Lesson 3 Flashcards
1.1 Explain who has jurisdiction over the EI program.
EI falls under federal jurisdiction and operates under the legislated authority of the
Employment Insurance Act (the “EI Act”).
What body provides oversight to EI
The Canada Employment Insurance Commission (CEIC) is the body that provides much of the oversight of EI. Its
mandate is to annually monitor and assess the EI program,
1.1 What body handles the delivery of EI
The actual delivery of the EI program is handled by Employment and Social Development Canada (ESDC), through Service Canada.
1.2 Identify the responsibilities of WC Boards/Commissions. (7)
- responsible for their own jurisdiction for the administration of WC
- Collect contributions from ERs
- pay benefits to EEs
- decide level and nature of adequate compensation for all work related injuries
- determine eligibility for compensation and rehabilitation
- establish rules and regulations and appeals procedures
- exclusive jurisdiction to deal with all matters pertaining to injuries that arise out of or in the course of employment
1.3 Describe how EI program is funded
Through ER and EE premiums
What does CEIC stand for
The Canada Employment Insurance
Commission
1.3 List three factors that affect the setting of premium rates for EI
(a) Assumptions of future demographic and economic conditions
(b) Current Premium rates, which are intended to be sufficient to cover expected EI benefit payouts
(c) The funded status of the EI Operating Account, since the objective for the EI Operating Account is to operate on a break-even basis.
1.4 Explain how a WC assessment premium is generally calculated
Generally calculated as a rate per $100 of assessable earnings (the assessment rate)
Generally include most earnings types.
Earnings from what kinds of work/income sources are included in assessable earnings for WC (7 in all jurisdictions and 5 from many jurisdictions)
In all jurisdictions:
- salary or wages
- overtime
-tips
-commission
-bonuses
-advances on future earnings
- vacation pay
For many jurisdictions this also includes:
- profit sharing
- paid layoff
-maternity or sabbatical leave - taxable benefits
- ER contributions to employee benefits
1.5 Identify factors that influence WC assessment rates (4)
- recent accident cost experience in industry class
- financial position of the WC board commission
- prevailing economic and labout conditions
- current adjudication policies
Each WC board/commission has its own unique method of calculation the amount of premiums to be collected from employers to fund the program reflecting its own situation
1.5 Identify 3 factors that employers actual assessment rates depend on
- The industry classification of the employer
- whether the WC Board/Commission applies experience rating to that employer
- The existence of any safety based program incentives in place in the jurisdiction
1.6 Explain the impacts of industry classification
WC boards/commissiong have the power to group industries according to their hazard potential.
Jurisdictions use either NAICS or their own internal processes to classify employers and then combine individual industrial classifications into larger rate groups.
Rate groups typically include similar industries although unrelated ones can be included on the basis of risk
What is NAICS
The North American Industry Classification System from stats Canada that is used by some WC boards/commissions as a framework for classifying employers. Other boards have their own internal methods.
1.7 Describe experience rating as it applies to the WC system
The rate that an employer contributes is affected by the experienced claims.
1.7 What is prospective experience rateing
considers an employers past experience relative to the rate group and the applies a discount or surcharge to future rates
1.7 what is a retrospective experience rating system under WC
Assesses an employer based on expected experience and then at year end reconciles with actual experience and issues a refund or an invoice for the difference
1.8 Explain the tax treatment of EE and ER contributions to EI and EI benefits paid
ER premiums contributions are deductible from taxable income.
EE premiums also give rise to a tax credit.
