Retroactive wage loss supplement final approval

Review the information on the claim file that indicates a WLS may be payable retroactively (i.e., for a period in the past). Assess the information and develop a plan for making the decision. 

Consider whether the retroactive wage loss is payable because:

• A DRDRB or AC decision provides specific direction to pay or adjust a WLS retroactively for determining eligibility for a retroactive WLS.
• Of a reconsideration of a previous decision due to an administrative review or new evidence. Refer to WCB Policy 01-08, Reconsiderations, reviews and appeals.
• Medical information supports a change in work restrictions and the job option used to estimate earnings is no longer suitable from the date of the medical appointment onward. 

When the worker does not have any new or changed work restrictions, the worker is not eligible for retroactive wage loss benefits. Continue to step 8 to make the decision. 

When the evidence supports that the worker has been unfit for any work for a retroactive period, review the worker's eligibility for temporary total disability (TD01) benefits or long-term temporary total disability (TD04) benefits. Do not proceed further with this procedure. Refer to the 3-2 Collaborative care planning procedure.

When the evidence supports that the worker is fit for work but there are new or changed work restrictions, confirm the date for the change and ensure the new or changed work restrictions are clearly documented in the medical report. If unclear, consider what additional assessments are needed to confirm the work restrictions (e.g., medical consultant review, Independent Medical Examination, Functional Capacity Evaluation, etc.). 

Determine if there is information on file that supports the worker was employed at any time during the retroactive period. If so, consider the time periods worked and the available information to support the worker's earnings (e.g., pay stubs, income tax). Plan to confirm this information as the worker's actual earnings may be used to calculate the retroactive WLS.

Review the claim and the worker's other claims for reporting from previous re-employment services to check if a suitable walk-in job option was identified that aligns with the worker's new or changed work restrictions. 

• If a suitable job was identified, confirm if the publication date was within the one-year time period before the effective date for the retroactive wage loss or the existing WLS.
• If no suitable job was identified, review labor market information to confirm if the same job was researched during the appropriate time period. 

If salary records are not available, send a request to review historical salary records. Only salary records that were published within the year before the retroactive TPD or wage loss supplement start date can be used. For example, if the effective date of the retroactive TPD is March 1, 2020, use salary records published in the year before March 1, 2020.

If there is not enough information on file, consider what next steps are needed to make the decision. This may include requesting missing information, arranging for additional assessments, exams, re-employment services, obtaining salary information, etc. 

Discuss the review for retroactive benefits and gather additional information. 

Ask the worker:

• How have the changes or new work restrictions affected your ability to perform your duties?
• Where did you receive medical care or treatment during the retroactive period?
• What income supports did you have during the retroactive period?
• Did you work at any time during the retroactive period?  If so,
  • Where did you work and what were your job duties (i.e., job title, job description)?
  • What time period(s) did you work (i.e., dates employed) and why did the job end (i.e., the reason the worker stopped working, if not employed for the entire retroactive period)?
  • What was your rate of pay while working? Did you experience a loss of income (i.e., earned less than 90% of their net date-of-accident earnings)?
• Were you looking for work during that period and what types of jobs did you apply for? This information may be helpful to identify a suitable job option.
• To send in their income tax or earnings information for the retroactive period.
• What their retirement plans are if they are age 50 or older.

Discuss if a medical referral, such as an opinion from a medical consultant, a comprehensive functional capacity evaluation or an independent medical examination, is necessary to confirm the worker's restrictions if they are unclear or a specific date supporting the change in restrictions cannot be determined. If relevant, obtain their agreement to attend.

Explain the next steps for determining the worker's eligibility for retroactive benefits based on their claim circumstance. Consider the worker's financial circumstances and if they are experiencing any hardship. If so, consider whether a TPD should be issued based on minimum wage while awaiting the outcome of re-employment services (See step 4). Discuss that the WLS may be adjusted depending on the outcome of re-employment services.

The worker was employed during the retroactive period

Discuss that once their earnings information (e.g., income tax, pay stubs, etc.) is received, the information will be reviewed and may be used to calculate a new WLS or adjust their existing WLS for the retroactive period, unless the worker is considered under-employedA worker is under-employed when they work in a position that did not pay as much as they were capable of earning.. 

Explain that if:

• They stopped working for:
  • reasons unrelated to their compensable injury, the new WLS will be calculated or the existing WLS will be adjusted as if they had worked for the entire retroactive period.
  • reasons related to their claim, but they were still fit for some type of work during the retroactive period, their earnings will be estimated for the period(s) they did not work.
• They were employed in a position that did not pay as much as they were capable of earning (i.e., the worker was under-employed during the retroactive period), a referral for re-employment services will be made. Confirm the worker's commitment to participate in these services.

