More on LOE benefits

When a decision is made by the WSIB to pay LOE benefits, there are some key rules that they must abide by to pay said benefits. Similarly there are some rules that you are required to follow as well.

Bellow, we have noted some of those key rules that you need to be aware of, in order to ensure that you are compliant with respect to your requirements and remain eligible to receive LOE benefits.    

 
Cooperation in the process

In our opinion, one of the more critical rules is that while you receive LOE benefits you continue to participate in your recovery and return to work. The WSIB's role is to help you return to work that is safe and productive, is within your capabilities and limits, and, to the extent possible, pays you the same or close to what you were earning before your injury or illness.

    How your LOE benefit is calculated

    How the WSIB calculates your LOE benefit depends on the date of your injury.
    _____________________________________________________________________________________________________

    • DATE OF INJURY - ON OR AFTER JANUARY 1, 1998, the rate is based on 85% of your take-home pay up to an annual maximum
    • DATE OF INJURY - ON APRIL 1 TO DECEMBER 31, 1997, the rate is based on 90% of your take-home pay up to an annual maximum
    • DATE OF INJURY - BEFORE APRIL 1, 1985, the rate is based on 75% of pay before deductions up to an annual maximum

    _____________________________________________________________________________________________________

    Receiving your LOE benefit

    Your employer is responsible for paying your wages for your full shift for the day of your injury or illness.

    Your LOE benefit normally starts the day after your injury or illness, and when you begin to miss time from work. Your LOE benefit continues until:

    • your work-related injury or illness no longer affects your ability to return to your pre-injury work; or

    • you’re no longer losing pay; or

    • the day you reach 65-years-old if you were less than 63-years-old the day of your injury; or

    • two years after the date of your injury if you were 63-years-old or older the day of your injury.

    After you reach age 65 and after your LOE benefits stops, you may still be eligible to receive loss-of-retirement-income benefit.

    How the WSIB pays your LOE benefit

    You’ll receive an LOE benefit payment every two weeks. If your loss-of-earnings is ongoing, the WSIB will review your benefit every year until you have received it for six years (72 months). After six years, the WSIB will review your claim and in most cases, will make it permanent. After this happens, you have the choice to have it paid to you as a lump sum if it is 10 per cent or less of your full loss-of-earnings amount.

    After the sixth year, the WSIB can review your benefit if:

    • you are taking part in a return-to-work plan or health-care treatment that hasn’t finished at the six year mark; and/or

    • your work-related condition gets significantly worse, and/or

    • you didn’t report any significant changes to us before the end of six years.

    Each year the WSIB adjusts LOE benefits to take into account inflation.

    Significant changes

    When the WSIB reviews your benefit, they look at whether there are any significant changes to your return-to-work status, medical condition or income. You have to inform the WSIB of any significant changes within 10 days of the change happening. Significant changes can include:

    • If you return to work; or

    • If you start to receive other income or government benefits; or

    • If there are important updates in your medical condition.

    If you do not report significant changes your benefits can be reduce, suspended or discontinued. If the WSIB believes you have misled them on purpose or held back information, it can result in legal charges and, if you are found guilty, you may go to jail or have to pay a penalty up to $25,000.

    Return-to-work support

    If your employer is not able to provide you with safe and suitable work after your injury or illness, the WSIB will work with you to develop a return-to-work training plan. You will continue to receive your full LOE benefit as long as you continue to co-operate in your recovery and return to work.

    If you choose not to co-operate, the WSIB may suspend or reduce your benefits.

    If you return to work but your injury or illness causes you to miss work again, you may be entitled to an LOE benefit up to six years after the date of the original injury and/or illness.

    Whether your workplace injury or illness was 30 years ago or recently, we have both the expertise and the tools to help you.

    Have a look at our WSIB Settlement Kits page, you will likely find one that addresses your issues. If there isn't one, just send us an email describing your problem and we will do our best to create one for you!