PERMANENT DISABILITY AWARDS
1. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-1
2. LEGISLATIVE FRAMEWORK AND INTERPRETATION . . . . . . . . . . . . . . . . . . . . . 13-1
3. THE PENSION ASSESSMENT PROCESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-2
3.1 The Medical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-2
3.2 The Board’s Rating Schedules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-3
3.3 Disabilities Not Covered by the Board’s Rating Schedules . . . . . . . . . . . . . . . . 13-4
3.4 Pre-existing Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-4
4. CALCULATION OF THE PENSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-5
4.1 General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-5
4.2 Cost-of-living Increases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-5
4.3 Minimum Payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-6
5. DURATION AND FORM OF PAYMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-6
6. 100% PENSION AND SURVIVORS’ BENEFITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-7
7. PAYMENT OUT OF COUNTRY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-7
8. ASSISTING THE WORKER WITH A PENSION APPEAL . . . . . . . . . . . . . . . . . . . . . 13-7
8.1 Preliminary Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-7
8.1.1 The Nature of Pension Appeals at the WSIB . . . . . . . . . . . . . . . . . . . . 13-7
8.1.2 WSIAT Appeals vs. WSIB Appeals . . . . . . . . . . . . . . . . . . . . . . . . . . 13-7
8.1.3 Downside Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-8
8.2 Re-assessment on the Basis of Deterioration . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-8
8.3 Types of Challenges to Initial Pension Ratings . . . . . . . . . . . . . . . . . . . . . . . . 13-10
8.3.1 Expanding the Areas of Rating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-10
8.3.2 Challenges to the Factual Basis of the Rating . . . . . . . . . . . . . . . . . . 13-11
8.3.3 Challenges to the Determination of the Arrears Date . . . . . . . . . . . . . 13-12
8.3.4 Challenges to the Way in which the Schedule or
Other Rating Guide Has Been Applied . . . . . . . . . . . . . . . . . . . . . . 13-12
8.3.5 Challenges to the Benchmark in the Rating Schedule or Guide . . . . . 13-13
8.4 Multiple Injuries / Enhancement Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-13
8.5 Dominant Arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-14
8.6 The Rating of Low Back Pensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-14
PERMANENT DISABILITY AWARDS
Written by Nicole Godbout
Updated by Jo-Ann Seamon
Awards for permanent disabilities are available only for injuries which occurred prior to
January 2, 1990. For accidents on or after that date, the scheme provides for two different types
of benefits: the Non-Economic Loss (NEL) award and either a Future Loss of Earnings (FEL) or
Loss of Earnings (LOE) benefits, depending on the date of accident. These benefits are discussed
in Chapter 16: Non-Economic Loss, Chapter 17: Future Economic Loss, and Chapter 26: Loss of
Permanent disability awards for pre-January 2, 1990 injuries are often referred to as “pensions”.
Although the term has no statutory grounding, its meaning is well-known and it is widely used
by those involved in workers’ compensation matters. It is also the term which will be used
throughout this chapter in preference to permanent disability awards.
This chapter looks at how the Board and the WSIAT interpret the statutory provisions relevant to
the determination of pensions and at how these are assessed and calculated. It also examines
some approaches to challenging the Board’s determination of a pension rating.
All statutory references in this chapter are to the pre-1990 Act unless otherwise stated.1 The
provisions of the pre-1985 Act (injuries prior to April 1, 1985) and pre-1990 Act (injuries from
April 1, 1985 to January 1, 1990) are essentially the same. The difference relates to the way in
which the compensation rate is calculated (see Section 4.1 below, and Chapter 23: Compensation
Rate). Section numbers in the pre-1985 differ from those in the pre-1990 Act. Note that
references to section numbers below are from the pre-1990 Act.
2. LEGISLATIVE FRAMEWORK AND INTERPRETATION
Subsection 45(1) of the Act provides:
Where permanent disability results from the injury, the impairment of earning
capacity of the worker shall be estimated from the nature and degree of the injury...
