Non-Economic Loss Award: Who Qualifies?

Non-Economic Loss Award: Who Qualifies?

A non-economic loss award (NEL) acknowledges how a work-related injury impacts the worker’s life beyond the scope of the workplace. Non-economic loss benefits compensate workers for permanent impairment caused by a work-related injury or illness that occurred after January 1, 1990.  

This NEL award does not compensate for lost wages because of a workplace injury. Instead, it compensates for the loss of abilities due to the resulting permanent impairment.

What Is Permanent Impairment?

A permanent impairment refers to a physical, mental, or functional loss of ability that is not likely to improve, as outlined by a medical report. To determine the level of permanent impairment, the Workplace Safety and Insurance Board (WSIB) must assess if the injured party has reached maximum medical recovery (MMR). Maximum medical recovery refers to the level at which the worker stops showing signs of improvement with their condition and determines that any future improvement is unlikely to occur.

You may qualify for a non-economic loss award if:

  • Your workplace injury occurred after January 1, 1990
  • Your suffer from permanent impairment as outlined by the Workplace Safety and Insurance Board
  • Your NEL medical assessment confirms that you have reached maximum medical recovery

What Is a Non-Economic Loss Medical Assessment?

Before you qualify for a non-economic loss award, a clinician from the NEL must confirm you meet the requirements.

A NEL assessment is a medical evaluation given by a doctor assigned by the Workplace Safety and Insurance Board or at a Regional Evaluation Centre. Either way, a qualified physician reviews your files, compiles a report, and sends a copy to you and the WSIB. You may want to show your report to a specialist or to your family doctor to confirm the results.

The NEL Determination

The WSIB utilizes all available medical information, including the NEL assessment, to evaluate your level of impairment and create a claim file.

The clinician interprets the medical information provided in your file to determine your level of permanent impairment. The WSIB should notify you when this process takes place. If there is insufficient medical information to process your claim, the Workplace Safety and Insurance Board may ask you or your doctors for additional information.

What Is a 0% Permanent Impairment Rating?

A 0% permanent impairment rating means that, according to the WSIB, you do not have any permanent impairment. If the WSIB determines a zero degree of impairment, you will not be eligible for a non-economic loss award. A 0% permanent impairment rating also makes you ineligible for any additional loss of earnings benefits, and if your condition worsens, you may not request a new non-economic loss determination.

What Is the Value of a Non-Economic Loss Award?

The WSIB utilizes the medical information from your doctor and your claim file to calculate your degree of permanent impairment, reported as a percentage: the greater the impairment, the higher the percentage.

The formula to determine the monetary amount of your non-economic loss award multiplies the impairment percentage by a set amount calculated by the WSIB and adjusted each year to account for inflation.

To calculate your NEL, the WSIB uses the following formula:

  1. Start with a base amount, according to your age when you reached MMR.
  2. Add or subtract from this number depending on whether you were over or under age 45 at the time of the injury.
  3. $25,490.34 is the highest amount to be added or subtracted.

The WSIB multiplies your base number with your impairment percentage, plus or minus your age at the time of the injury, to determine the amount of your NEL award.

How Do I Receive My NEL Award?

Since March 30, 2011, most NEL award payouts have come as lump sums. If your non-economic loss award exceeds $12,745.17, you may opt to receive your award as a monthly payment in lieu of the lump sum. To receive a monthly payment, you must inform the Workplace Safety and Insurance Board within 30 days of notification of your award. You cannot change your decision on a monthly payment or lump sum later.

If your case predates March 30, 2011, the rules relating to monthly payments and lump sums do not apply.

Can I Contest the Amount of My Non-Economic Loss Award?

If you do not agree with the amount of your NEL, you may file a request for reconsideration through an Appeals Resolution Officer at the WSIB. You must file this request within six months of the initial determination. You can follow the status of your appeal online.

If you are not satisfied with the results of your appeal, you have six months to present your dispute to the Workplace Safety and Insurance Appeals Tribunal. This tribunal is the highest level of appeal to which injured workers may dispute an NEL award.

What If Your Condition Worsens?

You may apply for a new NEL determination with a one-year waiting period from the original determination. To qualify for a new NEL determination, your initial impairment rating must be more than 0%, and your physician must provide written confirmation of your worsened condition.

Your doctor should provide a written comparison of the latest physical assessment with the findings from the last NEL determination, explaining in detail the deterioration of your condition. Should the Workplace Safety and Insurance Board agree with the assessment, it will recalculate your non-economic loss award using the same metrics as the original determination.

What Is the Difference Between a NEL Award and a Permanent Disability Benefit?

The permanent disability benefit applies to workers who have a permanent disability caused by a workplace injury sustained before January 2, 1990. These workers may be eligible for a lifetime monthly pension to compensate for physical impairment and loss of the ability to earn.

The amount of permanent disability compensation depends on several factors, including:

  • The severity of the disability
  • The amount of income earned before the accident
  • The date of the workplace injury

Pension amounts by date:

  • 75% of gross earnings for accidents occurring before April 1, 1985 (adjusted for inflation)
  • 90% of gross earnings for accidents occurring between April 1, 1985, and January 2, 1990 (adjusted for inflation)

For additional information on non-economic loss awards and disability benefits, please contact the Workplace Safety and Insurance Board.

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