If the worker worked for the date-of-accident employer during the retroactive period but reported that they stopped working due to their compensable injury, call the employer to:

• obtain details about why the worker stopped working
• confirm the date for their last day of work, and to
• verify earnings information.

The worker was not employed during the retroactive period

Discuss whether previous re-employment services were completed. If they were not, explain that a referral will be made to help identify a suitable job option that can be used to estimate their earnings for the retroactive period and going forward, if applicable.

If previous re-employment services were completed and:

• A suitable job was identified, describe how the job duties and physical demands align with the worker's new or changed work restrictions. For example, if the worker has a lifting restriction, the job cannot require lifting beyond the allowed weight. Explain how the worker meets the skills, education and experience requirements for the job.
• A suitable job was not identified, explain that a referral for re-employment services will be made to identify a suitable job option that can be used to estimate earnings for the retroactive period and going forward, if applicable.
  • Refer for a job option report when a job is only needed for the retroactive period.
  • Refer for re-employment services (i.e., triage assessment followed by supported job search services) when a job option is required for the retroactive period and going forward.
• If the retroactive WLS was directed by the DRDRB or AC and it will take longer than 30 days to implement, a TPD based on minimum wage may be used to estimate earnings in order to provide benefits while re-employments services are being completed. Explain that the WLS may be adjusted depending on the outcome of re-employment services.  

Confirm the worker' agreement to participate in these services. If the worker does not agree to participate, explain their duty to cooperate in return-to-work services and if they choose not to participate, the service will be completed on a documentary basis.

Confirm work restrictions

Request any missing medical reporting for the retroactive period to confirm the worker's fitness for work, what level they were fit for and if the restrictions changed during the period. 

Make referrals for any reviews and/or assessments (e.g., medical consultant opinion, comprehensive functional capacity evaluation, independent medical examination, etc.) needed to confirm the work restrictions.

Review all information gathered to confirm if the medical information supports a change in the worker's work restrictions. If so, identify the date for the change. Consider:

• Using the date of first medical that indicates a change in functional ability.
• Reviewing all the medical reporting to determine when the worker began reporting the symptoms that resulted in the change to the work restrictions.
• Requesting an opinion from an internal medical consultant as to when the new work restrictions reasonably began.
• Using the date of the last rate-based payment if the restrictions did not end on last claim closure.

Re-employment services referrals

Make a referral for re-employment services when a suitable job option was not identified during previous re-employment services and the worker was not employed or was employed in a position that did not pay as much as they were capable of earning (i.e., the worker was underemployed) during the retroactive period. 

Request a job option service report to obtain a suitable position(s) for the retroactive period. The re-employment provider may recommend a triage assessment when no re-employment services were previously completed.

When a new job option is required moving forward and the worker has agreed to participate in supported job search services, determine if the worker is eligible for re-employment benefits (VR04) to look for work in the new position.  

Once re-employment services are completed, determine if a suitable job option has been identified that covers the retroactive period. If so, the salary information to estimate earnings for the retroactive period can be used. If applicable, the salary information can be used to estimate earnings moving forward, unless a different job option was requested to use moving forward.

Note: A job lead is not required when estimating earnings for retroactive periods because it is not possible to find job leads for the past. However, if the same position will be used to estimate earnings moving forward, a job lead is needed to support the position is accessible now.

A retroactive TPD based on minimum wage may be paid before a job option is identified in order to ensure that the worker does not experience financial hardship while waiting for a suitable job option to be identified.

Calculate an interim retroactive TPD based on minimum wage when it will take longer than 30 days to identify a suitable position to use for estimating earnings.  An interim retroactive TPD based on minimum wage may be considered when: 

• Implementing a changed decision from DRDRB or the AC that directs payment of a retroactive wage loss supplement.
• Customer Service reconsiders a previous decision based on new evidence or an administrative review, which results in the need to pay a retroactive wage loss supplement.

Once the calculations are received from the Payment unit, request approval from the supervisor to pay an interim TPD benefit based on minimum wage. 

Call the worker to discuss the decision to approve or not approve the interim TPD benefit. If approved, ensure the worker understands that the WLS benefit may be adjusted depending on the outcome of re-employment services.  Send the appropriate letter.

After the completion of re-employment services, review the results and adjust the interim TPD benefit based on the suitable job option identified for estimating purposes.

After receiving the workers' earnings information (e.g., tax information, pay stubs, record of employment, etc.) and/or completing re-employment services, determine the earnings to be used for calculating the WLS, taking into account the specific circumstances of the claim as detailed below. Consider whether the interim TPD benefit needs to be adjusted. 

