Note: This is not a policy; it is a supplementary document to illustrate how the WSIB will administer the Workplace Safety and Insurance Act, 1997, (WSIA) and Policy 18-05-03, Determining the Degree of Permanent Impairment in practice. If there is a conflict between this Administrative Practice Document and the WSIA and/or WSIB policy, the decision-maker will rely on the WSIA and/or WSIB policy, as the case may be.
Key principles
- People are entitled to receive benefits for injuries and diseases that result from accidents that arise out of, and in the course of their employment.
- Decision makers will gather relevant information and weigh evidence to make adjudicative decisions.
- Work-relatedness is established when determining initial entitlement. Decision makers continue to evaluate the work-relatedness of a person’s ongoing impairment throughout the life of a claim.
- A work-related impairment is considered permanent when it continues to exist after maximum medical recovery (MMR) has been reached.
- A person who has a permanent work-related impairment is entitled to a non-economic loss (NEL) benefit based on the degree of their work-related impairment, as determined by the WSIB.
Introduction
Section 46 of the Workplace Safety and Insurance Act, 1997 (WSIA) states that if someone’s injury results in a permanent impairment, the injured person is entitled to compensation for their non-economic loss (NEL). An impairment is defined as “a physical or functional abnormality or loss (including disfigurement) which results from an injury and any psychological damage arising from the abnormality or loss”.
The American Medical Association Guides to the Evaluation of Permanent Impairment (third edition revised) (AMA Guides) is the rating schedule used to determine the degree of permanent impairment resulting from a work-related injury/ illness (O. Reg. 175/98 s.18 (1)).
When the AMA Guides does not provide rating criteria for a specific impairment, the regulation states that rating criteria for body parts, systems or functions that are most similar (analogous) to the specific impairment from the AMA Guides may be used (O. Reg. 175/98 s.18 (2)).
Determining the degree of someone’s work-related permanent impairment is the responsibility of decision makers in the WSIB’s Permanent Impairment Program. Decision makers in the Permanent Impairment Program are guided by relevant policies (including Operational Policy Manual [OPM] document 18-05-03, Determining the Degree of Permanent Impairment), the AMA Guides, and also considers all health care information in the claim file.
In rare circumstances where someone’s physician or other health care professional involved in the case cannot provide sufficient information to determine the degree of the person’s permanent impairment, the WSIB may arrange for the person to attend an independent medical assessment.
If the AMA Guides do not provide rating criteria for a specific impairment, if there is no close analogy in the AMA Guides, or if application of the AMA Guides would result in an unfair assessment of the person’s impairment, the WSIB has established other rating guidelines for determining the degree of the impairment in these cases.
Post-COVID condition (long COVID)
This document outlines the WSIB’s rating guidelines for determining the degree of permanent impairment for post-COVID condition (also known as long COVID).
Background
The AMA Guides are not diagnosis-based. Therefore, there is no specific impairment percentage prescribed in the AMA Guides for a diagnosis of post-COVID condition. Instead, the AMA Guides provides rating criteria based on the person’s area of impairment (body area or body system).
Persistent symptoms from a post-COVID condition affecting specific body areas or systems may include these (or other) presentations:
- fatigue
- joint pain
- chest pain
- palpitations
- shortness of breath
- brain fog
- difficulties with concentration
- recurrent headaches
- dizziness
- respiratory problems
- cardiovascular issues
- gastrointestinal difficulties
- loss of taste
- loss of smell
Severity of symptoms
The number of symptoms experienced by someone with a post-COVID condition may range from one to multiple symptoms as in the examples above, and can range in severity from mild to severe.
People that present with this diagnosis and have symptoms that are severe enough to be measured on specific objective tests, would meet the threshold for impairment of one or more body areas/ systems outlined in the AMA Guides. These people would receive a permanent impairment rating for those specific body areas/ systems.
On the other hand, there are people with mild post-COVID conditions who demonstrate mild symptoms or groups of symptoms that impact their activities of daily living, yet would not meet the threshold for impairment outlined in the AMA Guides. Instead, using the AMA Guides these mildly symptomatic people with definite limitations in daily living activities could receive a 0 percent permanent impairment rating, which is not considered a fair assessment of their degree of impairment.
