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 directs the payment or adjustment of a WLS retroactively.
• A previous decision is reconsidered 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, making the job option unsuitable from the date of the medical appointment onward. Review the medical reporting that was used in determining the worker's fitness for work during the retroactive time period and compare with the current medical reports to determine if there is a change in their work restrictions going forward. 

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

When the evidence supports the worker was unfit for any work during the retroactive period, review the worker's eligibility for temporary total disability (TD01) benefits or long-term temporary total disability (TD04) benefits. Do not continue with this procedure. Note: Current medical reporting cannot be used to confirm a worker's fitness for work for a retroactive period. Medical reporting that was available during the retroactive period is used. Refer to the 3-2 Collaborative care planning procedure. 

When the evidence supports the worker is fit for work but there are new or changed work restrictions, confirm the date of 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.). 

Check if there is information on file indicating the worker was employed during the retroactive period. If so, review the time periods worked and available earnings information (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 to see if previous re-employment services identified a suitable walk-in job option that aligns with the worker's new or changed work restrictions. 

• If a suitable job was identified, confirm if the publication date falls within one-year 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 relevant 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 additional assessments, exams, re-employment services, obtaining salary information, etc. 

Discuss the review for retroactive benefits and gather additional information. 

Ask the worker to confirm the following:

• Work restrictions: How have the changed or new work restrictions affected your ability to perform your duties?
• Medical care: Where did you receive medical care or treatment during the retroactive period?
• Income: What income supports did you have during the retroactive period? Ask the worker to send in their income tax or earnings information for the retroactive period.
• Employment: Did you work at any time during the retroactive period?  If so,
  • Where did you work and what were your job duties (e.g., job title, job description)?
  • What were the dates of employment 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? Did you experience a loss of income (i.e., earned less than 90% of their net date-of-accident earnings)?
• Job search: 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.
• Retirement plans: What are your retirement plans (if they are age 50 or older)?

Discuss the medical referral(s) needed to clarify their work restrictions and/or establish a specific date for the change in restrictions, if unclear. Types of referrals may include a medical consultant opinion, a comprehensive functional capacity evaluation, or independent medical examination, etc. 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 benefit should be issued based on minimum wage while awaiting the outcome of re-employment services (refer to step 4). Discuss that the WLS may change depending on the outcome of re-employment services. Any change to the WLS is effective the date the re-employment services end. The retroactive minimum wage-based WLS paid is not adjusted.

Note:  The worker must be offered the opportunity to participate in re-employment services if a new suitable job option is required going forward.

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 underemployed (not earning as much as they were capable of). 

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.
• They stopped working for 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 underemployed 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 was employed with 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
• 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 change depending on the outcome of re-employment services.  Any change to the WLS is effective the date re-employment services endThe date that re-employment services ends may be the date the worker's SJS ended or the date they start a new job if earlier than the SJS end date. In some circumstances the worker may choose not to participate in re-employment services which would be the date to use for re-employment services ending.. Any retroactive WLS paid is not adjusted.

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 reporting that indicates a change in functional ability.
• The worker began reporting the symptoms that resulted in the change to the work restrictions.
• Of the last rate-based payment if the restrictions did not end on last claim closure.

If a date cannot be determined, consider requesting an opinion from an internal medical consultant.

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 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. 

In rare cases, it may be appropriate to estimate a worker's earnings using no post-accident earnings (zero-based) for the retroactive period, even if they were fit for some level of employment. This could be due to factors such as: 

• Incorrect decisions or information that led to the need for a retroactive wage loss supplement.
• Contributions to the delay by the worker or employer.
• Significant barriers faced by the worker that would make employment unlikely.
• Other factors outside the worker's control.

For example, an error in the fitness-for-work decision was identified which prevented the employer from offering suitable work as they did not have the correct information. The worker would not be expected to look for another job because they were still employed with their date-of-accident employer. Each case should be reviewed individually to ensure fairness.

Request the appropriate service based on the claim circumstance:

• Job option service report to obtain a suitable position for the retroactive period only. The re-employment provider may recommend a triage assessment when no re-employment services were previously completed.
• Re-employment services (i.e. triage assessment followed by SJS) when:
  • a job option is required for the retroactive period and going forward. Include on the referral form that a job option is required for both time periods.
  • a new job option is only required moving forward.

When the worker agrees to participate in supported job search services, pay re-employment benefits (VR04).  

After re-employment services are completed, determine if a suitable job covering the retroactive period has been found. If so, use the salary information to estimate future earnings, unless another job option was obtained.

