- Health care (attendance allowance)
- Pensions (arrears)
- Permanent impairment {NEL} (rating schedule) (whole person concept)
- Health care (independent living) (severely disabled worker)
- Pensions (conversion to NEL ratings)
The issues under appeal were: a) the correctness of the January 9, 2017 arrears date for the pension disability (PD) award increase from 45% to 60% for chronic pain disability (CPD) in relation to a 1988 compensable accident; b) the quantum of the PD award for CPD when converted to a non-economic loss (NEL) rating; c) the quantum of the 54% whole person NEL award; and d) entitlement to a Independent Living Allowance (ILA) and Personal Care Allowance (PCA).
The appeal was allowed, in part. OPM Document No. 18-07-01, "Determining the Degree of Disability", allows for a reassessment of a worker's permanent disability benefit in the event that the compensable disability worsens. The Vice-Chair found that the permanent worsening date for the increase from 45% to 60% should be changed from January 9, 2017 to November 7, 2016.It was submitted that the worker's 60% PD benefit is equivalent to a 60% NEL award, and the worker's complaints should have been characterized as a marked impairment. The Vice-Chair noted that PD benefits and NEL ratings are not considered to be equivalent as each uses entirely different rating schedules. With respect to the conversion for the purposes of determining entitlement for the Serious Injury Program, it was found unlikely that the worker's 60% PD benefit was equivalent to a 60% NEL benefit. It was noted as important to follow the proposed procedure as set out in Decision No. 1322/05, which requires rating the worker's condition according to the prescribed NEL rating schedule. It was confirmed that the 45% NEL conversion of the worker's CPD was correct.Additionally, the worker's whole person impairment rating was calculated by converting the worker's PD rating to a NEL rating, and then combining this rating with her NEL award for carpal tunnel syndrome in accordance with the Combined Values Chart in the AMA Guides. There was no error identified, and the quantum of the worker's whole person NEL rating was confirmed at 54%.Lastly, "severely impaired" workers may be entitled to an ILA or PCA. The worker did not meet the minimal threshold to allow entitlement under these policies. The Vice-Chair referenced Decision No. 387/19, which noted that the "threshold requirement promotes consistency in decision making." There were no exceptional circumstances identified to allow for the granting of entitlement of the ILA and PCA despite not meeting the threshold requirements.