WORKPLACE INJURY INSURANCE: Worker s Handbook

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1 WORKPLACE INJURY INSURANCE: Worker s Handbook A GUIDE TO YOUR WORKERS COMPENSATION INSURANCE

2 The following information is provided as a basic guide to your Workers Compensation Insurance. For more complete information, please refer to the Workers Compensation Act, which can be found on our website under Policy & Legislation. At the same location, you will find the WCB Policy Manual, which contains explanations and interpretations of the Act. Both the Act and Policy Manual can also be found at various libraries across the province, and a paper copy of the Policy Manual can be purchased from the WCB for a one-time fee of $75. INDEX What is Workers Compensation Insurance?... 2 Who is covered? When injuries happen Health-care benefits Short-term benefits Sample benefits calculation Long-term benefits Annuity Vocational rehabilitation services Survivor benefits Protecting your job: re-employment Frequently asked questions Your responsibilities WCBNS Worker s Handbook 1

3 WHAT IS WORKERS COMPENSATION INSURANCE? The Workers Compensation Board (WCB) of Nova Scotia promotes workplace injury prevention and provides injured workers with financial and healthcare benefits and services to help them safely return to work. The WCB was established by the provincial government in 1917 to administer the Workers Compensation Act. The Act was designed to protect workers and employers from financial loss due to workplace injuries. The WCB is a no-fault agency, meaning that assistance does not depend on who was at fault when the injury occurred. Today, we focus on three key areas: Injury prevention and education We provide social marketing to increase awareness of the importance of safety in the workplace, and prevention information and education to both employers and workers across the province. Return to work We assist injured workers and their employers with safe and timely return to work after a workplace injury. This reduces the overall human and financial costs of workplace injuries. Benefits We provide income replacement benefits, health care, vocational rehabilitation and return-to-work assistance to workers injured on the job. 2 WCBNS Worker s Handbook

4 WHO IS COVERED? Most businesses are required to have workers compensation insurance, if they employ three or more workers at the same time. For some businesses, coverage is not required either because the industry in which the business is engaged is not mandatory under the Workers Compensation Act or because the business has fewer than three workers employed. Banking, insurance and agriculture are examples of some industries that do not require coverage. Although some businesses are not required to have workers compensation insurance, businesses in non-mandatory industries and those with fewer than three workers may purchase coverage voluntarily. When a business is registered with the WCB, everyone working for the business is covered under the Act. Full-time, part-time, casual/seasonal workers, workers hired through a Human Resources and Skills Development Canada grant, and subcontractors who do not have their own coverage are all covered under the employer s insurance. This includes officers of corporations, as long as they are salaried employees of the business (receiving a T4). Employers who are self-employed or in a partnership are not required to have coverage for themselves, but they must provide coverage for their workers, if there are at least three workers and the business is in a mandatory industry. WCBNS Worker s Handbook 3

5 The exception to this coverage is for family members living in the household of the sole proprietor, partners, active officers or directors of a limited company. These family members are counted as workers, although coverage is not mandatory for them. Also, they are not covered under the regular account. Voluntary coverage is available if it is desired. WHEN INJURIES HAPPEN If an injury happens while on the job, or in the course of employment: 1. Report your injury to your employer immediately. If possible see your supervisor, first aid attendant or company nurse before you leave work. 2. If necessary, get immediate medical attention. Ask your health-care professional to send the WCB a report as soon as possible. 3. If you lose time from work or require medical attention, fill out a WCB Accident Report form, or have your supervisor fill out the form for you. Ensure that your employer reports the injury to the WCB within 5 business days of being notified that the injury has occurred. 4. Keep in regular contact with your employer, doctor and WCB case worker. Provide them with any information that might help you return safely to work. Report any injury to your employer right away, whether or not it requires medical attention or time off work. Your report creates an official record that can be referred to if there are any complications later. 4 WCBNS Worker s Handbook

