Mod 4 Set 3 - Government - Disability

Question 1

What does WC stand for?

Answer 1

Workman’s Compensation

Question 2

Give a brief overview of WC plans

Answer 2

– WC programs are set up at the provincial level
– WC is essentially a form of “no-fault” insurance
o an employee is guaranteed benefits for injury, disease or death
“arising out of and in the course of employment”

Question 3

If an employee is injured at work, they can choose to do what 2 things?

Answer 3

1. Take legal action against the er for negligence, OR 2. Claim Worker Compensation (WC) benefits

Question 4

What are some benefits provided by WC?

Answer 4

o Health care oSTD and LTD
o Rehabilitation
o Survivor benefits

Question 5

Are WC benefits taxable?

Answer 5

No they are not taxable

Question 6

How does one become eligible for WC?

Answer 6

o generally mandatory for all ee’s in industrial occupations
BUT
o Some provinces exempt following groups from mandatory WC coverage:
– domestic(work at home) ees
– casual or contractees
– ees in certain service industries
– ees In the “knowledge” industries such as finance and insurance

Question 7

How are WC programs funded?

Answer 7

– WC system is funded solely by employers;
o employee(ee) contributions are not permitted
o government doesn’t contribute in any way

Question 8

How and who decides how much the er pays for their premium?

Answer 8

– Employers whose ee’s are covered by WC are “assessed” by their respective provincial WC board to determine the premium that they (the er) will have to pay

Question 9

What are the two assessment methods for determining the premium that the er pays?

Answer 9

1. Individual Liability

2. Collective Liability

Question 10

Explain the individual liability method of determining the premiums that ers have to pay, who is this method used by?

Answer 10

– Individual Liability method is used by
o government or public agencies
o Crown corporations
o large public transportation companies (e.g. airlines, railways)
o employers are individually liable for accident & sickness costs (related to the WC claim), and these are usually paid on a “pay as you go” basis
– the claims however are adjudicated and administrated by the respective WC board (which is called WSIB in Ontario)

Question 11

What does the employer’s annual assessment (what they pay WCB) include?

Answer 11

o actual cost of claims (accident & sickness occurrence), plus o a charge for WCB admin and adjudication services

Question 12

Explain the collective liability method of determining the premiums that ers have to pay.

Answer 12

Under this method;
o employers are divided into industry classes, and
o each year, each class is assessed a premium rate (or assessment rate)

Question 13

What are “experience rating refunds”? How do these work as incentives?

Answer 13

Refunds that the employers can claim if they have low disability claims
Experience rating refunds are an incentive for employers to
sponsor initiatives that will help reduce claims such as – accident prevention programs
– early return to work initiatives

Question 14

What are the two types of “experience rating refunds”?

Answer 14

(1) Prospective, and

(2) Retrospective

Question 15

Explain the Prospective experience rating refund. Who uses this method?

Answer 15

– under this method the average industry assessment rate to the rate for the current year is adjusted down for ers in that group with good WC claims experience over the past year (s) and for ers with poor claims experience over recent years, a surcharge is charged

Used by small businesses in ontario

Question 16

Explain the Retrospective experience rating refund. Who uses this method?

Answer 16

– Assessments are adjusted retroactively (after year is over). A refund of contributions can be made to ers with good claims experience, while a surcharge may be applied to ers with poor experience

– this method is used by large businesses in Ontario

Question 17

How does WC provide Health care benefits?

Answer 17

– WC pays all medical expenses incurred as a result of an occupational accident or disease

health care costs covered by WC:
o hospital charges, physician and surgical fees(costs normally
covered by provincial health care plans)
o drugs and ancillary services(costs often covered by private medical plans-individual or employer plans)

Question 18

How does WC provide STD benefits?

Answer 18

– these benefit begin the day following injury and are paid weekly
– the benefit period may range from 3 months to 2 years
– the payment ranges from 75-90% of net earnings pre-injury

Question 19

When do the LTD benefits start?

Answer 19

– LTD begins after STD period expires and, under the “permanent disability awards system there are/were two benefit categories.

Question 20

Explain the difference between Permanent partial disability and permanent total disability.

Answer 20

(i) Permanent Partial Disability
– Ee is permanently unable to perform his/her regular job functions, but could perform some type of employment or participate in a rehab program
– Disabled ees will receive a monthly benefit, usually at some % of the permanent total disability benefit amount

(ii) Permanent Total Disability
– Ee is unlikely to ever work again (at their regular or any other type of job)
o Disabled ees receive a monthly benefit
o Benefit is paid until ee reaches age 65 or dies or recovers
(whichever comes first)

Question 21

The calculation for WSIB benefits

Answer 21

put on calculation sheet

Question 22

Does WC provide survivor benefits?

Answer 22

– Payable when an ee dies as a result of an injury or disease incurred in course of employment
– Surviving spouse and any dependent children receive: o an income replacement benefit
o lump sum (some provinces)
o funds to cover funeral costs
o benefits usually paid for spouses lifetime or to age 65 (but stop on remarriage)
o child benefit stops at age 18 (unless child disabled or full time student)

Question 23

What kind of survivor benefits are offered with WSIB (ontarios WC program)

Answer 23

o Burial Expenses (no limit)
o counseling/other support
o Lump Sum Payment to spouse (or dependent if no spouse) o Monthly Survivor benefits (spouse and dependents)

Question 24

In ontario, what must one do to receive WC benefits?

Answer 24

1. Cooperate in recovery by following any suggested treatment
2. Have regular health exams as required by WSIB (this is done annually)
3. Cooperate in “Early and Safe Return To Work” programs
4. Report any changes to your medical condition or income to WC board
   If an ee does not cooperate, STD/LTD benefits may be reduced or discontinued.