before the PCI review date for the case assistant to initiate the PCI process.
3. Call the worker 30 days before the PCI review date
Case assistant
Monitor incoming medical information up to designated PCI review date. One month before the PCI review date, call the worker to gather additional information and request any outstanding medical reports.
Ask if the worker has consulted a doctor (for the work injury) in the past six months and request a copy of any report(s), imaging, etc. If they have not recently seen a doctor, ask about any changes in the status of the injury.
If there have been ongoing difficulties, consult with a clinical consultant to determine if updated medical reporting is required. Call the worker back to advise if they need to see a doctor for an updated medical report or if the PCI can proceed with the available medical reports already on file.
If an in-person evaluation is required, discuss
any travel and/or accommodations needed.
what they can expect the day of the exam.
how long after the assessment they will be notified of the results.
If attempts to reach the worker are unsuccessful, send the appropriate letter.
If no additional case management is required, transfer the claim to the case assistant to monitor the claim for the PCI review date and to gather information for the PCI review.
Before making a referral for a PCI review or a PCI medical exam, ensure all outstanding medical reports have been received and that all required information is current and available for the review including:
Entitlement for all injuries is up to date including accepted and non-accepted injuries, and aggravations of pre-existing conditions/injuries.
All related medical reports such as x-rays, CT scans, MRI, specialist consultations, surgical reports, etc.
Any medical documentation or reports for non-compensable part of body when determining if an enhancement factorAn enhancement factor will usually be included when the worker's disabilities involve parts of the body with identical functions (for example, both arms, both legs, both eyes). An enhancement factor will usually be included when the worker's disabilities involve parts of the body with identical functions (for example, both arms, both legs, both eyes). applies. Refer to the Enhancement factor section.
Review the information. If the information shows that a PCI evaluation should proceed and involves:
The worker's injury resolved with no remaining impairment, assess if other issues need attention. If all matters are settled,send the appropriate letter and close the claim.
A new PPD award, confirm the following information is on file:
A signed Worker's Report of Injury or Occupational Disease (C060) form.
The compensation rate, and any increase(s) to the rate.
Proof of age (for new PPD awards). This can include birth certificate, driver's license with photo, government-issued photo ID, citizenship card or papers and baptism certificate.
Confirmation of the worker’s trade status (that is, learner, apprentice, less than 18 years old, retired, etc.), if applicable.
The date the worker would have obtained journeyperson status, as well as the earnings relating to the apprentice and journeyperson status, if applicable.
An adjustment to a previous PPD award, go to the next step. Note: As a previous PPD award was issued, the information required for the PPD award was gathered when the initial PPD was set up.
A Permanent injury award (PIA)A Permanent Injury Awards applies to compensable accidents from January 1, 1985 through December 31, 1994. , refer to the Permanent injury award section.
If the worker cannot be contacted, does not respond to letters or cannot be located, but PCI is possible or probable, document this information on the claim. Do not proceed further with this procedure until a response is received. If there are no other outstanding issues, the claim may be closed.
Administrative tasks
If not completed previously, update the relevant eCO screens:
Injury Details for all accepted and not accepted injuries, including the injury status of temporary or permanentThis applies when an injury is accepted for an aggravation of a pre-existing condition., if applicable. PCI cannot be assessed if the decision is in pending status.
Treatment Details for all accepted surgeries and treatment not accepted.
Consult the Disability Duration Reference to assist in assessing if the worker's injury may lead to a permanent clinical impairment and to determine the appropriate timing for evaluation.
Send the Care Plan Conclusion (CL041E) letter.
Document in a file note (Contact/Claimant Contact Unsuccessful)that PCI is “possible” or “probable", but the worker could not be located or did not reply to the Follow up Review of PCI (CL021A) letter.
5. Refer for PCI assessment
Determine if the PCI review type is scheduled or unscheduled and identify the PCI category (pure or non-pure) and proceed with the referral process. If uncertain, discuss with claim with a clinical consultant.
Pure PCI:
Non-Pure PCI:
PCI is the only issue on the claim.
There are no questions or indications on the claim about a pre-existing condition or aggravation.
There are no questions about the diagnosis, further treatment or investigations.
Fitness for work or work restrictions do not need to be clarified.
There are one or more issues (e.g., work restrictions, fitness etc.) that need to be addressed at the same time as the PCI assessment.
Note: WCB decision makers should discuss injuries such as the loss of sense of smell or taste, impotence and/or infertility with a PCI medical consultant or clinical consultant.
For psychological or brain injuries, consult with the PCI medical or clinical consultant if assistance is required in determining the type of examination needed (i.e. comprehensive psychological assessment, independent psychiatric medical exam, neuropsychological assessment, etc.) Refer to the Timing of PCI reviews sections.
Send the referral for PCI review. If applicable, request that enhancement factor be considered as part of the PCI review. Note: The medical consultant provides an opinion on whether the enhancement factor applies. The decision maker calculates the enhancement factor.Refer to the Enhancement factor section and Policy 04-04, Part II, Application 7: Permanent Disability.
The Medical Services department reviews the referral form and determines the appropriateness of the PCI request including the timing of the referral and evaluation method required for PCI rating. Refer to the PCI evaluation methods section.