6 If you do not lose time from work or require medical attention, it is not necessary to report your injury to the WCB. But, again, keep a record of the particulars of the injury/incident (i.e., time, place, date, people involved, type of injury, how it happened, etc.) in the event the information is required later. All reports, whether from employers or doctors, should be sent to the WCB as quickly as possible. Delays in receiving reports can create delays in us making claim decisions. An injury that develops over time may also be covered, if it is a direct result of your employment. If a disease is due to the nature of your job and causes a loss of earnings, permanent impairment or death, you or your dependants are entitled to compensation as if the disease was an injury. The WCB pays for injury-related health-care expenses starting from the day of the injury. HEALTH-CARE BENEFITS Workers Compensation Insurance covers the costs of health-care services required as a result of a workplace injury. This includes hospital care, visits to a doctor or chiropractor, surgery, prescriptions, dental expenses, or other health-care items such as braces or crutches. Workers are eligible for healthcare benefits whether or not they lose time from work. Injured workers may go to the health-care professional of their choice, be it their doctor or a chiropractor. The worker must tell the health-care professional that it is a work-related injury so that they can send reports to the WCB. The employer or the WCB may also choose the health-care service provider for the worker to see. WCBNS Worker s Handbook 5

7 In the case of a serious injury, when a worker must leave the workplace immediately for health-care treatment, the employer is required to pay the cost of an ambulance to transport the worker to a healthcare professional or facility, or to bring the healthcare professional to the scene. The WCB will provide any special services or equipment required for a worker s recovery, such as artificial limbs or wheelchairs. As well, any maintenance and repair of special devices will be covered. Eye glasses damaged in a workplace incident may be repaired or replaced. A maximum of $150 will be paid for frames. Generally, repair or replacement must be done within three months of the incident. Dentures and/or natural teeth that are damaged as a result of a workplace injury may also be repaired or replaced. SHORT-TERM BENEFITS Workers compensation benefits are based on an earnings-loss system. This means the worker is paid a percentage of the wages lost as a result of an injury. This is often the difference between what they were earning before their injury and what they are earning after their injury. This is referred to as their earnings loss. Temporary earnings-replacement benefits (TERB) are usually paid every two weeks for as long as a worker is medically unable to return to work. For the first 26 weeks after an injury occurs, the worker is compensated at 75% of their net earnings loss. If a worker is off work due to the injury for more than 26 weeks, the TERB then increases to 85% of their net earnings loss. 6 WCBNS Worker s Handbook

8 For 2006, the maximum earnings level used to calculate benefits is $45,100 (gross). Employers are allowed to top-up workers benefits if they choose, but this is not a requirement. There is a waiting period before a worker can begin to receive earning-loss benefits from the WCB. This period is two-fifths (2/5ths) of the worker s normal work week. The amount the worker would have earned during this period is taken off the first compensation cheque. For example, a worker who usually works five days a week would have two days worth of their net weekly benefit deducted from their first cheque (2/5 x 5 days). The deduction for a shift worker who works three 12-hour shifts per week would be 14.4 hours (2/5 x 36 hours). If compensation lasts more than five weeks, the 2/5ths deductible is paid back to the worker. Employers are allowed to pay, or top-up, workers the 2/5ths amount, if they choose. Of course, not every injury results in the worker being totally unable to work. For example, an injured worker may be able to work at a different job or for fewer hours per week. Since workers compensation insurance is based on lost earnings, benefits for these cases are based on the difference between earnings before the injury and earnings after the injury. WCBNS Worker s Handbook 7

9 SAMPLE BENEFITS CALCULATION The following example is based on a worker who earns a gross salary of $25,000 per year and who is now unable to work. First 26 weeks: Gross income $ Less: EI, income tax and CPP $ Net income $ Income replacement rate 75% Weekly benefit (TERB) $ After 26 weeks: Gross income $ Less: EI, income tax and CPP $ Net income $ Income replacement rate 85% Weekly benefit (TERB) $ LONG-TERM BENEFITS There are two types of workers compensation benefits for a worker who has a permanent injury. A worker may be entitled to one or both of these benefits. LOSS OF PHYSICAL ABILITY A worker who suffers a permanent impairment as a result of a work-related injury or disease may be entitled to a Permanent Impairment Benefit (PIB). A PIB compensates an injured worker for a permanent loss of physical ability of a particular body part or area as a result of a workplace injury. Eligibility is determined by a review of the medical information in the worker s file, as well as a medical assessment performed by a WCB Medical Advisor. The assessment is used to assist the WCB case worker in determining a permanent medical 8 WCBNS Worker s Handbook

