Cost Relief For Employers (POL-58)

The purpose of this policy is to explain how claim costs are divided between the employer and the rate group when recovery is prolonged due in part to an accident and in part to a cause other than an accident. 

REFERENCE

Workers Compensation Act, R.S.P.E.I.1988, Cap. W-7.1, Sections 6 (9)(11), 41 (7).

Workers Compensation Board Policy, POL-60, Reopening a Claim for Recurrence of Symptoms.

Workers Compensation Board Policy, POL-61, Pre-existing Conditions.

DEFINITION

In this policy:

“Cost Relief” means sharing total costs of a work-related injury between the employer and the employer's rate group

“Expected healing time” means the evidence-based period of time for healing following an injury or illness. 

“Rate group” means a group to which an industry is assigned for assessment purposes. 

“Work-related injury” means an injury arising out of and in the course of employment.

POLICY

1. Where a worker’s condition is, in the opinion of the Workers Compensation Board (WCB), due in part to an accident and in part to a cause other than an accident, the WCB will determine what portion of the worker’s claim costs are a result of the accident and what portion are a cause other than an accident. 
2. If a worker approved for benefits has objective evidence of a pre-existing condition, cost relief may be approved if the expected healing time of the compensable injury has been delayed due to the pre-existing condition.
3. Where the cause is in part related to something other than an accident, the portion of those costs will be charged against the rate group to which the worker’s employer belonged at the time of the accident. 
4. The WCB will consider written requests for cost relief from employers, which must include rationale.
5. The WCB will provide the employer with a written decision on cost relief, including an explanation of how cost relief was applied.
6. Self-insured employers are not eligible for cost relief.

HISTORY

Board of Directors Approval Date: January 24, 2002