If the PCI referral is inappropriate or premature, the task is returned to the decision maker with recommendations for next steps.
If a PCI examination is required, a booking expeditor arranges for the examination, including travel and accommodation, if required.
Following the examination, the PCI medical consultant reviews the medical reports on file for scheduled awards and/or documentary reviews, as well as the results from the PCI examination if one was completed. Based on the medical information, the medical consultant determines a percentage of loss in relation to the whole body (for example, an injury resulting in quadriplegia would be considered 100% loss of function). The PCI medical consultant will use the Alberta Permanent Clinical Impairment Guidelines and/or the American Medical Association Guidelines to assess the impairment amount, which determines the payment amount.
Note: The decision maker must remain assigned to the claim until the NELP, PPD, or PTD has been paid to the worker.
Administrative tasks
Pure scheduled or Pure non-scheduled PCI referrals
From the eCO Create a Referral screen, Complete the PCI Referral (FM555B) form, including which body part or condition is to be assessed.
Note: If there are questions regarding the PCI review (e.g., if PCI is likely, when PCI review should be done, etc.), complete the PCI referral (FM555B) form to obtain clarification from the medical or clinical consultant.
Non-Pure PCI referral
From the eCO Create Referral screen, complete the IME Referral Request (FM555A) andcheck the box which states PCI Review Required. Document the required information including which body part or condition is to be assessed and specific questions for PCI, work restrictions, diagnosis, causation, entitlement to other medical conditions, etc.
Include the following details on the FM555A or FM555B form, as appropriate:
Which body part is to be assessed for PCI.
If an NELP or PPD has already been issued for the same part-of-body.
Any possible impairment (pre-existing or work-related)
to the compensable injury sites, if determining the PCI rating.
to the opposite side of the compensable injury (e.g., the compensable left thumb was injured, and the right thumb has a non-compensable pre-existing disability that occurred prior to the date of accident). This ensures the medical evaluation includes comparisons for the Enhancement Factor when required.
Any other relevant questions.
6. Review for PCI rating and determine the type of award payable, if applicable
Review the PCI assessment memo to confirm if PCI was assessed.
For claims with a date of accident:
Before January 1, 1995, refer the claim to a pension adjudicator (except for brain injury claims) who will review and complete the remaining process for the PPD. Call the worker and explain that the file will be assigned to a pension adjudicator to review the PCI assessment for possible PPD award implementation.
On or After January 1, 1995, the original decision maker processes the NELP.
If PCI was not assessed and the PCI review is returned as premature or a PCI examination is recommended, call the worker to discuss the recommendations and return to this procedure at the recommended timeframe.
If the worker does not qualify for PCI, proceed to step 9 to communicate the decision.
If PCI was assessed for a claim with a date of accident before 1995, refer the claim to a pension adjudicator to review and process the PPD.
If PCI was assessed, confirm the percentage of clinical impairment from the memo. Consider whether:
The assessment was for a new PCI (initial rating) or a reassessment. For PCI reassessment, determine if the PCI increased or decreased. Refer to the PCI reassessment section.
The worker has previously received an NELP or PPD for the same body part.
The worker has a non-compensable pre-existing clinical impairment for the same body part.If yes, deductthe percentage of clinical impairment for the pre-existing condition from the overall PCI assessment.
The PCI rating or combination of PCI ratings is between 75% and 100%. If so, consider whether the worker meets the criteria for PTD status. Refer to Section 43 (2) of the WCA (Worker's Compensation Act) and Policy 04-04, Part I - Permanent Disability. Note: The decision related to PTD status is a separate decision and does not impact the worker's eligibility for a NELP. Continue with this procedure to implement the NELP.
Address any issues related to the PCI assessment with the Clinical Impairment medical consultant. If the concerns remain unresolved, discuss the matter with the supervisor or a Medical Services manager.
If it is determined that the worker's injury has resolved with no remaining impairment and no further case management is required, go to step 9 to communicate the decision.
Determine the type of award to be issued.
If the award to be issued is a NELP, go to the next step.
For claims with a date of accident before January 1, 1995, send a task with the description “Please review PPD and process” (except for brain injury claims) to the Pension Adj, Working Desk.”
When PCI is returned as premature or assessment is recommended, set a task for one month before the PCI review date.
Review the worker's previous claims for previous NELP or PPD issued (located on the Claim Folder Participant screen, Injury History tab).
To determine if the worker is eligible for PTD status, follow the internal 7.1-3 Implement a Non-economic Loss Payment procedure.
7. Calculate and request approval for a NELP
The effective date for a NELP award is the date of the independent medical examination or if an examination was not required, the date of the medical consultant PCI memo.
Ensure the following:
If an initial PCI is equal to or greater than 0.4% but less than 2%, the worker receives a 2% payment based on the maximum (e.g., $60,000 x 2%, or $1,200). Refer to Policy 04-04, Part II-Addendum A for the maximum NELP amounts for each year.
If a PCI reassessment occurs (e.g., a worker had further surgery or treatment after an initial PCI award was provided), it may result in an increase or decrease to the original PCI percentage. Should this occur, the new PCI assessment is considered new evidence that would result in a reconsideration of the PCI percentage. Refer to Policy 01-08, Part I - Reconsiderations, Reviews, and Appeals. Refer to the PCI reassessment and/or Increase in PPD section.
