Document name

Permanent Functional Impairment (PFI) – General

Document number

PRO 33/2024

POL 33/2024, Permanent Functional Impairment (PFI) Awards, provides guidelines for assessing permanent functional impairment and providing PFI awards.

1. When is a worker assessed for a permanent functional impairment (PFI)?
   1. WCB’s Operations staff will review injury claims to identify those where the worker may have, or may be left with, a PFI. Staff may request assistance from WCB’s medical officers to determine this.
   2. Operations staff will determine when it is medically appropriate for the worker to be assessed for a PFI.
      1. This is when the worker’s condition has reached maximum medical improvement (MMI) and clinical findings indicate that the worker’s medical condition is static and well stabilized.
      2. Impairment should not be considered permanent until a reasonable time has passed for the healing or recovery to occur.
      3. Staff may request assistance from WCB’s medical officers to determine when a worker’ condition has stabilized and is unlikely to change (improve or worsen).
   3. When the worker’s condition has reached maximum medical improvement (MMI), a PFI assessment will be requested. The process will be explained to the worker.
2. What information is required for a PFI assessment?
   1. WCB’s health care services team may arrange an appointment with a health care provider to determine functional measurements.
   2. WCB’s medical officers will use the medical reports in the worker’s injury claim file to complete the PFI assessment.
   3. WCB may request colour digital photographs where, as the result of a work-related injury, the worker has a permanent disfigurement. The WCB will reimburse all reasonable costs associated with providing photographs.
   4. WCB may arrange a mental health assessment to gather information required to complete a PFI assessment.

PFI assessments

3. How is a PFI assessed?
   1. Operations staff will request a WCB medical officer to determine the worker’s PFI rating.
   2. The medical officer will complete the PFI assessment based on the most current edition of The American Medical Association Guides to the Evaluation of Permanent Impairment (AMA Guides).
   3. In accordance with the AMA Guides, the medical officer will assess the injury alone or as part of a multiple injury rating that considers the overall whole person impairment (WPI). This will determine what percentage of the whole person (i.e., the worker) has suffered permanent impairment.
   4. If a worker has suffered multiple injuries from a single incident, the WCB medical officer will apply the AMA Guides’ Combined Values Chart (CVC) to rate the impact of the injuries on the overall whole person impairment.
      1. For example, scarring that is caused by an amputation will not qualify for a separate PFI rating as it is included in the assessment and impairment rating for the amputation.
   5. If a worker has impairment from multiple work-related injuries, the medical officer will apply the AMA Guides’ CVC, despite there being separate injury claim numbers and potentially many years between each injury.
   6. Impairment ratings completed using the AMA Guides are rounded to the nearest whole number and are expressed as a percentage.
4. How is a PFI assessed for a terminal occupational disease?
   1. Operations staff review medical reports to confirm the worker’s prognosis.
   2. If the worker’s health care provider confirms that the occupational disease is terminal (for example, an untreatable occupational disease with less than one year of life expectancy) and that it has resulted in any degree of permanent functional impairment, Operations staff will issue the maximum PFI award in effect at that time.
   3. Operations staff will consider each situation on a case-by-case basis and may request assistance from WCB’s medical officers.

PFI award calculations

5. How is a PFI award calculated?
   1. Payment of a PFI award is based on a percentage rating applied to the maximum award.
   2.  

      PFI %

      X

      Maximum PFI amount in effect at PFI assessment

      =

      PFI award, subject to the minimum amount in effect at PFI assessment

       

   3. The amount payable is determined by the minimum and maximum amounts in effect at the time of the PFI rating assessment.
      1. Amounts will be rounded to the nearest dollar.
      2. For example, a PFI is assessed in 2025.
         1. i. The minimum PFI award in accordance with legislation is $2,200 and the maximum PFI award is $55,200.
         2. ii. The PFI award calculations would be as follows:
            1. (a) If the worker is assessed to have a PFI of 3%, the lump sum payment will be $2,200 ($55,200 X 3% = $1,656; however, the minimum PFI award for 2025 is $2,200).
            2. (b) If the worker is assessed to have a PFI of 15%, the lump sum payment will be $8,280 ($55,200 X 15%).
            3. (c) If the worker is assessed to have a PFI of 75%, the lump sum payment will be $41,400 ($55,200 X 75%).
6. How are the minimum and maximum PFI award amounts established?
   1. The minimum and maximum PFI award amounts are established through The Workers’ Compensation Act, 2013.
   2. Effective January 1, 2029, the minimum and maximum PFI award amounts will be adjusted annually in accordance with the percentage increase in the Consumer Price Index. The amounts noted in the table, PFI Awards – Minimum and Maximum Amounts, within the Consumer Price Index (CPI) – Annual Increase procedure will apply.
7. How are workers notified if they are eligible for a PFI award?
   1. If a permanent impairment exists, a worker will be notified when a PFI assessment has been completed and a PFI award calculated.
   2. The lump sum PFI award will be expressed to the worker in terms of both dollars and percentage.
8. What happens if the worker passes away prior to receiving a PFI award?
   1. Where a worker, who was eligible for a PFI, dies prior to the award payment, the PFI award will be paid to the worker’s estate.
   2. If it is determined that payment should be made to someone other than the worker’s estate, Operations staff have the authority to determine to whom the PFI award should be paid.

