Policy
Severely impaired workers who have difficulty with the activities of daily living are entitled to a personal care allowance (PCA) to hire attendants.
Guidelines
Severely impaired
Workers are considered severely impaired if their impairments are
- permanent and rated for either permanent disability (PD) benefits totaling at least 100%, non-economic loss (NEL) benefits totaling at least 60%, or
- likely to be permanent in the opinion of a WSIB medical consultant, and meet one of the criteria above.
For a worker receiving both PD and NEL benefits, the WSIB combines all the impairments for review under the most appropriate rating schedule (i.e., either the PD or the NEL rating schedule) and determines if one of the above criteria for severe impairment has been met.
Initial Entitlement Assessment
In most cases, a home visit will be conducted to help determine the level of assistance, if any, required by the severely impaired worker with regards to the activities of daily living (e.g., eating, maintaining good personal hygiene, grooming, and being mobile). Information is also gathered regarding any special medical requirements.
The WSIB determines the worker's specific needs using the Activities of Daily Living Scale (ADLS) form.
Entitlement to the PCA starts from the date the worker begins to need the services of an attendant due to the work-related injury/disease, and the criteria for severe impairment are met.
Attendants
The three categories of attendant care are
- skilled attendant care (to handle complex health care and hygiene)
- personal attendant care (to handle routine personal care), and
- general attendant care (to handle basic supervision).
Severely impaired workers may hire one or more attendants to provide the assistance they require. An attendant could be
- a non-agency attendant such as a spouse, family member, or friend, or
- an agency attendant, such as a nurse.
Unless specially authorized by the WSIB, the combined hours of care provided by multiple attendants must not exceed 24 hours per day.
Payment
Non-agency attendants
Payment for non-agency attendants is based on the WSIB rates for each of the three levels of care. These rates are reviewed annually and may be adjusted to reflect changes in the cost of living and any other factors that have a direct impact on the rates. For up-to-date rates for personal care, see 18-01-05, Table of Rates.
NOTE
Generally, the WSIB also pays the non-agency rates for workers living outside of Canada. The WSIB adjusts these rates only if it is demonstrated that the amount properly and reasonably charged in the worker's community is significantly higher than the Ontario rate.
The WSIB pays the PCA to the worker each month unless
- the worker requests that the attendant be paid directly, or
- a Power of Attorney has been designated.
Agency attendants
Rates for agency attendants are negotiated with and paid directly to the agency.
Continuation during hospitalization
For workers admitted to a hospital, the PCA may continue for up to two months during the hospitalization.
Continuation during attendant’s annual paid break
The PCA may continue for up to two weeks once per year while the attendant takes a well-deserved break. The WSIB will cover the cost of another attendant, while the worker’s usual attendant is away on break.
Registration as employer
A worker employing a non-agency attendant must register with the federal and provincial governments and make the appropriate remittances (i.e., CPP, EI, income tax). The WSIB reimburses the worker for the employer portion of these remittances.
A worker employing a non-agency attendant, including a family member, for more than 24 hours per week is automatically registered with the WSIB as an employer. Such attendants are covered as workers under the Workplace Safety and Insurance Act. The associated costs are paid for by the WSIB. The WSIB reimburses a worker for bookkeeping costs, up to an annual maximum, if
- the costs are related to the worker's role as an employer, and
- the worker submits receipts.
The maximum bookkeeping fee is reviewed annually (for the current fee, see 18-01-05, Table of Rates) and may be adjusted in keeping with changes in the cost of living and any other factors that have a direct impact on such expenses.
NOTE
Agency attendants are considered employees of the agency regardless of the number of hours they spend with a worker.
Material change
A worker must advise the WSIB of any material change, e.g., a change in medical status, which may affect entitlement to the PCA. Failure to report a change within 10 days of its occurrence may result in a benefit-related debt (see 18-01-04, Recovery of Benefit-related Debts, and 22-01-02, Material Change in Circumstances-Worker).
Reviews
Upon notice of a material change, the WSIB determines if a review is required to
- assess ongoing entitlement to the PCA, and/or
- evaluate the level of the monthly personal care needs.
Reviews may also be conducted if requested by the worker, the worker’s health care professional, employer, or at the discretion of the WSIB (e.g., WSIB receives information indicating the worker’s condition has deteriorated/improved significantly).
In most cases, a home visit will be conducted, and a new ADLS will be completed to determine what adjustments, if any, need to be made to the PCA. Once the review is completed, the PCA may be confirmed, increased, decreased, or discontinued.
Changes to PCA
Any increase in the PCA is paid as of the date the worker required a change in the type or level of attendant care.
The WSIB only decreases the PCA if there is a significant change in the worker’s work-related impairment(s), usually resulting in at least a 10% reduction in the PCA. If the PCA is decreased or discontinued, the change becomes effective the month following the date of the WSIB review.
Application date
This policy applies to all decisions made on or after August 1, 2007, for all accidents.
Document History
This document replaces 17-06-05 dated October 12, 2004.
This document was previously published as
17-06-05 dated January 31, 2002
17-06-05 dated April 6, 2001
17-06-05 dated May 23, 2000
17-06-05 dated June 15, 1999
06-01-07 dated July 1989.
References
Legislative Authority
Workplace Safety and Insurance Act, 1997, as amended
Sections 32, 33
Workers' Compensation Act, R.S.O. 1990, as amended
Section 50
Minute
Administrative
#6, June 1, 2007, Page 438