Process documentary awards or payments in the same manner as if the worker had been examined, ensuring the assessed PCI is consistent with WCB entitlement. Refer Appendix D, Alberta Permanent Clinical Impairment Guide for details.
Request approval for the NELP award from the appropriate approver level. The supervisor will move the request for approval to the next level of authority, as appropriate. See the Levels of Authority manual.
The supervisor/manager/director will review the recommendation and the relevant documents and confirm whether the NELP award was correctly assessed, ensuring that any previously issued NELPs have been considered in the assessment, and approve or not approve the recommendation.
Administrative tasks
For a new NELP, complete/Update the eCO Permanent Clinical Impairment screen with the exception of decreased NELPs. Ensure to:
Complete all the fields and enter a separate record for each body part that qualifies for a NELP.
A pop-up box will appear for each separate body part (i.e. body part), asking the claim owner if they would like to request the NEL payment now? For multiple PCI records, select “No” on each pop-up box, except the last pop-up box. This ensures one cheque is generated for all records entered.
Input the effective date field with the date the worker reached maximum medical plateau (i.e. date of the PCI exam or the medical memo for documentary reviews).
The PCI percentage field (if the PCI is greater than 0.4% but less than 2%, manually enter 2%).
Complete the enhancement factor percentage field, if applicable.
When a new PCI record is added for the initial payment, the system generates:
A pop-up box for each record (i.e., body part) completed, asking the claim owner "Would you like to request your NEL payment now?" If:
Yes is selected, the Payment Prompt screen is automatically populated for processing.
No is selected, a golden dollar sign ($) will show on the PCI icon. Edit the PCI record, located on the Permanent Clinical Impairment Summary section, for processing at a later date (e.g., worker requested release at a later date because they were out of country).
A new PCI record in the Permanent Clinical Impairment Summary list on the Permanent Clinical Impairment screen and the Injury History tab at the Claimant line level.
A claim event (Permanent Clinical Impairment) which may send a Forms & Corr. task to the claim owner's task list. See the Permanent Clinical Impairment screen for further information.
The effective date for a PPD award is usually the first day in which the worker was not in receipt of full benefits (e.g. TTD, re-employment assistance), following the date of accident or date of surgery (for a scheduled award).
Before proceeding with PPD, ensure the following information has been obtained or addressed:
The worker's proof of age (e.g., birth certificate, baptism certificate, driver's license with photo, government-issued ID or citizenship card/papers).
A signed worker's report of accident (C-060).
Earnings information is correct (including any increased to the Section 56 rate)
Entitlements to other allowances (e.g., ELS, ELP)
Once the above information is received or addressed, call the worker to discuss the next steps.
The pension adjudicator reviews the PCI memo and determines the percentage of PCI to issue as a PPD award and the effective date. The effective date of an initial PPD award is usually the first day in which the worker was not in receipt of full benefits (e.g., TTD, Re-employment Assistance), following the date of accident, or on the date of surgery (for some scheduled awards). For determining the effective date for an increased PPD award, refer to the Increase in PPD section.
The pension adjudicator forwards the information to the Payment Unit to complete the calculations for the PPD or PTD award. Subsequently, the Payment Unit requests approval to implement the award from the appropriate level of authority. The supervisor advances the approval request to the next authority level as needed. Refer to the Levels of Authority manual for further guidance.
The supervisor, manager or director reviews the recommendation along with the pertinent documents, verifies that the PPD award has been accurately assessed, ensures that any previously issued PPDs have been accounted for in the assessment, and then approves or does not approve the recommendation.
Administrative tasks
Pension adjudicator or special needs case manager:
Document the details of the new, increased or decreased award. Include:
the reason the PCI qualifies for an increase or should not be decreased, if applicable.
If the overpayment or advance will be recovered and the amount that will be recovered.
Identify if the PPD is new, increased, or a documentary award. Complete separate records for each increase.
Complete the permanent clinical impairment details section of the Permanent Clinical Impairment screen for initial PPD award.
For an increased PPD awards, add a new line with the effective date for the increase the percentage increase (i.e., If a worker was previously issued a 10% PPD for the shoulder and now has an increased PPD totaling 15%, the previously issued 10% was already entered). Add another line with the effective date for the increase and the 5% increase.
Assign the Team Desk Payment/Fatal & Pension as a performer at the claimant level and send a file note task requesting that the pension award be implemented.
Payment Unit sends a file note (Compensation Payments) to the supervisor to request approval for the PPD award.
9. Communicate the decision
Review the decision from the supervisor, manager or director and action the NELP, PPD or PTD accordingly.
Call the worker to discuss the decision. For PPD awards, the pension adjudicator or special needs case manager discusses the decision with the worker.
If the worker does not qualify for PCI, explain the reason why they do not qualify. Reasons why a worker may not qualify for PCI include an invalid IMEAn invalid IME means that the finding from the examination are not consistent with the worker's injury and, therefore, the examiner is unable to determine a PCI rating. , PCI is assessment confirmed a rating of less than 0.4%Policy 04-04 confirms that the minimum assessable impairment is 0.4%. Workers assessed at less than 0.4% are not eligible for a PCI payment. ., etc. When the worker's IME was invalid and it was their first one, explain that a second exam will be arrange in six months. Discuss the importance of completing a valid exam so that PCI can be determined and explain that if a repeat (second IME) is invalid, PCI review may not be able to proceed.