PFI reassessments

9. What happens if a worker’s impairment changes?
   1. WCB may complete a reassessment of a PFI rating if a change in the worker’s level of permanent functional impairment is indicated. A review will only be conducted if there is objective medical evidence indicating a change in the condition for which the worker has an impairment.
   2. In cases of progressive impairment due to disease or repetitive trauma, each stage of the impairment will not be compensated. These situations will be managed as increases to the original injury rather than as new injuries. As a result, the difference between the former rating and the recent rating will be calculated according to the established legislation at the time of the initial PFI assessment.
   3. If the reassessment results in an increase to the worker’s PFI rating:
      1. The worker is entitled to the difference between the new award amount and what they previously received.
      2.  

         New PFI %	-	Prior PFI %	=	Additional PFI %
         Additional PFI %	X	Maximum PFI amount in effect at time of initial PFI assessment	=	Additional PFI award, subject to the minimum amount in effect at PFI assessment.

          

      3. In all situations, the amount payable is determined by the minimum and maximum amounts in effect at the time of the initial PFI assessment (see the attached table, Permanent Functional Impairment (PFI) Awards – Minimum and Maximum Amounts). 
      4. In all situations, the amount payable is determined by the minimum and maximum amounts in effect at the time of the initial PFI assessment (see the attached table, Permanent Functional Impairment (PFI) Awards – Minimum and Maximum Amounts).
      5.  A worker who received the initial PFI award based on the minimum award is not entitled to receive further payment unless the rating results in the PFI award exceeding the minimum PFI in effect at time of initial PFI assessment.
         1. For example, if the worker is rated a 1% PFI and receives the minimum PFI award and years later is reassessed another 1% for a total of 2%, they would not be eligible for additional payment.
      6. If the reassessment results in a decrease to the worker’s PFI rating, recovery of the prior PFI award will not be pursued. However, WCB will review the worker’s qualification for other entitlements such as independence allowance. If applicable, the worker’s independence allowance level will be reduced or discontinued effective the first of the month following the reassessment date.

PFIs for multiple injuries or multiple claims

10. If a worker suffers multiple injuries from a single incident which result in a PFI, are they eligible for multiple PFI awards?
    1. WCB’s medical officers will rate the impact of the injuries on the overall whole person impairment (using the AMA Guides’ CVC) to account for the effects of multiple impairments.
    2. If it is determined that the worker has a PFI rating, one PFI award will be provided.
11. If a worker suffers a second work-related injury which results in an additional permanent functional impairment, are they eligible for another PFI award?
    1. WCB’s medical officers will rate the impact of the injuries on the overall whole person impairment. They will apply the AMA Guides’ CVC.
    2. The worker is entitled to the difference between the new award amount and what they previously received:
    3.  

       New (overall whole person) PFI %

       X

       Maximum PFI amount in effect at PFI assessment

       =

       PFI award, subject to the minimum amount in effect at new PFI assessment

       -

       Prior PFI award(s)

       =

       Additional PFI award

        

    4. For example, a PFI is assessed in 2025.
       1. The worker had a previous injury and had received a PFI award in 1995 of $1,100. The worker also had a second previous injury and received a PFI award in 2023 for $2,200.
       2. In 2025, the worker is assessed for a PFI resulting from a third injury. Through the AMA Guides’ CVC, it is determined the worker has a PFI rating of 15%.
       3. The worker’s PFI award is calculated as follows:
          1. The minimum PFI award in accordance with legislation is $2,200 and the maximum PFI award is $55,200.
          2. A PFI of 15% in 2025 is eligible for a PFI award of $8,280 ($55,200 X 15%). However, the PFI award would be reduced by the prior PFI awards paid to the worker ($8,280 - $1,100 - $2,200).
          3. The worker would receive a PFI award of $4,980.

Independence allowances

12. Will a worker who has been assessed as having a permanent functional impairment receive an independence allowance?
    1. In all situations, guidelines in the Independence Allowance policy will apply.
    2. Workers with a PFI rating of 10 per cent or greater will be considered for the independence allowance (i.e., to cover costs for home maintenance, etc.).
    3. PFIs solely provided for hearing loss claims will not be eligible for an independence allowance.