All EI benefits are subject to income tax
1.9 Outline the tax treatment of WC benefits (3+1 exception)
WC benefits aren’t taxable, assignable, or attachable except in Quebec where up to 50% of the income replacement benefit may be garnished to pay alimony
2.1 List 5 kinds of employment listed as insurable under the EI act
1) Employment in Canada under any written or implied contract where earnings are received from an employer
2) Employment in Canada as described in 1) by His Majesty in right of Canada
3) Service in the army or police
4) Employment included by regulations in the EI act
5) Employment in Canada of an individual as the sponsor or coordinator of an employment benefits project
2.1 List 6 kinds of employment that may be included as insurable employment in addition to those specifically listed in the EI act
1) Employment outside or partly outside Canada that would be insurable employment if it were in Canada
2) The entire employment of a person who is engaged by one employer partly in insurable employment and partly in other employment
3) Employment that is not employment under a contract of service if it appears to CEIC that the terms and conditions of service and the nature of the work performed by persons employed in that employment are similar to the terms and conditions of service and the nature of the work performed by persons employed under a contract of service
4)Employment in Canada by Her Majesty in right of a province if the government of the province waives exclusion and agrees to insure all its employees engaged in that employment
5) Employment in Canada by the government of another country or political subdivision if that country consents
6) Employment in Canada by an international organization if the organization consents
2.1 List 8 types of employment excluded by the EI act
1) Employment of a casual nature other than for the purpose of the employer’s trade or business
2) Employment of a person if such person controls more than 40% of the voting shares of a corporation
3) Employment in Canada by her majesty in right of a province
4) Employment in Canada under an exchange program if the employment is not remunerated by a Canadian employer
5) Employment in Canada by an international organization
6) employment that is an exchange of work or services
7) Employment excluded by regulations made under certain subsections of the EI Act
8) Employment if the ER and EE are not dealing with each other at arms length
2.2 Outline 7 eligibility criteria that must be met to receive regular EI benefits
1) Their employment qualifies under the EI definition of insurable employment
2) They have lost their job through no fault of their own
3) They have paid EI premiums
4) They have been without work and pay for at least 7 days in the last 52 weeks or since the start of their last EI claim whichever is shorter
5) They have worked the required number of hours based on where they lived and the unemployment rate in their area
6) They are actively looking for work and keep a record of ERs contacted
7) They are ready willing and capable of working each day
2.3 Describe how the amount of EI benefits is determined
The regular benefit is 55% of average insurable earnings although it may be up to 80% for low income families.
2.3 Describe how the duration of the benefits period for EI is determined
Based on the number of hours worked under insurable employment and the unemployment rate in the area.
Duration ranges from 14 weeks to 45 weeks
2.4 Describe how additional earnings received by an individual receiving ER benefits affect the amount of their EI benefits
While collecting regular, parental, maternity, sickness, compassionate care or caregiving benefits, claimants can keep 50¢ of benefits for every dollar earned, up to
90% of the claimant’s previous weekly earnings (roughly 4.5 days of work).
Earnings above this threshold are deducted from EI benefits, dollar for dollar.
2.4 What are they two kinds of earnings usually made while a claimant is receiving EI
money received from an employer when a claimant leaves their job (called “separation payments”)
money earned while collecting benefits from such sources as return-to-work and callback pay; self-employment earnings; money received as payment for wrongful dismissal and income from an employment pension, military or police pension; or a Canada Pension Plan/Québec Pension Plan
(CPP/QPP) pension
2.5 Outline circumstances under which an individual must repay EI benefits and the maximum clawback amount
An individual whose annual net income for the taxation year (including EI benefits) exceeds 1.25 times the maximum yearly insurable earnings must repay some or all EI benefits received. The clawback amount is the lesser of either 30% of the EI benefits received or 30% of the amount of net income exceeding 1.25 times the maximum yearly insurable earnings
2.5 What two things does EI benefit repayment not apply to
1) Special benefits
2) Regular benefits paid to individuals who received less than one week of regular benefits in the previous ten years.
3.1 Describe the special benefits provided through the EI program and QPIP (5)
1) sickness
2) maternity
3) parental leave
4) compassionate care
5) caregiving leave
Quebec residents are not eligible for maternity or parental leave due to the existence of QPIP
3.1 What are the eligibility requirements for special benefits from EI (1 general)
- a major attachment to the workforce meaning 600 insurable hours in the qualifying period
- self employed individuals may register for EI benefits
3.1 Describe QPIP benefits
Quebec parental, adoption, maternity, paternity or parental leave
3.1 What are the 6 requirements for eligibility for QPIP
1) Be a parent of a child (born or adopted)
2) Have contributed to the plan as an EE or self employed worker
3) Have experienced an interruption in earnings due to birth or adoption
4) Have insurable earnings of at least $2000 during the reference period
5) Be a resident of Quebec at the start of the reference period
6) In the case of a self-employed worker, have resided in Québec on December 31 of the year prior to the start of the benefit period.