If PCI was assessed, discuss how the PCI rating was determined.
Explain any of the following that apply:
The medical assessment results and the percentage of loss of function determined by the medical consultant.
The amount of the award or why the PCI will be decreased and what will happen to the overpayment.
The percentage and whether the award will be paid monthly or as a lump sum.
That PCI (i.e., the NELP or PPD award)does not compensate for lost earnings; it is an additional benefit paid to recognize measurable impairment.
That, if their injury worsens, they should contact their claim decision maker. (This can sometimes result in another assessment.)
Send the appropriate letter to the worker with a copy to the employer, if applicable. For PPD awards, the pension adjudicator or special needs case manager sends the letter.
Notes for NELP:
If the PCI is under 2%, indicate the actual PCI percentage in the letter.
If a reassessment of the impairment occurs to the same injury site, a reassessment confirms an increase in impairment and the total PCI remains less than 2%, the worker will not receive an additional NELP unless the total PCI exceeds 2%.
Address any overpayments, if applicable (i.e. PCI decreased following reassessment). If further case management is not required and all issues have been resolved, close the claim.
Administrative tasks
NELP awards
Document the conversation in a file note (Contact/Claimant Contact).
Issue the payment using the appropriate TOP/NOP code:
NEL-01 for NELP awards
NEL-02 for enhancement factor
Send the appropriate NELP letter with a copy to the employer:
PCI Assessed CL100A) Letter
PCI Not Assessed (CL100C) Letter
PCI - NELP - Increased - Previous Error (CL100J) Letter
Document the conversation in a file note (Permanent Disability).
The payment unit issues the PPD award using TOP/NOP code: PWR-01 for PPD awards
Send the appropriate PPD award letter:
PPD New (Lump & Monthly) (CL080) Letter
PPD Increase (Lump & Monthly) (CL080C) Letter
PPD Decrease or No Increase (CL080K) Letter
Note: The employer is not sent a copy of the PPD award letters.
Follow the appropriate internal procedure
5.1 Overpayment Collection
5.2 Diagnose a Cost Adjustment and Cost Correct/Forgive it or Collect it as an Overpayment
PCI Reviews and Awards
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Enhancement factor
An enhancement factor is applied when the worker's disabilities involve parts of the body with identical functions (e.g., both arms, both legs, both eyes, etc.). The combined disability must be both significant and result in assessable impairment.
Proceed with reviewing for an enhancement factor if the disability is:
Compensable: The result of the accepted injury or work condition, OR
Non-compensable: A non-compensable disability is only considered if it pre-existed the compensable disability, except in cases of vision or compensable lung conditions combined with a non-compensable heart condition, and when
There is existing medical evidence on file of the non-compensable disability and its impact, or
Requested by the worker or worker representative. If requested, the full extent of the non-compensable disability must be known based on previously completed medical assessments. WCB will not undertake investigation to diagnosis a non-compensable disability.
If medical documentation supports a pre-existing non-compensable disability, the affected part of body may be assessed along with the compensable part of body to rate its associated level of impairment. Relevant assessablemedical documentation may include (but is not limited to) specialist reports, operative reports, MRI, CT scan, x-rays, visual acuity and audiology tests, etc.
Note: Respiratory claims that qualify for a cardiac enhancement with a date of accident on or after January 1, 1995, are processed in the same manner as other compensable disabilities.
PCI reassessment and enhancement factors
If PCI is reassessed at a later date and the side of the body with the greater impairment changes, delete the original enhancement factor from the PCI screen and add a new enhancement to recognize the impairment for the new side of the body. Any overpayment created from deleting the enhancement factor should be recovered from the new NELP payable to the worker.
Note: This applies to NELPs only. The enhancement factor for PPDs is not entered separately on the PCI screen; it is included in the total amount that is entered for the PCI amount.
Example of applying the enhancement factor for NELPs:
A worker's PCI was assessed at eight percent for the right shoulder and six percent for the left shoulder. An enhancement factor of three percent was applied for the left shoulder (50% of the lower impairment).
Upon reassessment of the worker's PCI, the rating changed to 10% for the right shoulder and 12% for the left shoulder. The new enhancement factor is five percent for the right shoulder (50% of the lower impairment) and the worker is no longer eligible for an enhancement factor for the left shoulder.
To make the adjustment, the original enhancement factor for the left shoulder is removed from the PCI screen, which results in an overpayment for the NELP that was paid based on the original enhancement factor. A new enhancement factor of five percent for the right shoulder is then entered into the PCI screen. Any overpayment caused by removing the original enhancement factor should be deducted from the NELP payable to the worker for the enhancement factor on the right shoulder.
Retirement age and enhancement factors
For claims with a date of accident prior to January 1, 1995, WCB applies the enhancement factor to the permanent disability pension.
The only exception is for claims that have an enhancement factor applied when a compensable lung condition affects a non-compensable heart disease. For these claims, the enhancement factor stops when a worker turns age 65, unless they provide satisfactory evidence that they intended to work beyond age 65, had they not been injured.See Policy 04-04, Part II, Application 7; Enhancement Factor.