Permanent disability is defined in s.45(12) as follows:
“permanent disability” means any physical or functional abnormality or loss, and any
psychological damage arising from such abnormality or loss, after maximal medical
rehabilitation has been achieved.2
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While s.45(1) speaks of estimating the “impairment of earning capacity of the worker”, the
wording has been interpreted to mean that the estimation is to be based solely on “the nature and
degree of the injury”. The process is not intended to measure the “actual” impact of a disability
on the earning capacity of a given worker, but the “usual” or “average” impairment of earning
capacity which an average, unskilled worker with that particular disability would suffer.3
Thus all workers with an identical disability receive, in theory, an identical pension rating
regardless of their individual circumstances. For example, a bricklayer with a back disability that
prevents ever returning to that trade will receive proportionally the same pension rating as a
worker with the same disability who is employed in skilled office work. The fact that the earning
capacity of the first worker will likely be much more adversely affected than that of the second
is not a factor relevant to the determination of the pension award. However, pension supplements
do look at issues of earning capacity (see Chapter 14: Pension Supplements for a full
3. THE PENSION ASSESSMENT PROCESS
3.1 The Medical Examination
Pensions are usually rated once treatment is complete and maximum medical recovery (MMR)
has been achieved.4 Under Board policy, a worker is considered to have reached MMR “when
there is unlikely to be any further significant improvement in the worker’s medical condition”.5
Some permanent disabilities may be rated using reports from outside physicians, usually
specialists. This is routinely done with disabilities such as hearing loss or impaired vision.
However, as a rule, the pension rating is based on a medical examination conducted by a Board
doctor. This Board doctor is generally not a specialist, although psychological impairment
ratings involve a psychiatrist while chronic pain disorder ratings involve two doctors, one of
whom is a psychiatrist. Note that for both psychological and chronic pain ratings, a prior
assessment is usually carried out by a social worker whose report will be available when the
pension rating is undertaken.
The role of the Board doctor is first to determine the worker’s residual clinical impairment, if
any. “Clinical impairment” refers to the observed limitations and restrictions in functioning
which have an impact on a worker’s ability to carry on activities of daily living.
Following the examination (which is generally very brief), the Board doctor will assign a
percentage figure to the permanent disability. This figure is meant to represent the usual
impairment of earning capacity associated with the clinical impairment observed by the Board
A written report of the examination is prepared and filed with other medical reports in the
worker’s claim file (for assessments conducted more than a few years ago, the report is found in
the memoranda section of the file). There is no explanation given by Board doctors as to how
they arrive at their ratings.
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3.2 The Board’s Rating Schedules
Most of the percentages assigned by Board doctors come from a schedule established by the
Board, called the “Ontario Rating Schedule” (the infamous “meat chart”). The Ontario Rating
Schedule is found in OPM, Document 18-07-02.
The Ontario Rating Schedule is established pursuant to s.45(3) to provide a list “of percentages
of impairment of earning capacity for specified injuries or mutilations that may be used as a
guide in determining the compensation payable in permanent disability cases”.
It provides percentage figures for the rating of the following:
• hand injuries;
• injuries to the upper and lower extremities and spine;
• impaired vision; and
• kidney injuries.
The Board has developed other schedules for the rating of disabilities not included in the Ontario
Rating Schedule such as psychological disability, chronic pain, and hearing loss. These are also
found in the OPM.6
The percentage figures listed in the Ontario Rating Schedule are said to represent the
approximate impairment of earning capacity which an average unskilled worker would suffer as
a result of each of the listed injuries7 (although there is admittedly no scientifically valid basis
for that statement).
In theory, a pension rating should simply involve matching a worker’s clinical impairment with
the appropriate percentage figure found in the Ontario Rating Schedule for that impairment. This
is essentially what happens for amputations.
For most ratings, however, the process is not quite that simple because the Ontario Rating
Schedule only provides a benchmark figure in respect of the kind of disability suffered by the
worker. A good illustration is provided by back disabilities for which the Ontario Rating
Schedule reads as follows:
Ratings for the spine:
• total immobility of spine (usual distribution) 60%
• cervical and/or thoracic 30%
• lumbar and/or lumbosacral 30%
Back disabilities rarely involve total immobility of either the lower or upper spine. The 30%
figure is thus used as a benchmark figure by reference to which a less-than-totally immobile
back is rated. Essentially, Board doctors are said to assess the impact of the back disability on
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activities of daily living and make a judgement as to how it compares with the impact a totally
immobile lower or upper back would have.
A similar process is followed in the rating of essentially all other scheduled injuries except
amputations. The process is often referred to as a “judgment rating”.
In its leading case on pensions, the WCAT determined that only Board doctors (as opposed to
outside physicians) have the training and “implicit” knowledge necessary to make judgment
3.3 Disabilities Not Covered by the Board’s Rating Schedules
There are a number of disabilities that are not covered by the Ontario Rating Schedule or other
schedules developed by the Board. These include disabilities relating to respiratory diseases,
head injuries and heart, neurological, dermatological, and allergic conditions. The OPM does not
provide information about the rating of most of these disabilities.
