Temporary partial disability benefit (TPD) reviews

This step is typically completed by the case assistant but may be completed by the case manager if they are actively managing the claim.

Monitor the claim for scheduled and unscheduled reviews

Monitor the claim for new information, such as a change in salary, change in employment status, confirmation of permanent work restrictions, or to apply a cost-of-living adjustment (COLA) to an existing TPD benefit. 

Note: Cost of Living Adjustments for TPD benefits are applied in the worker’s birth month, provided the benefit continues into the next calendar year and at least two years have passed since the date of the accident. For a COLA review, refer to the Cost-of-Living Adjustment (COLA) section. 

When new information is received before the scheduled review date and the claim is being monitored by the:

• Case assistant, transfer the claim to a case manager to review it.
• Case manager, continue to step 5. 

Otherwise, start the review process 60 days before the next scheduled review date. 

Sixty (60) days before the scheduled review date

Review information related to the initial TPD benefit approval including: 

• The initial TPD approval file note.
• Start and end date for the TPD benefits.
• The basis of the TPD and the information that needs to be gather (e.g., earning information such as paystubs, medical information to confirm work restrictions).

This step is typically completed by the case assistant but may be completed by the case manager if they are actively managing the claim.

Initiate the review by requesting information from the worker. 

Gather information from the worker

Call the worker to explain the upcoming review of their TPD benefit. Confirm if there have been any changes since the last review and discuss any additional assessments needed to confirm if their work restrictions changed, ended or became permanent. Obtain the worker's agreement to participate.

Confirm employment status and earnings - If the TPD is based on:

• Estimated earnings - Confirm the worker is still unemployed or underemployed. If employed, gather details about the job, including the position, start date and salary.  
• Actual earnings - check that the worker's job, salary and employment status have not changed since the last review. If anything has changed, gather details about the change (e.g., new job, lay off, salary increase) and when it happened.  

Obtain proof of earnings - Explain to the worker that they are required to submit proof of their earnings. Acceptable proof includes:

• An official Canada Revenue Agency (CRA) Proof of Income Statement 'Option C' computer printout.
• Employer-provided pay stubs when income tax information is not available at the time of review.
• Statement of business activities if the worker is an owner/operator or self-employed. 

Offer support 

• If worker needs assistance obtaining confirmation of their earnings from CRA, advise they can authorize a representative to request the information on their behalf by completing the Authorize a Representative for Offline Access (AUT-01) form (www.canada.ca/en/revenue-agency/services/forms-publications/forms/aut-01.html) and sending it directly to the CRA.
• Offer an in-person meeting to discuss the review. If they agree, inform them that they will receive a letter explaining the TPD review process, and that a case manager will contact them to schedule the meeting.
• Confirm if they are able to submit the required information and what reasonable time frame would be for them to obtain it. If they request additional time, find out why they need it and agree upon a date for the worker to submit the information (i.e., the requested information should be available before the end date for the current TPD authorized period).
• If they advise they are unable to submit the required information, consider other options including:
  • Contacting their employer directly by phone or email to obtain their gross earnings information.
  • Asking the worker to have their employer provide a letter that confirms the worker's earnings.
• If the worker's TPD benefits will likely end before the information is provided, explain that any extension to their TPD benefits will need approval by the supervisor.
• Ask the worker to submit acceptable documentationAcceptable forms of documentation include an official Canada Revenue Agency (CRA) Proof of Income Statement 'Option C' computer printout, or employer provided pay stubs (when income tax information is not available at the time of review). of earnings or complete and sign the appropriate form when they live outside of Canada.
• Confirm if they have any concerns or need other assistance from WCB?

Determine if a TPD benefits extension is required

Consider if it is likely the information will be received before the TPD authorization end date.

If the information is:

• likely to be received before the TPD authorization end date, continue to step 4 to monitor for receipt of the required information by the agreed-upon date.
• unlikely to be received before the TPD authorization end date:
  • Case assistant, transfer the claim to the case manager to consider a TPD extension.
  • Case manager, continue to the next step to request a TPD extension. 