Administrative tasks
To apply the enhancement factor enter:
The PCI percentage for the compensable injury in the PCI percentage field
The enhancement factor into the enhancement percentage field.
Note: If the enhancement factor is added at the time of reassessment, the PCI percentage from the initial review/assessment will already be noted in the PCI screen. Refer to the eCO help pages.
Refer Procedure Resource Library for additional information on application of enhancement factors.
Follow the appropriate internal procedure
5.1 Overpayment Collection
5.2 Diagnose a Cost Adjustment and Cost Correct/Forgive it or Collect it as an Overpayment
Increase in PPD
The pension adjudicator determines the effective date for an increased PPD award through one of the following methods:
Deterioration of disability and midpointing.
Surgical procedure with a scheduled PCI award.
Deterioration (midpointing) and a surgical procedure with a scheduled award.
Deterioration of disability and midpointing
Midpointing is used when a worker's compensable permanent disability is expected to deteriorate over a long period of time. The effective date for the increased PPD is determined by selecting the midpoint between the date of the last assessment and the date of the current examination which confirmed the increase in disability.
The date used for midpointing is based on medical documentation (e.g., specialist consultation report, WCB medical exams, physician reports, and occasionally return-to-work dates).
Surgical procedures with a scheduled PCI award
When an increase in PPD award is due to a surgery that qualifies for a scheduled PCI award (for example, back surgery, revision of amputation, etc.), the effective date is the date of the surgical procedure or the first break in rate-based benefits after the surgery, if benefits were issued.
For example, an initial PCI assessment was done on January 20, 1993, and the worker received a 3% PPD award to recognize loss of range of motion of their left thumb at the interphalangeal (IP) joint. Later the worker underwent surgical amputation of their left thumb at the IP joint. The worker received a 7% PPD increase (total of 10% with the initial PCI rating) to recognize a left thumb amputation. The effective date of the increased 7% PPD award is the date of the surgical amputation procedure.
Deterioration (midpointing) and a surgical procedure with a scheduled award
In cases where the PPD award has increased, as medical documentation confirms that a portion of the increase is due to deterioration in a worker's compensable condition and another portion is due to a scheduled PCI for surgery, the effective date for the award is determined in two parts. The portion of the PCI increase that is due to:
deterioration based on medical documentation is calculated using a midpoint. Dates used for midpointing are based on medical documentation such as specialist consultation reports, WCB medical examinations, physician reports and occasionally return-to-work dates. This portion of the award is issued prior to surgery to recognize the deterioration of the injury before surgery.
deterioration resulting from the surgery is effective the date of the surgery. This portion of the award is issued at the time of the surgery, with the exception of a worker receiving a rate-based benefit (i.e. TD, VR) following the surgery. In those circumstances, this portion of the award would be issued the day after the rate-based benefits end.
For example: The worker initially received a 3% PPD award for a reduced range of motion in the left hip, as determined by an independent medical examination (IME) conducted on January 20, 1993. The worker underwent hip replacement surgery on January 10, 2007. A second IME done on February 20, 2009, confirmed deterioration in the left hip range of motion,resulting in 15% total PCI.
To calculate PCI percentage and determine the effective date:
Part 1 is calculated as half the difference between the current PCI rating and the previous PCI rating:
15% -3% =12% increase in PCI.
Half of the total increase 12% is 6%.
Part one is issued for the first half as a 6% increase bringing the total PCI to 9% (6% increase + the original 3%) to recognize the deterioration of the worker's left hip prior to the surgery. The effective date is the midpoint between the date of the initial assessment (January 20, 1993), and the date of surgery (January 10, 2007).
Part 2 is issued as 6% increase which is the other half of the difference between the current PCI rating and the previous PCI rating. Part 2 is issued to recognize the deterioration following the left hip replacement surgery. The effective date of the increased PPD award is January 10, 2007, the date of the surgery. The exception would be if the worker was placed on rate-based benefits (e.g. TD, VR) following the surgery, the effective date would be the first day after the rate-based benefits end.
Part 1 midpoint award (6% + the original 3% = 9%) plus the Part 2 midpoint award (an additional 6%) brings the total PPD award issued to 15%.
The medical department determines if an in-person medical assessment is required for the rating of a PCI. There are five ways a PCI can be rated:
Scheduled award PCI - A scheduled award is a designated percentage for a specific loss of function resulting from surgery, amputation or a body part being removed, etc. A scheduled award may be determined by a documentary review. The PCI medical consultant reviews the medical information on file and completes a PCI rating memo. A scheduled award may be issued on a documentary basis, where medical information on file confirms the following:
A joint replacement (any joint)
An amputation (any body part)
Spine surgery at any level
Spine fractures at any level
Loss of organs (e.g., an eye, spleen, kidney, etc.)
Other - for loss of sense of smell or taste, impotence and infertility, discuss with a PCI medical consultant or clinical consultant.
Documentary PCI - A PCI assessed without an in-person evaluation for back, wrist, elbow, hip, knee or ankle. The percentage of PCI is based on the information on file.
PCI-physical therapist (PT) review - When the measurements are not present on the claim to provide a documentary rating for a shoulder, elbow, wrist, hip, knee and ankle/foot, an evaluation is done with a specially trained physical therapist in the community. The physical therapist completes measurements for a PCI rating. Once the measurements are received a PCI medical consultant reviews them and completes a PCI rating memo.