Information about the rating of some diseases is provided in Chapter 8: Occupational Disease,
Section 6. For further information about the rating of diseases contact the Director of the
Occupational Disease and Survivor Benefits Program, formerly the Complex Case Unit
(Diseases). The Board may have a documented practice regarding rating a particular disability
that the Director may be willing to provide. In addition, from time to time, this type of
information has been shared with the WSIAT and may be documented in a case dealing with the
disability in question. A search of WSIAT decisions regarding that disability might be fruitful.
3.4 Pre-existing Conditions
In cases where a worker has a pre-accident impairment and suffers a work-related injury or
illness to the same body part or system, the Board will probably have allowed entitlement on an
“aggravation basis”. This long-standing practice was formally recognized with a Board policy
produced in 2005.9 If the worker never returns to the pre-accident state and the Board accepts
that there is a permanent worsening, the worker may be entitled to a pension.
An award may be reduced to reflect the role played in the overall impairment by a condition that
existed before the work accident. The Board has a specific policy regarding prior conditions.10
The policy distinguishes between a measurable and a non-measurable prior condition. A
measurable condition is one that could have attracted a pension rating for permanent disability.
The evaluation in cases of measurable prior condition takes into account the following factors:
1) the value of the prior condition by itself;
2) the value of the new condition by itself;
3) the value of the entire disability; and
4) an enhancement factor equal to the value of the entire disability less the sum of the
values of the prior and new condition.
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The pension awarded is (except for total loss of sight) the total of the value of the new condition
plus the enhancement factor. For non-measurable conditions, the award is not reduced if the
prior condition only produced a minor pre-accident disability. Prior conditions producing
moderate or major pre-accident disability lead to a reduction of 50% and 75% respectively.
However, not much attention is paid to the above policy. In practice, awards are generally not
reduced unless the prior condition constituted an actual disability with restrictions on ability to
carry on activities. Overall, discounts for prior disabilities are fairly rare. What the Board is
more likely to do in the presence of a marked pre-existing disability is deny a pension altogether
on the basis that the whole of the current disability is attributable solely to the prior condition.
4. CALCULATION OF THE PENSION
The dollar value of the pension is obtained by applying the percentage rating of the worker’s
pension to that worker’s compensation rate. For accidents which occurred on or after April 1,
1985, the compensation rate is equivalent to 90% of the worker’s net average earnings at the
time of the accident. For accidents prior to that date, the compensation rate is 75% of gross
average earnings. Both are subject to cost-of-living increases.
The determination of average earnings and compensation rate is discussed in Chapter 23:
4.2 Cost-of-living Increases
Like most other benefits and dollar amounts stated in the Act,11 pensions are increased on
January 1 of every year in accordance with indexing factors set out in legislation.12 Automatic
yearly indexing reflecting the percentage change in the Consumer Price Index (CPI) as published
by Statistics Canada was in place between January 1, 1986 and January 1, 1994. For periods
prior to that, cost-of-living increases were legislated on an ad hoc basis.
From January 1, 1995 until December 31, 1997, there were two indexing factors. The first was a
continuation of full indexation, and it was applied to the pensions of those with 100% pensions
or those in receipt of the additional $200 payment under s.147(14) of the pre-1998 Act. All other
pensions were partially indexed in accordance with a formula set out in s.148(1) of the pre-1998
From January 1, 1998 forward, there are two indexing factors for pensions: full indexing to CPI
and a partial indexing formula which is set out at s.49 of the WSIA.13 Two major changes
resulted from Bill 99. First, the partial indexing formula has changed, resulting in a further
decrease in cost-of-living protection for those to which it applies. Second, the pensions of those
in receipt of s.147(14) payments are no longer fully indexed.
Workers whose benefits are based on 90% of net average earnings may sometimes wonder why,
in any given year, the increase in the dollar amount of their pension does not reflect the increase
in the indexing factor. This is because the indexing is not applied directly to the pension, but is
used to adjust the worker’s average earnings prior to the accident. The Board then applies its
current net average earnings table to this amount, in order to determine the earnings which
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would be left after deductions for probable income tax and EI and CPP premiums. Since these
deductions change from year to year, the percentage increase in the amount of net average
earnings, and therefore the pension, is not the same as the increase in gross earnings.
See Chapter 23: Compensation Rate, for explanations of the indexing formulae, as well as charts
showing the yearly indexing factors and all previous ad hoc increases.
4.3 Minimum Payable
The Act provides a minimum rate for the calculation of pensions no matter how low the
worker’s earnings were at the time of the accident.14 In 2005, the minimum value of a 100%
pension for accidents prior to April 1, 1985 was $1,461.77 monthly. For accidents on or after
that date until January 1, 1990, the 2005 minimum value was $1,548.13 monthly.