10 impairment (PMI) rating. The PMI rate is used to calculate the PIB. The calculation is: PIB = (PMI rate x 30%) x (85% x net average weekly earnings) After 16 months, if a worker has medical information that shows a change in their condition, a further medical assessment can be performed to determine if their PMI rate has changed. This change in their PMI rate would then affect the amount of their PIB. LOSS OF EARNINGS If a worker s financial loss is greater than their PIB, they may also receive an extended earningsreplacement benefit (EERB). The EERB compensates an injured worker for a permanent loss of earnings, and is based on the difference between the worker s earnings before the injury and their earnings or ability to earn after the injury. This difference is called the worker s earnings loss. The worker is eligible for an EERB if the difference between their earnings loss and their PIB is greater than zero. If it is, the worker is eligible for an EERB calculated at 75% of this difference for 26 weeks after their injury, and then 85% of the difference until he or she is 65 years old. WCBNS Worker s Handbook 9

11 ANNUITY At age 65, if the worker is still receiving an EERB, it ends and is replaced by an annuity that is created when the worker starts receiving long-term benefits. When long-term benefits begin, the WCB begins setting aside an additional 5% of the worker s total EERB and PIB into an annuity. This amount may be paid as a lump sum at age 65 or in instalments, depending upon the amount of the annuity and the preferences of the worker. VOCATIONAL REHABILITATION SERVICES For workers who suffer permanent impairment and are unlikely to return to their pre-injury job, the WCB may provide a vocational rehabilitation program. A vocational rehabilitation plan is developed to assist the worker in overcoming difficulties that may affect their return to work, and help the worker get a job at a wage level similar to that of their previous position. The plan may include services like skills or educational upgrading, job search preparation and on-the-job training. A vocational rehabilitation plan is developed by the worker and his or her WCB case management team, and is built around the skills and abilities of the worker and the current labour market. 10 WCBNS Worker s Handbook

12 SURVIVOR BENEFITS If a worker dies in, or as a result of, a workplace injury, or from an occupational disease, the worker s dependants may be eligible for certain survivor benefits. In cases of an occupational disease or illness, an autopsy may be required to determine the cause of death. DEATH BENEFIT The WCB provides a lump-sum death benefit of $15,000 to the spouse. This is a one-time payment. If the worker was receiving compensation at the time of the injury, the WCB pays the spouse an additional lump sum of three times the worker s monthly benefit. SURVIVOR BENEFIT The WCB also pays the spouse a monthly survivor benefit, which is 85% of the deceased worker s net earnings. The survivor benefit is paid until age 65, at which time it is replaced by an annuity based on an additional 5% of the total survivor benefit paid. DEPENDANT CHILD BENEFIT Each dependant child is eligible to receive a monthly benefit of $196. These payments are made until the child turns 18, or until age 25, if the child s education is continuing at a recognized institution. A child who is physically or mentally incapable of earning may receive a benefit indefinitely. The maximum amount of survivor benefits dependants can receive (including both the survivor benefit and the dependant child benefit) cannot exceed the total EERB and PIB payable on the claim. WCBNS Worker s Handbook 11

13 OTHER SURVIVOR BENEFITS If the worker had no spouse or dependant children, but other people were dependent on his or her income, these people may receive benefits for up to five years. The amount of the benefit will be based on the dependant s particular situation. The WCB will also pay up to $5,000 for the worker s funeral and up to $500 for transportation of the body within Nova Scotia. The WCB pays the actual cost (or a reasonable portion) of transportation of the body outside Nova Scotia. PROTECTING YOUR JOB: RE-EMPLOYMENT Certain employers are required to re-employ workers when they are ready to safely return to work. This applies to employers with 20 or more workers, but does not apply to employers in the construction industry and other industries specifically exempted in the Workers Compensation Act and regulations. When a worker is able to return to work, if he or she is able to do the essential duties of the job they held before the injury, the employer must offer the worker this position. If the position is not available, the employer must offer a similar position. If there is no similar position, the employer must offer suitable work. Then, as positions open up that are more like the worker s previous job, the employer must offer them to the worker. 12 WCBNS Worker s Handbook

