Document name

Allowance – Independence

Document number

PRO 31/2016

POL 31/2016, Allowance – Independence establishes guidelines for providing independence allowance (IA).

Permanent Functional Impairment (PFI) Evaluations

1. Medical and Health Care Services (MHCS) will provide PFI evaluations in accordance with the most current edition of the American Medical Association: Guides to the Evaluation of Permanent Impairment (POL 23/2010, Permanent Functional Impairment (PFI) – General).

Reviewing Eligibility

2. If the worker has a PFI rating of 10 percent or more from all eligible claims, Operations will send a questionnaire to determine if the worker is eligible for IA.  
3. The questionnaire will allow Operations staff to determine if the worker:
   1. Continues to live in their home, rental unit or condominium.
   2. Needs to move from their home, rental unit or condominium because of the injury.
   3. Is able to continue maintaining their home, rental unit or condominium (e.g., interior and exterior).
   4. Requires help maintaining their home, rental unit or condominium because of the injury.
   5. Needs special transportation services (e.g., taxi, Paratransit) because of the injury.
4. After reviewing the questionnaire, Operations staff will review the claim to determine if the worker’s needs are a result of the work injury.
5. Workers living in nursing homes, extended care facilities or other special care facilities do not normally need IA. However, Operations staff may issue IA to the worker’s spouse or children if they maintain the worker’s home.
6. If the worker’s needs are a result of the work injury, Operations staff will issue IA to the worker.
7. Operations staff will issue IA to the customer annually on the first of the month following the anniversary of their commencement of earnings loss date. A customer is eligible to receive IA if they continue to have a severe PFI and require IA to maintain their independence.

Multiple PFI Awards

8. If the worker has more than one PFI award from a number of claims, the Operations staff member responsible for the claim with the largest PFI will send the PFI10 letter and review the questionnaire.
9. If the worker receives a new PFI award after the WCB issues IA, Operations staff will determine if the worker should receive more IA. If IA should increase, Operations staff will issue a prorated payment to the worker, for the period beginning the first of the month after the new PFI award to the anniversary of the worker’s first earnings loss. Thereafter, the WCB will issue the adjusted amount annually.
10. If the worker has more than one PFI award from a number of claims, Operations staff will divide the cost of IA based on the PFI rating attributable to each claim.

Reassessments

11. If a reassessment results in a decreased PFI rating, Operations staff will determine the impact on IA qualification at the worker’s next annual review. Operations staff will not calculate and recover overpayments on previously awarded IA.