Determine if a TPD benefit suspension is required

If the worker has not provided the information after two attempts:

• Case assistant, transfer the claim to the case manager to consider a TPD suspension.
• Case manager, consider if a suspension of the TPD benefits should be recommended. Continue to the next step.

In-person meeting required (case manager)

Call the worker to book a meeting. During the meeting, discuss the TEL review, and together, agree on a plan to address the worker's concerns and set a new date for the worker to provide the information, if required.

This step is completed by the case manager. 

Request TPD extension or suspension approval

Send a recommendation to the supervisor to: 

• extend the TPD benefit to the agreed-upon date when the worker requires more time to submit the required information.
• not extend (suspend) the TPD benefit when the worker has not submitted or is unable to provide the required or alternate information. 

Extension

Review the supervisor's response. When the extension is:

• Approved, ask the case assistant to request the TPD payments until the approved extension date. Continue to monitor for receipt of the required information.
• Not approved, call the worker to discuss any recommendation and/or the decision to suspend their TPD benefits because they have not submitted the required information to complete the TPD review. Advise that once the required information is received, the TPD benefit review will continue. Communicate the decision in writing and do not continue with the procedure. 

Suspension

Review the supervisor's response. When the suspension is:

• Approved, call the worker to explain the decision to suspend their TPD benefits because they have not submitted the required information to complete the TPD review. Advise that once the required information is received, the TPD benefit review will continue. Communicate the decision in writing and do not continue with the procedure.
• Not approved, action any recommendations made by the supervisor and contact the worker to discuss them.  

This step is completed by the case assistant or case manager. 

Upon receipt of the reminder task, review the claim to determine if the required information is on file.

Note: The case assistant will make two attempts to gather the required information. If it is not provided after the second request, the claim will be transferred to the case manager to complete this step.

If the required information has been submitted:

• Case assistant: Transfer the claim to a case manager. Do not continue with this procedure.
• Case manager: Continue to the next step to complete the review.

If the required information has not been submitted or the worker indicates they will not be able to provide it: Call the worker and discuss the reason why they have not submitted the required information. Return to step 2.  

This step is completed by the case manager. 

Assess the information

Review the claim, current earnings information, medical reports and any other relevant information to determine if there have been any changes to the worker's work restrictions, re-employment plan, earnings capacity or employment status. If there are, consider if the position used for the TPD is suitable. If a new position is required, consider the most appropriate benefit to pay (e.g., TPD based on minimum wage, re-employment benefits) and follow the appropriate procedure.

If the TPD benefit is based on actual earnings and the earnings decreased: Assess the reason for the decrease in earnings.  Determine the impact to the TPD and whether additional assessments, services or benefits are required (e.g., the job is not suitable, the worker decided to leave the position). 

If the TPD benefit is based on estimated earnings and the worker is working, and their actual earnings are higher, consider adjusting the TPD benefit using their actual earnings. 

Confirm how long the TPD has been paid and determine whether it should be converted to another wage loss benefit (i.e. TEL or ELP).

Make a referral, if required

Consider if a referral or further assessment is needed to confirm work restrictions (e.g., medical consultant, independent medical examination [IME], functional capacity examination [FCE]). If a referral is required, call the worker to discuss the reason for the referral and obtain their agreement to attend. When the worker does not agree to attend, discuss their duty to cooperate.

If a referral is not required, continue to the next step.

Obtain approval for an extension, if required

Consider the TPD authorization end date and request approval from the supervisor to extend the TPD benefit until the results are received, if needed. If the extension is:

• Approved, make the referral and ask the case assistant to request TPD payments until the approved extension end date.
• Not approved, action the supervisor's recommendations as appropriate.

This step is completed by the case manager. 