An Interim TPD benefit was paid on minimum wage

If an interim TPD benefit was paid, review the outcome after completion of re-employment services. 

If a suitable job option:

• Was identified that pays:
  • more than minimum wage, use the salary information for the job option to estimate earnings and adjust the interim TPD benefit.
  • minimum wage, the retroactive interim TPD benefit does not need to be adjusted.
• Was not identified and the decision is made:
  • On or after July 1, 2024, and the decision that the worker is eligible for a new or adjusted WLS for a retroactive period:
    • was not due to a reconsideration by Customer Services or a decision from the DRDRB or AC, a new WLS may be paid, or the existing wage loss may be adjusted based on no post-accident (zero based) earnings.
    • was due to a reconsideration by Customer Service or a decision from the DRDRB or AC, a new WLS may be paid, or the existing wage loss may be adjusted based on minimum wage when specific criteria outlined in Policy 01-08, Part II, Application 4 - Question 11 are met.
  • before July 1, 2024, use no post-accident (zero-based) earnings to estimate earnings. Refer to the No post-accident earnings (zero-based) WLS section below.

DRDRB or AC has directed payment of WLS based on specific earnings

Calculate the retroactive WLS or adjust the existing WLS based on the specific earnings as directed by the DRDRB or AC. 

Worker was employed during the retroactive period

If the worker was employed during the retroactive period, and

• Earning as much as they were capable of earning, use their actual earnings for the period of time they worked to calculate the retroactive wage loss benefit.
• Not earning as much as they were capable of (i.e., the worker was under-employed), calculate the WLS using estimated earnings for the suitable job option identified if it pays higher than the worker's actual earnings. If it does not pay higher, calculate the retroactive WLS using the worker's actual earnings.
• Stopped working because of reasons unrelated to their compensable injury, calculate WLS as if they worked the entire retroactive period.
• Stopped working because the position was not suitable, calculate the WLS for those periods using the estimated earnings for suitable job option identified.

Continue to the next step to obtain approval for the new retroactive WLS or adjusted existing WLS for the retroactive period.

Worker was not employed during the retroactive period and earnings will be estimated/re-estimated

If a suitable job option was identified, use the salary information for the job option to estimate earnings. If salary information is not available for the position, it can be assumed the position paid at least the legislated minimum wage in effect on the start date of the retroactive benefit. 

Calculate a retroactive WLS based on minimum wage without identifying a suitable job option when the WLS is payable as a result of a reconsideration by Customer Service (due to an administrative review or new evidence) or a changed decision from DRDRB or the AC and the decision was made on or after July 1, 2024. See Policy 01-08, Part II, Application 4 - Question 11. 

Minimum wage may be used to estimate/re-estimate earnings when:

• The original estimation of earning capacity was based on earnings in excess of minimum wage.
• The worker is realistically employable. A worker is not realistically employable when they only have a minimal level of fitness (e.g., only fit for a few hours of work per week, sub-sedentary work, etc.) or have such significant compensable and non-compensable barriers that they are likely not employable. In these cases, minimum wage should not be used to estimate earnings.
• All attempts to identify a specific job, position, or occupation that can be used for estimating purposes have been exhausted.
• The effective date of the change to the WLS is more than one year ago. When the effective date is less than one year ago, use existing labour market information to re-estimate earnings.

No post-accident earnings (zero-based) WLS 

When all attempts to identify a suitable job option have been exhausted and a job option cannot be identified, use no post-accident earnings (zero-based). When the decision to pay the retroactive wage loss was made:

• before July 1, 2024, a new WLS may be paid or the existing WLS may be adjusted.
• on or after July 1, 2024, and was not due to a reconsideration or a decision from the DRDRB or AC, a new WLS may be paid or the existing WLS may be adjusted.

Determine and calculate the retroactive WLS benefit

Determine the type of WLS benefit payable. Pay the retroactive wage loss benefit as a:

• TPD benefit when a WLS was not paid for the retroactive period.
• TPD benefit if the worker was already paid a TPD for the retroactive period.
• A new TEL if the earnings impairment will be end within 6 years.
• A new ELP if the earnings impairment is permanent and the retroactive period payable is within the current year.
• An adjustment to the worker's existing TEL, ELP or ELS benefit if the worker is already in receipt of one of these WLS types.  

Submit a proposal to the supervisor requesting approval to pay a new WLS benefits or to adjust an existing WLS retroactively, and the WLS going forward, if applicable.