For workers with permanent partial disabilities or pensions of less than 100%, the minimum is
subject to the modified indexing formula. This means that minimum partial pension amounts for
2005 can be calculated by multiplying the percentage rating by $1,220.06 for accidents prior to
April 1, 1985, or by $1,292.14 for accidents on or after that date.
Therefore, if a worker tells you that he or she is receiving a 10% pension equalling $70.00 a
month, you know something is wrong. Perhaps the worker is mistaken about the amount or rate
of the pension or, alternatively, the pension may have been commuted in part or the Board may
have made a mistake in calculating the pension. In 2005, the value of a 10% pension cannot be
lower than $122.00 a month for pre-1985 accidents or $129.21 a month for pre-1990 accidents.
5. DURATION AND FORM OF PAYMENT
Whether the pension is paid as a lump sum or on a periodic basis depends to a great extent on the
percentage rating. Pensions higher than 10% are paid periodically. Pensions of 10% or less are,
in theory, paid as a lump sum unless the worker elects otherwise or the Board determines that the
disability is likely to deteriorate in the future. In practice, however, the Board almost invariably
chooses to pay 10% pensions on a periodic basis, probably on the assumption that the nature of
most disabilities rated at 10% (the bulk of which are musculoskeletal injuries and, in particular,
injuries to the back) is such that they are likely to deteriorate. See Chapter 15: Pension
Commutations for a discussion on commutations and lump sum payments.
Periodic pensions are paid on a monthly basis, in contrast to temporary benefits which are paid
on a bi-weekly basis.
Pensions are usually awarded for the lifetime of the worker, the main exception being pensions
for psychological disabilities which may be awarded on a provisional basis for review at a later
date, typically after two years. Although extremely rare in practice, the WSIB has rescinded or
reduced permanent pensions.
The WSIAT has confirmed that permanent pensions cannot be rescinded if a worker’s condition
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6. 100% PENSION AND SURVIVORS’ BENEFITS
The death of a worker who is in receipt of a 100% pension is automatically treated as if it were
the result of a work accident.16 The spouse and dependent children or other dependants are
automatically entitled to the survivors’ benefits provided for under the Act.17 This is the case
even if the worker dies for reasons which are not related to the injury. Board policy restricts this
to workers who receive a 100% pension under a single claim.18 See Chapter 22: Survivors’
7. PAYMENT OUT OF COUNTRY
The pension is fully portable: entitlement to the payment of the award is not lost when the
worker gives up residence in Canada. The Board should be informed and arrangements made
before departure. Payment will be mailed to the address given by the worker in the new country
of residence. Cheques can also be sent to the appropriate Canadian Embassy or Consulate or
diplomatic post handling Canadian affairs if the worker requests it.19
The Board has special agreements with Italy, Portugal, and Greece which make it possible to
have the pension assessed or reviewed in those countries.20
8. ASSISTING THE WORKER WITH A PENSION APPEAL
8.1 Preliminary Comments
8.1.1 The Nature of Pension Appeals at the WSIB
When you are appealing the level of a worker’s pension before the Board, what you are really
doing is trying to convince the decision-maker to have the pension re-assessed by a Board
doctor. It is unheard of for adjudicators to grant an increase of their own motion. They may
agree to refer the matter to a Board doctor if they find your arguments persuasive. However,
they will invariably follow whatever recommendation is made by the Board doctor.
The same is generally true of appeals resolution officers, although there are instances of appeals
officers granting an increase to a pension without referring the matter of rating to a Board doctor
or declining to follow the recommendation of the Board doctor with respect to the percentage
8.1.2 WSIAT Appeals vs. WSIB Appeals
Judgment-ratings by Board doctors carry considerable weight at the WSIAT. However, WSIAT
panels are not so blindly deferential to Board doctors that they will decline to exercise
independent judgment in appropriate cases. A panel that has concerns about the correctness of a
rating may very well be prepared to substitute its own rating for that of the Board doctor.
This is especially true where the rating schedule provisions are detailed, such as the
psychological disability schedule. For an illustration of a panel rating a psychological disability,
see Decision 389/91.21
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8.1.3 Downside Risk
When you object to the level of a pension, you should be aware that there is always a possibility
the pension will be decreased rather than increased. However, this rarely happens. The Board
doctor reviewing the pension rating is unlikely to downgrade a rating previously assigned by one
of his or her colleagues. Therefore, the risk of losing part of a pension on appeal is so remote
that it should not usually give cause for great concern. Nonetheless, it is wise to mention the
downside risk to the worker. The appeals resolution officer or the WSIAT vice-chair will often
point this out at the start of a hearing.