Review the available information to determine whether to extend, adjust, convert the TPD to a TEL or ELP, or discontinue the TPD benefit. 

When a worker receiving TPD benefits reaches normal retirement age or decides to retire early, refer to the TPD benefits at retirement section.

TPD extension

When there is no change from the latest plan, determine how long to extend the TPD benefit (i.e., to when temporary work restrictions or the loss in earnings is expected to end). Continue to the next step to send the recommendation to the supervisor for the TPD extension.

TPD adjustment

When the TPD is based on:

• Actual earnings and the earnings increased since the last review, adjust the TPD benefit to reflect the increase.
• Actual earnings and the earnings decreased, adjust the TPD based on the same position., if appropriate.  When a new position is required, follow the 8-1 Wage loss supplement (WLS) final approval procedure.
• Estimated earning and the salary recordsALIS Occupational Profiles (the Government of Alberta website) is the primary source or LMP (Labor market Profiles) when not available in ALIS. to support an increase in earnings, the TPD benefit is adjusted based on the salary records in estimated earnings.
• Minimum wage and approved for more than one year, apply the WCB maximum yearly percentage increase in effect the year the TPD was initially approved until the yearly post-accident earnings reach the legislated minimum wage. Refer to the Resource Library.  
• No post-accident earnings, refer to the TPD based on no post-accident (zero-based) earnings section.

Ask the Payment Unit to calculate the TPD amount based on the earnings (i.e., salary record for estimate earnings, actual earnings, or minimum wage) to be used. Once the calculations are completed and the CPL has been updated, continue to the next step to obtain approval from the supervisor for the TPD adjustment. 

If the TPD should be adjusted retroactively, follow the 8-2 Retroactive wage loss supplement final approval procedure. 

TPD conversion to a TEL or ELP

Determine if the same or a new position will be used for the TPD to TEL or ELP conversion to confirm the reduction plan and review dates.

If the same position will be used, include the period the TPD was paid in the five-year reduction plan (i.e., the ELP36 review should take place 36 months after the start date of the TPD).

If a new position will be used, do not include the period the TPD was paid for the five-year reduction plan (i.e., the ELP36 review should take place 36 months after the start date of the ELP).

TPD to be discontinued

Discontinue TPD benefits when the:

• Loss in earning capacity ends (i.e., worker reaches pre-accident earnings).
• The worker no longer has compensable work restrictions.
• The worker's medical condition stabilizes, and compensable work restrictions are confirmed as permanent.
• The worker's medical condition deteriorates and results in a further period of temporary total disability. 

Request approval

Send a recommendation to the supervisor requesting approval to extend, adjust or convert the TPD benefit. Complete the Case Planning Line as appropriate for the TPD recommendation. 

The supervisor reviews the recommendations and sends to the appropriate level of authority, if required. Refer to the Levels of authority (LOA) for initial approval of ELPs, TELs, TPDs and ELSs in the Resource Library.

Case manager

Review the recommendations from the supervisor and/or other levels of authority (manager, director), as appropriate. If the recommendations were not approved, return to step 6 to determine the impact to the TPD benefit and resubmit for approval. 

Call the worker to discuss the outcome of the TPD review and any next steps. Explain the decision to extend, adjust, convert to a TEL or ELP or end the TPD. 

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

When the TPD is being adjusted, extended or converted to a TEL or ELP, discuss the change in benefit type (if needed), amount, reduction plan, next review date (i.e., yearly review date or 36-month review date if converted to a TEL or ELP), and any steps that need to be taken before the next review, if applicable.  

When the TPD is converted to a TEL or ELP, ensure the worker understands that the TEL or ELP amount may be reduced over time, unless the earnings are based on no post-accident (zero-based) earnings. 

Communicate the decision in writing. Transfer the claim to the case assistant to make payments and monitor, as appropriate. 

Case assistant

Review the file note from the case manager and add a reminder task to review the file. 

At the next scheduled review date, repeat the above steps.