3.2 Outline the duration period for EI & QPIP maternity benefits
EI payable for a maximum of 15 weeks
QPIP for a maximum of 18 weeks and paternity is payable for 5 weeks
.
3.2 Outline the duration period for EI (2) and QPIP (2) parental benefits (max Total & max to one for EI)
Standard EI parental benefits are 40 weeks but have a maximum of 35 weeks for one parent
Extended EI is over 69 weeks but one parent can’t receive more than 61 weeks
QPIP is payable for 32 weeks and adoption benefits are payable for a maximum of 37 weeks
3.2 Outline the duration period for EI sickness benefits
15 weeks
3.2 Outline the duration period for EI compassionate care benefits
26 weeks
3.2 Outline the duration period for EI caregiving benefits
35 weeks for a child 15 weeks if caring for an adult
4.1 Explain the premise behind EI-approved wage loss replacement plans
EI is the second payer after STD or illness/injury plans
What ER sponsored plans that provide coverage for an illness or injury under EI qualify the sponsor for a reduction in EI premiums
Weekly indemnity and cumulative sick leave plans
4.1 What are the criteria for approval for EI approved ER sponsored plans that provide coverage for an illness or injury under EI qualify the sponsor for a reduction in EI premiums (7)
1) coverage must start no more that 3 months of employment or if on hourbank 400 hours
2) Coverage must be on a 24 hour basis
3) He waiting period for payment of benefits may not exceed 7 days
4) The plan must be the first payer
5) Benefits must be at least equal to EI
6) Full benefits for new disabilities must be reinstated no later than one month after the employee returns to work
7) Employers must share the EI premium reduction with employees
4.2 A wage indemnity can contain limits to the payment of benefits that will not prevent the ER qualifying for an EI premium reduction. Identify 17 scenarios where it is acceptable that benefits aren’t payable to EEs
1) EE not under physician care
2) covered under WC or CPP/QPP
3) Intentional self infliction
4) Result of injury from armed forces
5) results from war or a riot
6) occurs while on vacation of paid leave
7) EE is on EI special benefits
8) occurred while committing a criminal offence
9) engaging in work for wages while receiving disability
10) during strike or lockout
11) EE is in prison
12) EE is outside canada
13) resulted from drug or alcohol use and the person isn’t getting treatment for their continued use
14) resulted from motor accident and getting insurance benefits
15) EE is getting a retirement pension from the same ER
16) EE undergoes cosmetic plastic surgery without prior illness or injury necessitating
17) EE receives benefits for recurring injury under LTD
4.3 Describe cumulative sick leave plans and provisions.
Provide coverage based on sick leave credits accumulated by the member.
May also provide maternity, parental, compassionate or caregiving benefits
4.3 Describe cumulative sick leave plans (2)
and provisions that qualify for a EI reduction (2)
Provide coverage based on sick leave credits accumulated by the member.
May also provide maternity, parental, compassionate or caregiving benefits
Must also meet the same 6 criteria as WI plans
At least one day sick leave must be credited for each month worked
4.3 Describe additional requirements for cumulative sick leave plans and provisions that qualify for a EI reduction 4 points
1) Period of sick leave credit may be prorated in relation to the total period of employment
2) Eligibility to use sick leave may be deferred due to temporary employment or probationary period for up to 12 months
3) There may be a cap on unused sick days but it may not be less than 75
4) the number of sick days must be at least 75 unless a shorter period applies as a result of the person’s termination or retirement or recovery.
Notice of termination must have been given prior to the injury or illness
4.4 Under the EI act a fraction of premium reductions must be passed on to EEs. Explain the premise and the fraction
5/12
The intention is to maintain the same ratio of EE to ER cost as EI premiums normally have
4.5 What is the Supplemental Unemployment Benefit (SUB) in EI
The SUB plan supplements EI benefits during temporary periods of unemployment without affecting the EEs level of EI benefits
May be due to a work stoppage, illness, training, injury, or quarantine
4.5 What advantages are there to registering a SUB plan with service canada (2)
EE’s weekly earnings during periods of unemployment can be increased without resulting in a deduction from EI benefits
Payments from a registered SUB Plan aren’t considered insurable earnings for EI purposes
