Document name

Earnings Verification

Document number

PRO 13/2021

POL 13/2021, Earnings Verification establishes the requirement for an annual earnings verification of claims receiving long-term earnings loss benefits.

General

1. How do Operations staff verify the annual earnings of workers receiving long-term earnings loss benefits?
   1. An annual Verification of Income Statement form (REQ) with a request for tax information and a Notice of Assessment (NOA) from the Canada Revenue Agency (CRA) is issued 60 days prior to the anniversary date of the commencement of the worker’s loss of earnings.
2. What happens when information from the CRA is not available?
   1. If information from the CRA is not available, Operations staff will determine what other form of earnings verification may be required.
   2. This will generally include verifiable documentation about the worker’s earnings from the previous year which may include, but is not limited to, the following documents:
      1. A record of employment.
      2. T4.
      3. Paystubs.
      4. Bank statements.
   3. There may be situations where CRA tax information is not available and verification of earnings may not be required (e.g., where a worker is living in a long-term care facility or where the worker is clearly unable to perform any gainful employment). Operations staff must review the worker’s file to determine if there is any evidence of the worker securing earnings from employment.
3. What happens when a worker does not return the information necessary to verify their earnings?
   1. If a worker does not return the necessary documentation for an annual review, Operations staff will notify the worker verbally (i.e., over the phone) and provide written notice.
   2. Depending on the circumstances of each claim, Operations staff may extend long-term earnings loss benefits for up to two months prior to referral to the Operations’ Customer Care Facilitator who has the discretion to determine what, if any, ongoing compensation is payable.
   3. If a worker still does not provide earnings verification information, their long-term earnings loss benefits may be suspended (POL 10/2021, Suspension of Benefits) until the complete required documentation is received.
4. Once earnings verification information has been received, Operations staff will review and confirm that the information received is sufficient to authorize ongoing long-term earnings loss benefits.
5. What information do Operations staff review when verifying a worker’s earnings?
   1. Operations staff will review a worker’s information received from CRA to verify:
      1. Earnings from the previous year.
      2. Changes to tax exemption status (TD1), and
      3. If they receive CPP/QPP disability or survivor benefits.
6. What happens when a worker’s earnings change during the course of the year?
   1. Workers are encouraged to contact the WCB if there is a significant increase or decrease to their earnings throughout the course of the year (e.g., part-time to full-time employment).
   2. Operations staff will recalculate benefits and adjust earnings capacity to avoid a potential overpayment during the annual earnings verification process.

Benefit Adjustments

7. Under what circumstances will Operations staff adjust a worker’s long-term earnings loss benefits?
   1. Operations staff will adjust a worker’s long-term earnings loss benefits when:
      1. There is a change of earnings capacity based on a difference between estimated and actual earnings.
      2. There is a change to a worker’s TD1 status.  
8. When do adjustments to long-term earnings loss benefits take effect?
   1. Subject to point 9, adjustments to long-term earnings loss benefits resulting from annual earnings verification are effective in the current year on the anniversary of the worker’s commencement of loss date.

Retroactive Adjustments

9. Under what circumstances may Operations staff retroactively adjust a worker’s long-term earnings loss benefits?
   1. Operations staff may recalculate and retroactively adjust a worker’s long-term earnings loss benefits when:
      1. There is more than a 10 per cent difference in earnings capacity adjustment between estimated and actual earnings.
      2. There is a change of earnings capacity as a result of a breach of The Workers’ Compensation Act, 2013, such as suspected or alleged fraud, deliberate misrepresentation or withholding of information affecting entitlement was involved.
      3. Approved or adjustments to CPP/QPP disability or survivor benefits.
      4. Any other situation determined by the Board.
10. Long-term earnings loss benefits that are retroactively adjusted will also be modified in the current verification year to reflect the actual or estimated earnings of the worker.
11. How are retroactive adjustments to long-term earnings loss benefits calculated?
    1. The retroactive adjustment will be calculated based on the date when the adjustment to the worker’s benefit entitlement is determined to have occurred (e.g., January 1st of the income tax year).