Note: A job lead is not needed to estimate earnings for retroactive periods since past job leads can't be found. 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.

When a job option report is required to identify a job option for the retroactive period, pay a wage loss based on minimum wage for the retroactive period. 

A retroactive minimum wage-based WLS benefit may also be provided to prevent financial hardship for the worker while they await the completion of re-employment services.

Consider paying a retroactive WLS based on minimum wage when: 

• It will take more than 30 days to find a suitable job for estimating earnings.
• Implementing a changed decision from DRDRB or the AC that directs payment of a retroactive wage loss supplement.
• Client Services reconsiders a previous decision based on new evidence or an administrative review, which results in the need to pay a retroactive WLS. 

When a worker is already receiving an existing WLS (i.e. ELP or TEL) based on earnings higher than minimum wage, the existing WLS may be adjusted to minimum wage while re-employment services are being completed. Request approval from the appropriate level of authority.  

When the worker is not receiving a WLS, calculate a new TPD based on minimum wage for the retroactive period. Once the calculations are received from the Payment unit, obtain approval from the supervisor to pay a TPD benefit based on minimum wage.

Call the worker to discuss the decision to approve or not approve the minimum wage based WLS benefit. If approved, ensure the worker understands that the WLS benefit may change depending on the outcome of re-employment services. Any change to the WLS is effective the date re-employment services end. Any retroactive WLS paid is not adjusted. 

Communicate the decision in writing.

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 circumstances of the claim as detailed below. 

A retroactive WLS benefit was paid on minimum wage

If a minimum wage-based WLS benefit was paid for the retroactive period while waiting for re-employment services to be completed, review the outcome of the service. 

If a suitable job option was identified that:

• Pays more than minimum wage: Use the salary to estimate earnings for a new WLS effective the date re-employment services end. The existing retroactive minimum wage-based benefit does not need adjustment.
• Pays minimum wage: The retroactive minimum wage-based WLS benefit does not need adjustment.

If a suitable job option was not identified and the decision is made:

• On or after July 1, 2024, and:
  • Not due to reconsideration by Client Services or a decision from the DRDRB or AC: Adjust the existing WLS benefit based on no post-accident (zero-based) earnings and propose a new WLS (ELP) based on no post-accident earnings effective the date re-employment services ended.
  • Due to reconsideration by Client Services or a decision from the DRDRB or AC: Propose a new WLS based on minimum wage when criteria in Policy 01-08, Part II, Application 4 - Question 11 are met. The existing retroactive WLS benefit does not need adjustment as it was already paid based on minimum wage.
• Before July 1, 2024: Propose a new WLS (ELP) using 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, 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 TPD or adjust the 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 for a new WLS effective the date re-employment services endedThe date that re-employment services ends may be the date the worker's SJS ended or the date they start a new job if earlier than the SJS end date. In some circumstances the worker may choose not to participate in re-employment services which would be the date to use for re-employment services ending.. 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 decision is made on or after July 1, 2024, and 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 can be used to estimate earnings when:

• The original earning capacity was estimated above minimum wage.
• The worker is realistically employableA 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.. If the worker has very limited fitness or significant barriers, minimum wage should not be used.
• All attempts to find a specific job for estimating have been exhausted.
• The change to the WLS is more than one year old. If less than a year, use current labor market information.

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.

In rare cases, it may be reasonable to not obtain an alternate suitable job option for the retroactive period and estimate earnings using no post-accident (zero-based) earnings, even when the worker was fit for some level of employment. Refer to step 3 under Re-employment services.

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, or
  • a new ELP starting in the current year and a TPD paid retroactively for the period prior to the current year. Note:  An ELP can start January 1 of the current year, but it cannot be paid retroactively in a prior year, so a TPD is paid for the retroactive period.
    • Ensure the CPL Line for the TPD for the retroactive period is approved first.  Once the TPD is approved and the TPD rate and benefits have been issued, add a review in 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 support the worker's level of fitness for the retroactive period and the medical reporting that confirms new or changed work restrictions and the worker's current fitness level and medical information that was previously available and supported the worker's fitness for work for the retroactive period.
• 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. 

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, explain that approval for a new WLS will be based on a newly identified job option and that the new WLS will be effective the date re-employment services endedThe date that re-employment services ends may be the date the worker's SJS ended or the date they start a new job if earlier than the SJS end date. In some circumstances the worker may choose not to participate in re-employment services which would be the date to use for re-employment services ending.. 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 going forward, the WLS for the retroactive period will not be adjusted.
• 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.

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. 

Communicate the decision in writing.

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.