5.1 What are the 5 key principles of the WC System from the Meredith Report?
1) No fault compensation
2) Collective liability
3) Security of benefits
4) exclusive jurisdiction (over work injury insurance)
5) Independent administration (separate from gov’t)
5.1 What are the 5 key principles of the WC System reflected in the design of the system?
1) immunity from lawsuits
2) Fair compensation and fair premiums
3) Benefit of the doubt to the worker - all else being equal decisions are in favour of the worker
4) Comprehensive injury prevention and disability management
5) Long term stability, financial security and cost effectiveness is built into the system
5.2 Explain how the term “quid pro quo” applies to the WC system?
Employers accepted collective liability and were no longer individually liable.
In exchange
Employees gave up the right to sue the employer and accepted compensation as provided for in the legislation through a system fully funded by ERs
5.3 Describe participation requirements for ERs in the WC system (1 req and 2 points)
- compulsory for many ERs in particular industries
- list of exempt industries and occupations varies by jurisdiction
- Some jurisdictions also require a minimum number of EEs for participation
5.3 Describe self-insured ERs under the WC system (4)
A WC board/commission may designate some ERs to be self insured
Generally these are federal/provincial governments and public agencies or crown corporations. Also included are large public interprovincial transportation organizations
WC Boards/commissions generally administer claims for self insured organizations and the ERs reimburse them monthly.
ERs may also be asked to maintain a deposit with the Board/commission to cover costs & expenses/
6.1 List 4 types of injuries covered by WC
1) Traumatic injuries that happen suddenly
2) Injuries caused by repeated activities including strains, sprains caused by repeated actions (tendonitis caused by word processing duties)
3) Occupational diseases caused by workplace conditions (respiratory problems from chemical exposure)
4) Reinjury and difficulties with an old work related injury
6.2 Identify types of benefits provided by WC jurisdictions (4)
- temporary and permanent disability
- rehabilitation benefits
- fatal and dependent benefits
- medical aid/health care related benefits
6.3 Describe the two definitions of earnings used by WC Boards/Commissions in the calculation of wage loss benefits.
Either as a percentage of:
1) net eligible earnings or;
2) Gross eligible earnings
Generally earnings are over the last 12 months
Most jurisdictions use net earnings.
6.4 Outline eligibility requirements for temporary disability benefits under WC 1 description)
Generally when there is medical evidence that the work related injury has resulted in temporary work restrictions that prevent the EE from resuming pre-accident employment or other suitable employment
6.4 Outline eligibility requirements for temporary disability benefits under WC
Generally when there is medical evidence that the work related injury has resulted in temporary work restrictions that prevent the EE from resuming pre-accident employment or other suitable employment
6.5 Define Concurrent condition
A concurrent condition is a non-compensable condition that exists at the same time as a compensable condition.
Includes underlying conditions like cancer and diabetes which will affect healing times. Pregnancy may also be in this category
6.4 Outline eligibility requirements for partially temporary disability benefits under WC
Partial disability usually means that there is medical evidence indicating they have compensable temporary work restrictions but can return to a modified version of their job or another suitable job
6.6 What are the two types of permanent disability benefits in WC
1) economic loss awards - loss of earnings capacity
2) non economic loss awards (loss of enjoyment in life due to disability) - usually a one time lump sum award
6.7 Outline types of fatality and dependent benefits provided by WC (4 points)
Can include immediate lump sum benefits, monthly benefits, funeral costs.
The spouse receives a monthly benefit based on the spouses age and the deceased person’s earnings and DOD
In most jurisdictions the spouse also receives a lump sum payment
Dependent children get monthly benefits until age 18 or later if they are in school. This benefit varies significantly by jurisdiction
7.1 Describe how the WC board/commissions asses whether an injured worker can return to work
EE’s doctor provides progress reports to the case manager.
The reports are used to facilitate return to work when appropriate.
The WC board works with employers to determine if there are other jobs the EE can do while recovering on a short term basis or for a few hours at a time.
What questions may be included in a IME (4)
an Independent Medical Examination may include
1) Is the injury temporary or permanent
2) Is there a permanent disability from the injury/illness
3) Can the EE return to the same kind of work
4) is there anything else that should be done to confirm diagnosis or further treatment to explore
An IME may occur at any point in the EEs recovery
