Injured Workers’ Handbook
The information in this handbook provides the reader with general information about the Workplace Health, Safety and Compensation Commission. It does not cover every issue or exception. If you want to interpret the law with respect to workers’ compensation, return-to-work obligations and injury prevention, please refer to the relevant legislation and regulations which are printed by the Queen’s Printer or visit our website at: www.whscc.nl.ca
Updated April, 2014
The Commission is responsible for keeping your personal information confidential and secure, and we take this responsibility very seriously.
We collect, use and disclose only information necessary to administer and interpret the Workplace Health, Safety and Compensation Act (the Act) and only when authorized by law, including the Act, Access to Information and Protection of Privacy Act (ATIPPA) and the Personal Health Information Act (PHIA).
For information on your privacy rights, how we
handle confidential information, how to access
and correct your records, or how to address
a privacy concern, please review the Personal
Information Privacy Statement, available on our
website at: www.whscc.nl.ca or by contacting
the Commission. You may also contact the
Commission directly at: 1-800-563-9000 or
709-778-1000 if you have any questions about
your personal information and/or our privacy
practices.
Introduction ...1
Return to work legislation Early and safe return to work ...1
Worker co-operation ...2
Penalties for worker non co-operation...2
Re-employment obligation...3
Re-employment penalties and payments ...4
Workplace injuries What to do if you are injured ...4
How to report the injury to the Commission ...5
Qualifying for compensation ...6
Benefits/services for injured workers Health care ...7
Health care supplies and adaptive aids...7
Wage-loss benefits ...8
Recurrence ...10
Additional child care costs ...10
Early and safe return to work...11
Accommodation ...11
Alternate duties...11
Alternative work ...11
Assistive devices ...11
Ease back...12
Modifications ...12
Modified work ...12
Labour market re-entry ...12
On-the-job training...12
Employment readiness ...13
Academic upgrading/ formal training ...13
Self employment...13
Extended earnings loss benefits (EEL) ...13
Permanent functional impairment (PFI)...14
Pension replacement benefits ...15
Dependency benefits...15
CPP disability benefits (CPP) ...16
Commonly asked questions and answers ...17
Worker Advisors ...23
Contact Information ...24
Introduction
The Injured Workers’ Handbook contains general information about the Workplace Health, Safety and Compensation Commission (the Commission), benefits available to injured workers, safe return to work options and commonly asked questions.
The Commission supports workers in their return to work and educates workplace parties in occupational health and safety issues. The Commission also provides benefits to injured workers or to a worker’s dependants if the worker dies as a result of a work injury or illness.
All decisions made by the Commission regarding a claim are based on the Workplace Health, Safety and Compensation Act (the Act), Regulations, Policies and Procedures.
As this is a no fault system, workers give up their right to sue an employer or another worker covered under the Act. A worker may be able to sue another party when there is a motor vehicle accident.
For details about motor vehicle accidents and third party actions, refer to page 18.
Return-to-work legislation
Early and safe return to work
Since January, 2002, all employers and workers are obligated under the Act to co-operate in the worker’s early and safe return to suitable and available employment with the pre-injury employer. Every effort is made to return the worker, where possible,
to his or her pre-injury job while recovering from the
work-related injury.
Worker co-operation
The Act sets out minimum requirements for workers regarding co-operation in the early and safe return-to- work process. Workers are required to:
1. Contact the injury employer as soon as possible after the injury occurs and maintain effective communication throughout the period of recovery or impairment.
2. Assist the employer, as may be required, to identify suitable and available employment.
3. Accept suitable employment when identified.
4. Give the Commission any information requested concerning the return to work, including information about any disputes or disagreements which arise during the early and safe return to work process.
Workers are eligible to receive appropriate benefits while co-operating in their active medical rehabilitation, and in the progressive early and safe return-to-work process.
Penalties for worker non co-operation
If the Commission determines that a worker is
not co-operating in the early and safe return-to-work
activities, the worker will be notified (verbally,
if possible and in writing) of the obligation to
co-operate in early and safe return to work, the
finding of non co-operation and the consequences
If a worker fails to demonstrate co-operation within one week after written notification from the Commission, or does not have a legitimate reason for not co-operating, the worker’s benefits may be reduced, suspended or terminated, as determined by the Commission.
Where there is evidence that a worker has been formally notified, in writing, of non co-operation in the early and safe return-to-work process in the past (either on the same claim or other claims), the Commission will not provide a subsequent one-week notification before benefits are reduced, suspended or terminated.
