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Benefit for Non-Economic Loss (NEL)

Benefit for Non-Economic Loss (NEL)

If you suffer permanent impairment from a work-related injury or illness, the WSIB will pay you a non-economic loss benefit to compensate you for the physical, functional, or psychological loss the impairment causes. This benefit is determined when your condition has reached a point where no further improvement can be expected. The amount paid is based on a legislated base amount times an impairment rating.

Your Medical Examination
To receive a NEL benefit, you may be required to have a medical examination to assess your condition. Your claim will be referred to the NEL Department and a NEL Clinical Specialist will review the information to determine if there is sufficient information on your file to rate your NEL benefit. If the information is complete, your NEL Benefit will be rated and you will receive a letter explaining the decision, as well as the payment.

If an examination is required, the WSIB will either refer you a Regional Evaluation Center to have your assessment done or send you a list of doctors specially trained to assess your type of injury or disease. In either case, you choose which doctor will examine you from a list that will be supplied to you. The WSIB will reimburse you for travel expenses if there is no suitable doctor in your area, and for lost wages that result from attending the examination.

After the examination, the doctor will send the WSIB a medical report. This report, as well as the medical information on you claim file will be reviewed to calculate your NEL benefit. You and your employer will each receive a copy of the doctor’s report as well as a letter to explain how the benefit was calculated.

(Note: If you live outside Ontario, or are incapable of travelling for an examination, the process for your medical examination is different; you will receive individual instructions in these cases.)

How are NEL benefits calculated?
Your NEL benefits are calculated by expressing your impairment as a percentage – the more serious your impairment, the higher the percentage. This percentage is then multiplied by a base amount determined by law. Your benefit is also adjusted for your age.

NEL benefits are calculated(395k, pdf)as follows:
  • The base amount for NEL benefit is $55,124.53for 2008
  • The base NEL benefit is adjusted for your age by:
    adding     $1,225.43 for every year under 45 years old you were at the time of the injury; and
    subtracting     $1,225.43 for every year over 45 years old you were at the time of injury;
  • The maximum base amount for injuries in 2008 is $79,629.83.
  • The minimum base amount for injuries in 2008 is $30,625.22.
  • Your impairment is expressed as a percentage, based on the examining doctor’s report. The more severe your impairment, the greater the percentage.
  • After the base NEL amount is adjusted for your age and for inflation, it is multiplied by your percentage impairment. The result is your NEL benefit.
For example: a 35 year-old woman with a 50% impairment and an accident date of 2008 would receive a benefit of:
55,124.53base + $12,254.30 for age) x 50% for impairment = $33,689.42.

How is the NEL benefit paid?

NEL benefit amounts under $12,249.65, NEL is paid in a lump-sum. If your benefit is over $12,249.65, you may choose to receive your benefit in monthly installments for the rest of your life, or as a lump sum. To choose the lump sum option you must notify the WSIB within 35 days of your benefit being determined.

What if my condition gets worse?

If you have medical evidence that your condition has worsened significantly, you can ask your adjudicator for a review 12 months after the date of the latest WSIB NEL decision. In exceptional cases, the 12-month rule may be waived.

More information is in this Q&Afor Workers(26k, pdf)

 

 
    AA Disability Consultants - Studio Di Consulenza Legale - Aurelio Acquaviva