Document name

Allowance – Independence

Document number

PRO 34/2024

POL 34/2024, Independence Allowance establishes eligibility guidelines for providing independence allowances.

1. What is an independence allowance (IA)?
   1. An IA is an annual life-time allowance paid to eligible workers to help offset additional costs incurred by a worker who has an accepted work-related injury to help maintain independence.
2. Who is eligible for an independence allowance (IA)?
   1. Workers who are assessed with a permanent functional impairment (PFI) rating of 10 per cent or greater and who incur additional costs to optimize or maintain their independence impacted by their work-related injury.
   2. Workers with a PFI rating solely for occupational hearing loss will not be eligible for an independence allowance.
3. How does WCB determine eligibility?
   1. When a worker has been assessed as having a PFI rating of 10 per cent or more, Operations staff will send a questionnaire to the worker to determine if the worker the impairment limits the worker’s independence.
   2. 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, rideshare, paratransit, etc.) because of the work-related injury.
      6. And if the worker has any other barriers to maintaining independence that should be considered.
   3. After reviewing the questionnaire, Operations staff will review the claim to determine if the worker’s needs are a result of the work injury.
   4. 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.

Calculation

4. If eligible, how is an IA calculated?
   1. A worker’s independence allowance amount will be based on:
      1. The worker’s PFI rating percentage and
      2. When the worker’s PFI rating was first determined as the worker’s IA amount is subject to the maximum IA in effect the year the worker’s PFI rating was first determined.
   2. If the worker has a PFI rating of:
      1. Less than 10 per cent, the worker is not eligible for an IA.
      2. 10 to 39 per cent, the worker will be eligible for an IA and the following calculation will be applied:
      3.  

         Worker’s PFI % 40% (maximum PFI)

         X

         Maximum IA amount ($) in effect, subject to when PFI is first determined

         =

         IA amount provided to worker ($)

          

      4. iii. 40 per cent or more, the worker will be eligible for the maximum IA amount.
   3.  Amounts will be rounded to the nearest dollar.
5. How is the maximum IA amount set?
   1. The maximum IA amounts are established through The Workers’ Compensation Act, 2013 and are noted in the table, PFI Awards – Minimum and Maximum Amounts, within the Consumer Price Index (CPI) – Annual Increase procedure will apply.

Payment

6. When is the IA paid?
   1. Once eligibility is determined, the IA will be paid to the worker. The worker’s first IA payment will be prorated from the first of the month following the IA decision to the worker’s next annual review of their claim file (i.e., anniversary date of the worker’s original commencement of loss of earnings).
   2. Every year thereafter, the IA will be paid on the first of the month following the annual review of the worker’s claim file.
7. How long will a worker receive an IA?
   1. A customer is eligible to receive IA for life, if they continue to:
      1. i. Have a PFI rating of 10 per cent or more, and
      2. ii. Require IA to optimize or maintain their independence.
   2. IA will be discontinued if the worker’s PFI rating decreases below 10 per cent or they no longer require it to maintain their independence (e.g., the worker sells their home after moving to a long-term care facility, etc.).

PFI Reassessments

8. What if a worker’s PFI is reassessed and the PFI rating increases or decreases?
   1. If a reassessment results in an increased PFI rating, Operations staff will determine if the worker is eligible to receive an increased IA amount. If eligible, Operations staff will issue a prorated IA payment to the worker, for the period beginning first of the month after the reassessment to the worker’s next annual review of their claim file.
   2. 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.

PFIs for multiple claims

9. What if a worker has been assessed for a PFI for multiple injury claims?
   1. In accordance with the Permanent Functional Impairment policy, if a worker was previously assessed for a PFI and has a subsequent injury assessed for a PFI, the new PFI rating will be based on the effect on the whole person, using the AMA Guides Combined Values Chart (CVC).
   2. A worker’s IA will be based on their combined PFI rating.
   3. If the worker’s PFI rating should increase and they are eligible for an increased IA, Operations staff will issue a prorated payment to the worker, for the period beginning the first of the month after the new PFI rating to the worker’s next annual review of their claim file. Every year thereafter, the WCB will issue the adjusted amount.