Re-employment obligation
Some employers may have a re-employment
obligation if a workplace injury occurred on or
after January 1, 2002, and if other conditions are
met. When a worker is terminated within six months
of re-employment, the Commission will determine
if the employer has fulfilled their re-employment
obligation. If you are dismissed from your employment
for reasons you believe are related to your work
injury, please contact the Commission immediately
to determine if your employer has a re-employment
obligation. Workplace parties may also have
obligations to injured and disabled workers under
human rights legislation.
Re-employment penalties and payments
If the Commission determines that the employer has not fulfilled the re-employment obligation, the Commission shall levy a penalty on the employer not exceeding the amount of the worker’s net average earnings with the pre-injury employer, for the 12 months immediately preceding the beginning of the loss of earnings as a result of the injury. Payment may also be made to the worker, up to a maximum of one year, as if the worker was entitled to compensation payments.
Workplace injuries
What to do if you are injured
• Get First-Aid treatment, if available.
• Report the injury to your employer immediately.
• Tell the employer what happened, where it happened and the names of any witnesses.
• Visit a physician, chiropractor or physiotherapist and tell the health care provider it’s a work injury.
Your employer is responsible for paying reasonable travel costs for your initial visit and/or reasonable medical care.
• Bring the employer’s copy of the physician Form 8/10, chiropractor Form 8/10c or the physiotherapy Form PR to your employer by the next working day or as soon as possible. You should receive your copy of the health care report and a copy for your employer at this visit.
• Report the injury to the Commission (see page 5).
It is important to actively participate in your recovery.
You may be assigned a case manager who will help direct appropriate medical treatment and assist you in your safe return to work. Ask questions of your case manager to ensure you understand the process and programs involved.
Feel free to bring a family member, friend or Worker’s Advisor to any meeting you have at the Commission, and consult your union representative where available.
How to report an injury to the Commission
Complete a Worker’s Report of Injury (Form 6), available from your employer or union office. Forms are also available from any Commission office and our website at: www.whscc.nl.ca. If you can’t complete the form yourself, have a spouse, relative or friend help you, or contact the Commission for assistance.
Please ensure all information, including your full name, complete mailing address, date of birth, MCP number and Social Insurance Number, are correct and accurate before you sign page 2 of this form.
Any missing or incomplete information may cause delays in the processing of your claim. Even though your employer and health care provider may have sent in their reporting forms, you must still send in your form 6. Your claim will not be processed unless a completed Form 6 is received.
Fax your form as soon as possible to:
709-778-1302 or fax toll-free at: 1-800-276-5257.
If you mail your form, mailing information is available on the back cover of this handbook.
If your form is not sent to us within three months of your
injury, the Commission may not accept the claim.
Qualifying for compensation
The Commission reviews your Form 6, the Employer’s Report (Form 7) and the Health Care Provider’s Report of Injury (Form 8/10, 8/10c and PR) when deciding whether or not you qualify for compensation.
If your claim is accepted you will receive written notification outlining your weekly compensation benefit rate, as well as other general information.
If your claim is referred to Case Management, the letter will identify your team, i.e. case manager, client services assistant and health care benefits assistant.
You will be issued a claim number which is your personal number. Please refer to this number when calling or visiting the Commission.
If your claim is denied, you will receive written notification with the reasons for denial and outlining the process should you wish to appeal.
If you prefer, the Commission can discuss your claim with your spouse, family member, or other representative such as a friend, lawyer, MHA or union representative, as long as there is appropriate authorization. To ensure confidentiality, complete a Form 13 – Authorized Representative Consent.
This form identifies the individual(s) at the Commission who you may contact to discuss your claim.
An authorized representative can only be an individual.
It cannot be a company or an organization.
The Form 13 is available on our website at:
www.whscc.nl.ca or from any Commission office.
You may change your authorized representative
at any time by writing the Commission.
Benefits/services for injured workers
Health care
The Commission pays reasonable health care expenses related to a workplace injury. These include physician fees, chiropractic fees, hospital costs, prescription drugs, physiotherapy, and occupational therapy. Also included are health care supplies and adaptive aids such as heating pads, crutches or prothesis.* The Commission also pays reasonable costs for travel, where appropriate, including accommodations and meals.
You can choose the health care provider you wish to see after an injury. In some cases, the Commission may request an examination by a specific physician.
If for any reason you want to change your health care provider, you will need to consult your case manager.
If you are referred to a physiotherapist, you must contact a physiotherapy clinic within 72 hours. Commission coverage for physiotherapy applies only to clinics who have signed a Memorandum of Agreement, (MOA). It is important to confirm this when booking an appointment. A physician referral is not required to attend a physiotherapy clinic where the worker avails of the service within two weeks from the date of a new injury. For more information on physiotherapy providers visit:
www.whscc.nl.ca/healthcare/ORProviders.whscc
Health care supplies and adaptive aids:
The Commission has secured commonly-prescribed health care supplies and adaptive aids through the
*Items may be subject to tendering costs
public tendering process. Health care supplies and/or adaptive aids require prior approval by the Commission before being obtained. When prescribing health care items, your treating health care provider should submit a completed Health Care Devices and Supplies prescription form to the Commission, including the rationale for the prescribed item(s), the measurements and/or size required.