Include the following information in the proposal:

• Reason for the recommendation, the time period the retroactive WLS is payable, and whether the WLS will be:
  • a new retroactive TPD benefit, or
  • an adjustment to an existing TEL, ELP or ELS benefit (e.g., reconsideration, DRDRB or AC decision, change in work restrictions, etc.), or
  • a new or adjustment to an existing ELP that will be paid retroactive for the current year and going forward, and a TPD for the retroactive period (the portion outside the current year).
    • If the WLS will be a new ELP, explain in the proposal that the retroactive period will be paid as a TPD.  Ensure the CPL Line for the TPD for the retroactive period is approved first.  Once the TPD for the retroactive period is approved and the TPD rate and benefits have been issued, update the CPL line with the ELP information for the current year and going forward.
    • If an existing ELP is already in place, edit the CPL and adjust new earnings amount (per hour/year and work cycle, if needed).
• That income tax/earnings information was obtained to confirm the worker's earnings during the retroactive period.
• The medical information used to confirm new or changed work restrictions and the worker's current fitness level.
• The position selected (including suitability and salary information) or if a position was not identified, the plan to pay a TPD benefit based on minimum wage while re-employment services are being completed.
• Details of the reduction plan when the wage loss benefit will continue for longer than one year.
• Job lead information to support the position is accessible going forward.

Note: Manager or director approval may be required if the amount of the retroactive payment exceeds the supervisor's level of authority. Refer to the Levels of Authority manual.

Review the supervisor's (and manager or director, if applicable) file note to confirm if the wage loss benefit is approved or not approved. 

If not approved, action any recommendations and return to step 6 to submit a new or updated proposal to the supervisor, if applicable.

If approved:

• For a new TPD, TEL, or ELP, proceed to the next step.
• For a new or an existing TPD, TEL, ELP, adjust the Case Planning line and send for approval.
• For an existing ELS, adjust the Earnings Loss Supplement line and send for approval.

Note: Once the appropriate line is approved by the supervisor/manager, the retroactive and future benefits can be paid.

Call the worker to discuss the decision and clearly express the rationale used to reach the decision (citing policy, medical information on the file, any important background information) during the conversation as well as within the letter. Notify the employer of the WLS when it will continue beyond the retroactive period based on the suitable position identified. 

If the retroactive WLS is approved, explain the information used to calculate the retroactive wage loss including:

• The type of wage loss payable and the basis for the wage loss - actual earnings, minimum wage, suitable job option or no post-accident earnings.
• If a previously approved WLS based on minimum wage will be adjusted based on a newly identified job option, discuss the job suitability and earnings that will be used for estimating purposes with the worker. Explain that while the worker's monthly wage loss benefit will reduce for the retroactive period, they will not be required to repay the overpayment.
• If the wage loss benefit going forward will be based on the same job and earnings used for the retroactive period or whether a new suitable job was identified.
• The worker's retirement plans if they are age 50 or older and will not reach their date-of-accident earnings within five years, if not previously confirmed. 

Ensure the worker understands how the job option meets the suitability criteria for the retroactive period and how it meets the suitability and accessibility criteria when the WLS will continue beyond the retroactive period. Discuss the monthly WLS amount, the approval period, the reduction plan (if applicable) and date of the next review.

Communicate the decision in writing.

Note: If the worker is not set up to receive payment through direct depositAlso known as electronic funds transfer - EFT., advise them of the option and the requirement to submit the appropriate form. 

Issue the payments as appropriate based on the wage loss benefit type and set future benefits, if appropriate.

For a retroactive TPD, once approval is received, the case assistant sets the new TPD rate or adjusts the existing TPD rate, and requests the retroactive benefits and future TPD benefits, as appropriate. Note:  Ensure the Case Planning line reflects the supervisor's decision as approved. The line must show approved to set the TPD rate.

For retroactive TEL, confirm the case planning line is approved for the retroactive effective date.  Once approved, the system automatically requests the payments for the retroactive period and future TEL benefits, if applicable.

For a New ELP with retroactive TPD, ensure the TPD line is approved before adding a review for a new ELP. The case assistant requests the TPD benefits for the approved retroactive period. Once the CPL is approved for the new ELP, the system automatically requests ELP payments as approved for the current year.  

For a retroactive ELS, confirm the ELS line is approved.  Once the ELS line is approved, an automated task is sent to the Payment Unit to set the ELS rate.  Once the ELS rate is set, the case assistant requests the retroactive payments and future ELS benefits, if applicable.

Note: Each retroactive adjustment to an existing line needs to be approved in sequence.  For example, when adjusting an existing ELP line that started March 21, 2021, obtain approval for the March adjustment first. Then, adjust the ELP36 line and obtain approval.

Continue to manage the claim or if no further case management is required, assign the claim to the case assistant for monitoring, if appropriate.