14 If a worker is unable to do the essential duties of the job they held before the injury but is able to do other work safely, the employer must offer the worker the first suitable position available. As the worker s condition improves, the employer must offer positions more suited to his or her abilities at that time. The WCB will help employers and workers to determine how the re-employment legislation affects their particular situation. If adjustments or modifications are required to assist a worker in returning to work, the WCB may also fund a portion of these costs. The employer s obligation to re-employ lasts up to two years after the injury and ends if the worker refuses an acceptable offer of re-employment. WCBNS Worker s Handbook 13

15 FREQUENTLY ASKED QUESTIONS 1. Who pays for workers compensation coverage? Employers pay the cost of workers compensation insurance through premiums set and collected by the WCB. Workers do not pay into the system. 2. Can I get help to present my claim? Yes, anyone can help the worker with any part of the process presenting information, filing an appeal, etc. As well, legal representation or other special assistance may be available through the Workers Advisers Program. Worker Advisers are appointed and paid for by Nova Scotia Environment and Labour to help workers appeal WCB decisions or apply for benefits. They may be contacted at What happens if a third party may be to blame for my injury? You must decide, within 180 days of the injury, whether you will receive compensation from the WCB or sue the third party on your own. If you decide to receive compensation, the WCB may sue the third party in order to recover the cost of your workplace injury. If you choose this option, you are entitled to the same benefits and services as those available to other injured workers during the WCB s legal action. 14 WCBNS Worker s Handbook

16 4. Can I appeal a claim decision? Yes. If you feel that an error has been made in your WCB decision, you may file an appeal with the WCB s Internal Appeals Department. This department operates outside WCB s dayto-day operations. An appeal must be filed within 30 days of the date you received the decision. A Hearing Officer will make a decision about your appeal, and this is the final decision of the WCB. If you do not agree with the WCB decision, you may appeal to the Workers Compensation Appeals Tribunal. The Tribunal is an external, independent body under the responsibility of the Department of Justice. You may contact the Tribunal at Finally, any participant (worker, employer, WCB, etc.) can appeal a Tribunal ruling to the Nova Scotia Court of Appeal. More information about appeals may be found in the brochure, Appealing a WCB Decision, which is available on our website ( look under Brochures & Publications), or by calling us directly. 5. After a claim is closed, can it be re-opened? If a healed injury flares up again, or turns out to be more serious than was originally thought, the claim may be reviewed. Any new healthcare information will be considered, and then, depending on the type of benefit requested, the claim could be re-opened. WCBNS Worker s Handbook 15

17 6. Can a worker receive compensation from more than one claim? Yes. The maximum compensation allowed is 85% of the worker s net earnings. If compensation from previous claims and compensation from the current claim total more than the 85% maximum, the benefits paid on the current claim are reduced accordingly. 7. Are my benefits taxable? No, but you do have to report benefits to the Canada Revenue Agency for tax credits. 8. Are my benefits adjusted for the cost of living? Beginning after December 31, 1999, long-term benefits and some survivor benefits are adjusted by half of the percentage change in the Consumer Price Index in Nova Scotia for the preceding year. 9. What about the cost of traveling to my WCB appointments? If the WCB requests a worker to travel for treatment, examinations or other reasons, we normally cover travel expenses. In some cases, workers may be entitled to travel expenses for health-care appointments, such as chiropractic treatment or physiotherapy. 16 WCBNS Worker s Handbook

18 YOUR RESPONSIBILITIES 1. Notify your employer of any injury as soon as possible. 2. File a claim for compensation within twelve months of an injury, except in the case of occupational disease or illness. 3. Send any information that may be required by the WCB. 4. Provide the WCB with complete and accurate information. 5. Take steps to minimize the physical and financial impact of your injury. 6. Seek health-care services or treatment to promote recovery. 7. Notify the WCB immediately of any change that may affect your claim, including return to work. 8. Undergo a medical examination, if requested by the employer, the WCB or the Workers Compensation Appeals Tribunal. WCBNS Worker s Handbook 17

19 VIRTUAL OFFICE Corporate and general information Injury prevention social marketing Young worker safety HALIFAX OFFICE Workers Compensation Board of Nova Scotia 5668 South Street PO Box 1150 Halifax, NS B3J 2Y2 Phone: (902) Toll free: General fax: (902) Injury reporting fax: (902) SYDNEY OFFICE Workers Compensation Board of Nova Scotia Medical Arts Building 336 King s Road, Suite 117 Sydney, NS B1S 1A9 Phone: (902) Toll free: Fax: (902)