MCRE (Medical consultant rating evaluation) review - The worker is seen by a specially trained physician who does both the evaluation and PCI rating. A MCRE report is sent to file with the PCI rating.
PCI examination- an evaluation with a specially trained physician or clinician to provide the findings needed for PCI rating. Once their medical report is received, a PCI medical consultant reviews the results and completes a PCI rating memo.
PCI reassessment
After the initial PCI assessment, a worker's compensable condition may be reassessed for PCI when deterioration or improvement in the worker's condition is expected (e.g., a worker has surgery or more treatment resulting in improvement or deterioration).
Any increase or decrease in PCI following PCI reassessment is considered new evidence that would result in a reconsideration of the PCI percentage.
If PCI reassessment confirms:
The worker’s condition has deteriorated (e.g., following a hip replacement or revision amputation surgery) the PPD or NELP should be increased.
The worker's condition has improved (e.g., more range of motion, improved sensation, etc.), the PPD or NELP should be decreased. For example, a worker is initially assessed as having a 15% PCI. Three years later, the worker has improved and is reassessed as having a 10% PCI. The PCI award is decreased due to the improvement of the worker's condition. Document the reason the PCI decreased. Do not adjust the previously issued NELP payment to avoid creating an overpayment.
If the PCI for the same body part increases in the future, ensure the previously issued NELP that was based on a higher PCI percentage is taken into consideration before issuing any additional NELP payment. For example, the worker's initial PCI that was 15% was decreased three years later to 10%. Two years later the worker is reassessed and their PCI increased to 17%. Since the worker was already issued a NELP for 15%, they are eligible for the additional 2% NELP payment.
If PCI reassessment confirms a decrease in the PPD amount, the pension adjudicator will notify the decision maker to obtain their agreement to decrease the PPD (if paid monthly).
A NELP increase must be at least 0.1% and can be paid after the minimum PCI of 2%.
The PCI must not be adjusted if the percentage changes due to the use of different impairment guides (for example, Alberta, American Medical Association, etc.) rather than a change in the level of impairment.
Examples:
A worker has a 15% PPD award. A recent PCI assessment indicates the worker is now assessed at 20% due solely to the difference in the guides (tables) used. In this case, the prior PPD% is not increased.
A worker has a 20% PPD award. A recent PCI assessment indicates the worker is now assessed at 15% due solely to the difference in the guides (tables) used. In this case, the prior PPD% is not decreased.
Claims with a date of accident on or after August 1, 1999, are not entitled to an increased NELP to the same site if:
A 2% NELP was previously paid; however, the assessed PCI was less than 2%, and
There is increased impairment, on the same or a different claim, but the overall clinical impairment remains under 2%.
Example: A 2% NELP was previously paid for a revision of amputation to the left index finger, distal interphalangeal joint (DIP) but the assessed clinical impairment was less than 2%. Reassessment confirms an increase in impairment on the same or a different claim, but the overall clinical impairment remains under 2%.
Administrative tasks
Document the decision to increase or decrease a NELP or PPD in a file note (Permanent Disability).
When a PCI decreased:
For a NELP, do not adjust PCI percentage in the Permanent Clinical Impairment screen. This ensures that an overpayment is not created for the previously issues NELP.
For PPD awards, document the PCI decrease in the Permanent Clinical Impairment screen.
A Permanent Injury Award (PIA) is intended to compensate for accidents that cause serious and permanent disfigurements or other lasting injuries. This compensation is considered when, in the opinion of WCB, the worker has not been adequately compensated and there are no other means for the WCB to provide compensation. The intention is not to offer extra compensation for lost wages, including future income or opportunities, nor to increase the maximum compensation rates or alter the method used to determine individual compensation rates.
Note: A PIA is generally paid as a lump sum, however, periodic payments may be considered at WCB's discretion.
When the worker meets the eligibility criteria, send a recommendation to the supervisor and outline:
The reason the PIA is being recommended
All entitlements the worker has received under the claim
Why the other entitlements do not provide adequate compensation
Do not include recommendations regarding the PIA amount.
If approved, the supervisor will forward their recommendation to approve or not approve the PIA to the next level of approval. A specialized committee, consisting of the director of Customer Service, the director of Medical Services, and a psychologist or their designate, will evaluate the recommendation. Additionally, they will explain the rationale for the PIA amount.
Note: The maximum value of the PIA cannot exceed the maximum NELP that is in effect at the time the PIA determination occurs.
Call the worker to discuss the decision to approve or not approve the PIA and send the appropriate letter.
If approved, send a referral to the Payment Unit to calculate the PIA award.
Administrative tasks
Send a file note (Permanent Disability) to the supervisor for review.
Document the discussion with the worker in a file note (Permanent Disability/PIA). Indicate “PIA Recommendation” in the description line.
Send the Clamant - Custom (CL000A) Letter
Send file note (Permanent Disability) to the Payment/Fatal and Pension, Team Desk and include the calculations for determining the amount of the PIA. Note: PIA is paid using TOP/NOPType of payment/nature of payment - this is the code used to issue the payment. PIP-01.