If an ordered item(s) is not suitable, you must notify the Health Care Benefits Assistant assigned to your claim immediately. He/she can advise you if the item is returnable. The following guidelines apply to return of items:
• The item must be returned in the original packaging and shipping material
• The item must be unused and in re-sale condition (not soiled in any way)
• The item must be returned within 3 days of receipt
Wage-loss benefits
When the Commission accepts your claim for wage-loss benefits, your compensation usually starts the day after your injury. Your employer is required to pay your full wages for the day of the injury.
The Commission pays wage-loss benefits while you are not working due to your compensable injury, receiving medical treatment and/or participating in a return-to-work or labour market re-entry program.
If you refuse treatment recommended by your physician, delay treatment or fail to participate in a return-to-work or labour market re-entry program without good reason, the Commission may interrupt or discontinue your benefits.
Wage-loss benefits are calculated as 80 per cent of your
pre-injury net earnings. Your net earnings are your gross
tax credits. There is a limit on the amount of earnings insured called the maximum compensable ceiling.
The Commission does not pay union dues or any other deductions you normally pay.The Commission considers Canada Pension Plan disability benefits re- lated to the injury and employer-sponsored pension benefits (which a worker applies for and receives fol- lowing a work injury) as earnings and deducts these from compensation benefits.
Your compensation benefits may be reduced if garnishment of wages exists due to support enforcement or social assistance payments.
Where there is entitlement, the Commission may pay wage-loss benefits until a worker reaches age 65. A worker who is 63 or older at the time of injury may receive benefits for a maximum of two years.
The Commission usually calculates your wage- loss benefits based on your average earnings.
When calculating your average earnings, the four pay periods immediately before the injury are considered.
9 INJURED WORKERS’ HANDBOOK
This calculation may change depending on your employment status (e.g. seasonal worker).
At 13 weeks, the Commission will recalculate your average earnings based on what you earned for the 12 months before the injury, which may include employment insurance benefits.
Federal and provincial income tax tables change each year and as a result, some clients may experience a slight increase or decrease in their benefit level during scheduled income tax adjustments.
Recurrence
If you recover and/or return to work, and your injury causes further disability, you may re-apply for benefits. You should report this to your employer as soon as possible, giving the full details of the recurrence.
To apply for recurrence review, you must send in a Form 6. Your employer submits a Form 7 and your health care provider files a Form 8/10 (physician), Form PR (physiotherapist) or Form 8/10c (chiropractor). The Form 6 and the Form 7 are available from your employer or from our website at: www.whscc.nl.ca.
Additional child care costs
An injured worker who pays for additional child care because of their work injury may be reimbursed if this amount is more than what they normally paid while working.
If there are additional child care costs because
you are attending medical treatment for the work
injury or attending a labour market re-entry program
sponsored by the Commission, you may apply for
reimbursement of the additional costs. If you are not
Early and safe return to work
All employers and workers are obligated under the Act to co-operate in the worker’s early and safe return to suitable and available employment with the injury employer.
Your employer must pay you for work performed during these programs and the Commission pays the difference, up to your compensation rate.
The programs, as defined below, assist workplace parties during return-to-work planning. The definitions should be read in the context of the hierarchy of return-to-work priorities. Other relevant policies, available from our website, should be consulted and considered when decisions are made on return-to-work programs.
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Accommodation is any change or adaptation to the work, hours of work, work duties or workplace, and includes the provision of equipment or assistive devices. In any specific case, accommodation can include, but is not limited to, any of the options outlined in the Commission’s Policy RE-18 or an appropriate combination.
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Alternate duties are non pre-injury duties within the worker’s functional abilities.
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Alternative work is a different job or bundle of duties (not the pre-injury job or duties) that is suitable and provided to accommodate a worker who has temporary or permanent functional restrictions as a result of the injury.
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Assistive devices include aids and attachments,
specifically designed for the worker and/or required
by the worker to perform job-related activities.
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Ease back is a gradual return to pre-injury hours of work achieved by increasing the number of hours worked over a defined time-frame agreed upon by the workplace parties and utilizing the functional abilities information relating to the worker. While the pre-injury hours of work vary, the pre-injury duties are the same.
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Modifications are changes to job schedule, equipment, organization of work and/or facilities.
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