The AMA Guides assesses the severity of mental and behavioural disorders based on how well a person performs in four areas of function. These four areas of function are activities of daily living, social functioning, concentration, persistence, and pace, and adaptation to stress. While the AMA Guides also provides classes of impairment, it does not provide specific rating percentages in each class. WSIB Policy 18-05-11: Assessing Permanent Impairment Due to Mental and Behavioural Disorders was developed to provide a rating scale that would capture limitations in the four areas of function outlined in the AMA Guides. Currently, this policy represents one of the few rating scales that is able to capture a person’s independence, appropriateness, and effectiveness in their ability to perform activities of daily living, and which holistically assesses the degree of impairment in this area of function.
In cases where certain mild post-COVID condition symptoms (or groups of symptoms) would not meet specific impairment criteria in the AMA Guides, the impact of these mild symptoms on the person’s ability to carry out activities of daily living would be assessed using the rating scale in the Assessing Permanent Impairment Due to Mental and Behavioural Disorderspolicy.
A permanent impairment rating using the scale in the Assessing Permanent Impairment Due to Mental and Behavioural Disorderspolicy does not suggest that this is a rating of psychiatric or psychological functioning. The scale is being used because it best captures the holistic impact of the post-COVID condition on this person’s activities of daily living as detailed in the AMA Guides and policy.
A permanent impairment rating using the scale in the Assessing Permanent Impairment Due to Mental and Behavioural Disorderspolicyshould also not imply that all criteria listed in the AMA Guides and/ or this policy must be met for an impairment rating to be considered.
Rating guideline
AMA Guides only
For post-COVID conditions where people have symptoms severe enough to be measured on objective tests, and would meet the impairment criteria for one or more affected areas/systems in the AMA Guides (e.g., respiratory, cardiovascular, smell/ taste, neurological impairment, etc.), their symptoms will be rated according to the relevant section(s) and criteria from the AMA Guides and relevant policy only.
Noting the more severe post-COVID conditions can affect multiple and separate body areas/ systems, criteria from the AMA Guides will be used to determine the permanent impairment percentage for each separate body area/system affected. The decision-maker will then convert the permanent impairment per cent for each body area/system to a whole person impairment value. The decision-maker will then combine with other whole person impairment ratings in this or other claims, to determine this person's total whole person impairment.
If there are one or more body areas/systems rated according to the AMA Guides but there are also other mild post-COVID condition symptoms that do not meet criteria for rating under the AMA Guides, the other mild symptoms are considered captured entirely under the AMA Guides rating.
Activities of daily living only
Where post-COVID condition cases demonstrate mild but persistent symptoms that cannot be rated by specific AMA Guides or WSIB policy criteria, symptoms will be assessed holistically based on the impact they have on the person’s ability to perform and/or complete their activities of daily living only, and will be assessed according to the activities of daily living criteria and scale from the Assessing Permanent Impairment Due to Mental and Behavioural Disorderspolicy only.
Criteria related to social functioning, concentration, persistence, and pace, ability to adapt to stressful situations, or other complex integrated cerebral functions, where not relevant to the post-COVID condition diagnosis, will not be captured in this rating.
AMA Guides and activities of daily living only ratings
In cases where post-COVID condition symptoms are more appropriately assessed based on a person’s ability to complete their activities of daily living only, and where there are also symptoms of loss of taste (ageusia), and/ or loss of smell (anosmia), the whole person impairment would be determined by combining the impairment based on activities of daily living only, with the impairment for loss of taste and/ or loss of smell outlined in the AMA Guides.
If there is an activities of daily living only rating in the claim for post-COVID condition, and there is worsening of the symptoms such that one or more of the symptoms becomes measurable on objective tests, and would now meet impairment criteria for one or more affected areas/systems in the AMA Guides or WSIB policy, on redetermination the new AMA Guides rating will replace the prior activities of daily living only rating.
Where there is an activities of daily living only rating in the claim for post-COVID condition and a subsequent rating for psychological/ psychiatric impairment is requested, the new rating for psychological/ psychiatric impairment will replace the prior activities of daily living only rating.
This rating method should be used to evaluate permanent impairment due to a post-COVID condition where the person has reached maximum medical recovery, and the case owner has been able to clearly delineate the symptoms secondary to the post-COVID condition.