Timing of PCI reviews
A PCI review typically takes place either two years after the date of accident or the last surgery. For certain types of injuries, the PCI assessment may be deferred for more than two years to provide sufficient time for achieving maximum medical recovery, such as psychological injuries leading to permanent work limitations and brain injuries causing mental and cognitive deficits.
In all cases, PCI reviews should only occur when the worker has reached maximum medical improvement (i.e., treatment has been completed, the condition has stabilized and further improvement is not expected).
Scheduled PCI reviews
A scheduled award PCI review may take place at any time before the usual two-year mark. The review is completed on a documentary basis because the loss of function for the compensable injury is known based on the current available medical information. A scheduled award is a designated percentage for a specific loss of function resulting from surgery, amputation, or a body part being removed, etc. See the PCI evaluation methods section.
PCI for psychological injuries
PCI is possible for a psychological/psychiatric injury or condition when the condition results in permanent work restrictions. PCI is only assessed when a worker has reached maximum medical improvement after optimal treatment for the condition has been attempted. If it is unclear whether PCI is anticipated or should be assessed, request an opinion from a WCB psychological consultant, clinical or medical consultant.
Current medical reporting is not required if it is confirmed that there has been no recent medical visit(s) for the work injury, there has been no reported changes and the condition appears to be stable.
PCI reviews for psychological injuries are completed through in-person assessment. The Medical Department will determine the most appropriate clinician for the assessment [e.g., Comprehensive psychological assessment (CPA) or Psychiatric independent medical examination (PIME), etc.).
PCI for brain injuries
PCI assessment for brain injuries typically takes place more than two years after the injury. The timing for the assessment is based on when it is medically established that the worker is at maximum medical and cognitive functional recoveryMaximum recovery or medical plateau for brain injuries is normally reached when the worker's medical and cognitive condition has stabilized, further significant medical improvement is unlikely, and permanent work restrictions can be confirmed..
Consult with a clinical or medical consultant to determine the appropriate time to arrange PCI (mental impairment) assessment.
If it is clear from the medical documentation on file that the worker is permanently totally disabled (PTD), it is not necessary to delay the PCI assessment. See Section 43 (2) of the Workers' Compensation Act.
Arrange a Neuropsychological Assessment (NPA) six months before the PCI review date. If a post-accident profile report was done by a neurologist and a neuropsychologist, ensure the information is on file. Once all the information is on file, consult with a clinical or medical consultant to determine if an independent psychiatric medical examination is needed.
Administrative tasks
If there are questions regarding the PCI review (e.g., if PCI is likely, when PCI review should be done, etc.), complete the PCI referral (FM555B) form to obtain clarification from the medical or clinical consultant.
There are four types of awards paid to recognize a worker's permanent impairment. In most cases, the type of award payable to a worker is based on when the accident occurred (the date of accident), except when the worker is considered permanently totally disabled.
Non-Economic Loss Payment (NELP)
NELPs are issued on claims with a date of accident on or after January 1, 1995. NELPs are issued as a lump sum payment.
NELPs compensate workers for the degree of impairment that is assessed for the loss or loss of use of, change or disfigurement of any body part, system or function. For NELPs, the minimum percentage is 2% (i.e., if the initial PCI rating is 0.4%, the percentage will be bumped up to 2%). A NELP is paid in recognition that a permanent clinical impairment (PCI) also impacts the worker's life outside of the workplace (personal or extra-curricular activities, daily living, quality of life, etc.). It does not compensate the worker for their inability to work or loss of earnings, which is done through a wage loss benefit [for example, Economic Loss Payment (ELP) or TEL (Temporary Economic Loss), etc.]. Refer to procedure 8-1 Wage loss supplement final approval and Policy 04-04 Part II.
The effective date for a NELP award is usually the date of the medical consultant's memo (documentary review) or the date of the independent medical examination for the PCI.
Note: NELP percentages are rounded to 2 decimal points.
Permanent Partial Disability (PPD)
PPD awards can be issued on claims with a date of accident before January 1, 1995. A PPD award is issued monthly for PCI rating of more than 25%. If the PCI is assessed at 25% or less, the PPD is issued as a lump sum payment; but the worker has the option to choose monthly payments instead. If PCI is assessed at more than 25%, a worker must provide evidence that they are otherwise in good health to be eligible for a lump sum commutation of their PPD award. Refer toPolicy 04-04, Part II, Application 8 - Lump Sum Commutations.
PPD awards compensate the worker for the degree of impairment that is assessed for the loss or loss of use of, change or disfigurement of any body part, system or function, and the assumed permanent loss of earning capacity resulting from the clinical impairment. For PPDs, the minimum percentage for loss of function is 0.5%.
An initial PPD award is usually effective the first day in which the worker was not in receipt of full benefits (for example, Temporary Total Disability, Re-employment Assistance, etc.) following the date of accident, or on the date of surgery.
A PPD pension award does not fully compensate a worker for loss of earnings capacity caused by the compensable injury. Determine if the worker is eligible for an earnings loss supplement (ELS). Refer to Policy 04-04, Part II, Application 6 - Earnings Loss Supplements.
Note: PPD percentages are rounded to 1 decimal point.
Workers, spouses, dependents or trustees who live outside of Canada and receive monthly pension or ELP benefits.
Spouses where the DOA is pre 1982 regardless of where they live and receive monthly pension benefits (the spouse must complete the marriage clause if the DOA is pre-1982).
For claims with a date of accident prior to January 1, 1982, if the spouse is receiving monthly pension benefits and is living in Canada, an annual affirmation form is required (C090 - Statement of Spouse form). The payment unit will send the C090 to the payee. If the claim owner requires assistance or has questions about the form.
Role of the Payment Unit
The Payment Specialist identifies which claims require an affirmation and determines and mails the affirmation form to the payee. If a payee is receiving multiple pensions, only one affirmation form is required.
Note: If the payee is receiving their benefits via wire transfer, the claim owner and Finance have already confirmed they are in receipt of benefits, so no affirmation is required.
Once a completed affirmation form is received, a payment specialist reviews the form to ensure it was completed correctly, documents in a file note that the affirmation was received and provides details of any steps to be taken or requests additional information if needed. Address and banking information changes are updated, if required and the payment specialist notifies the decision maker if there are any changes in marital status or dependents.
If the affirmation was not completed correctly or has not been received on file after three months, the Payment Unit notifies the decision maker and asks them tocontact the payee and request the affirmation be signed and returned to the WCB.
Monitor the claim for the affirmation; scan it to file once received. If the affirmation is not returned to the WCB within one month, send a reminder letter to the payee to complete the affirmation. If the affirmation is not received after an additional month, stop benefits andinactivate the claimuntil the affirmation is received.
When the affirmation form is received and scanned to file, an automatic taskis sent to the Payment Mail, Working Desk. The Payment Specialist reviews the claim to determine if the payments were stopped because the affirmation was not received and reinstates the benefits or award(s). Any retroactive payments will be issued; the decision maker is not required to notify the Payment Unit once the affirmation is received.
Administrative tasks
Send a task to the Payment/Maintenance, Team Desk to request assistance with the form.
The CLM01589M report confirms which claims require an affirmation. The payment unit reviews the affirmation exemption/special conditions list and excludes these claims from the list requiring affirmations.
Note:The worker's signature is no longer required for a change of address.
Send the Claimant custom (CL000A) letter to remind the worker or payee to complete the affirmation.
To stop benefits until an affirmation is received
Send a file note (Compensation Payments) to the Payment/Maintenance, Team Desk. Document:
the reason the benefits should be stopped,
the effective date,
the date(s) of the attempted (or successful) contact with the payee, and
whether the affirmation was received by the payee, and direction if it should be mailed/sent to an alternate address.
Early PPD pension cheque release
Early release of pension (PPD) payments may be considered on a case-by-case basis. It is not recommended that a worker be given more than one month in advance as interest charges will apply. Pension cheques are issued on the 20th day of the month. Because of financial transactions (deposits to accounts, etc.), early release should only occur in emergency situations.
When a worker requests an early release of their pension (PPD), consider when a special cheque (advance) should be considered. Advances may be considered to help protect the worker's home equity or consolidating, reducing or eliminating non-recurring debts which resulted from hardship caused by an extended period of disability.
Advances are not usually issued for:
Consolidating, reducing, or eliminating recurring debts.
Purchasing a recreational vehicle.
Financing a vacation.
Financial investment in business or stocks.
Any other purpose not considered to be in the worker's interest
If the decision is to approve a special cheque against the monthly PPD (i.e. an advance), discuss the repayment schedule with the worker (e.g., instalments will be deducted from the worker's ELP payments or the ELP payments are stopped until the amount for the special cheque is repaid in full) and ensure the worker understands that interest charges may apply.
Send a referral to the Payment Unit to issue the special cheque against the monthly pension (PPD). The payment unit modifies the payment as the pension (PPD) is issued via Electronic Funds Transfer. This ensures there are no issues with early release of payments.
The Payment Unit issues the advance. Once the advance has been issued, delete the pension advance payment and set up the recovery plan. Monitor for repayment of the advance.
Administrative tasks
To request the early release of a PPD, send a file note (Compensation Payments) to the Payment/Fatal & Pension, Team Desk. Include:
The basis for the special cheque
The date it is required
The repayment schedule
How the cheque should be delivered (i.e., mailed, pick-up at Edmonton front counter or a regional office, etc.)
To set up the recovery plan and initiate steps for repayment of the advance, follow the appropriate internal procedure:
5.1 Overpayment Collection
5.2 Diagnose a Cost Adjustment and Cost Correct/Forgive it or Collect it as an Overpayment
Reinstate a lump sum payment to a monthly pension
If a worker received a lump sum cheque that they did not request, ask the worker to return the original WCB cheque. Once the cheque is received, send the cheque to the Payment Unit for refund and ask them to reinstate the monthly pension.
If the returned cheque is sent directly to the Payment Unit, they will notify the decision maker and request an investigation of the returned cheque.
Contact the worker to discuss the reasons for the returned cheque and make a decision to refund or return the cheque. Notify the Payment Unit of the decision to:
Refund the cheque and reinstate the monthly pension, or
Return the cheque to the worker.
If the lump sum cheque has been sent by mail and cashed or has been deposited by EFT, the worker may repay the lump sum cheque by way of a certified cheque to the WCB, within 30 days of the lump sum cheque issue date.