A review of the pension assessment report may help you detect those cases that do carry a real
risk. Clearly, you should think twice about proceeding to appeal if the report suggests that the
Board doctor gave the worker the benefit of some doubt regarding the severity of the impairment
or regarding the likelihood of the disability being permanent. The risk of a pension being
reduced on appeal because of a pre-existing condition (discussed in Section 3.4 above) is also
something to keep in mind.
8.2 Re-assessment on the Basis of Deterioration
The most common ground on which a re-assessment, and therefore a potential increase to the
pension rating, is granted is that the worker’s condition may have deteriorated since the last
examination by a Board doctor. The argument put forward on behalf of the worker boils down to
this: while the initial (or most recent, if there was more than one) rating was not necessarily
wrong, the disability is now worse and deserves a higher rating and, at the very least, a review
by a Board doctor.
Keep in mind that, barring exceptionally strong medical evidence, there is little chance of the
Board ordering a new medical examination of the worker if one was done less than a year ago.
At best, the Board’s response to an objection to the pension rating following a very recent
examination will be to ask a Board senior medical adviser to review the written report of the
examining Board doctor for an opinion as to the correctness of the rating. However, these
“paper” reviews almost invariably result in a confirmation of the award.
Conversely, the longer the time elapsed since the last examination, the more likely it is that a
request for a new medical examination will be successful on appeal.
There are a number of considerations which may influence how you proceed when an injured
worker comes to you for assistance in requesting a pension increase. Ask yourself:
• how much of your resources you or your group generally feel is appropriate to invest in
• how much supportive information or documentary evidence you have at the time of the
initial interview and how much time you are prepared to invest in investigating the
• whether you have a “gut feeling” for some reason that the case is one which stands good
chances of success; and
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• whether it is possible to achieve a global permanent impairment rating (perhaps from
more than one claim) that would bring the worker into the “severely impaired” category,
thereby opening the door to substantial additional entitlements. See Chapter 21: Health
Care Benefits, Sections 2.2, 3.6, 3.7, and 3.8.
If there is little or no strong evidence of deterioration available to you at the time of the first
interview and you have little time to commit to the case, you may, at least, want to try what
could be characterized as a “shot-in-the-dark” approach or a “self-help” approach (or a
combination of both).
The first approach consists of simply writing to the Board, either in the worker’s name or your
own, to request a pension review (some sample letters are found in Appendix 13-A). A request
of this kind is a bit of a shot-in-the-dark. In most cases, the adjudicator will advise you or the
worker that your request will only be considered upon receipt of an up-to-date report from a
specialist. But, once in a while, re-assessments are arranged.
The “self-help” approach also involves little time commitment on your part. Essentially, you ask
the worker to have the family doctor arrange a referral for examination by an appropriate
specialist and have the report of the specialist’s findings sent to the Board. You may want to
provide a note of explanation for the worker to give to the family doctor. (See Appendix 13-B
for a sample form letter). It is also a good idea to follow up the examination with a letter to the
Board, just to make sure that the worker’s request for re-assessment is being considered (a
sample letter is also found in Appendix 13-B).
If the request is denied following receipt of the specialist’s report, consider ordering a copy of
the worker’s file. The file can be ordered in the worker’s name if you do not wish to be on
record as the representative. The specialist’s report will be on file. You can review its content
and decide whether or not you want to pursue the matter further.
Of course, the report obtained through the “self-help” approach is less likely to be as
comprehensive as a medico-legal report you request yourself. However, you can always write
back to the worker’s specialist at a later date if you decide this is warranted.
If you decide at the outset to invest a bit more time in investigating the case, start by ordering a
copy of the claim file. A review of the medical documentation may help you form an opinion on
the merits of proceeding further. If uncertain, ask the opinion of a more experienced
representative. In any event, you will need the medical information on file and, in particular, the
pension assessment report, in order to prepare a request for a medico-legal report.
If the file contains recent medical reports, review them carefully and compare them with the
pension assessment report and other medical reports of the same time period for any possible
evidence of change for the worse. You may be pleasantly surprised to find that there is already
enough evidence in the latest reports to proceed with an appeal. (See Appendix 13-C for a
sample letter to the WSIB).
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8.3 Types of Challenges to Initial Pension Ratings
Unlike appeals done on the basis of deterioration in the worker’s condition, the approaches
covered below involve a challenge to the initial pension rating awarded by the Board doctor.
These approaches can be used alone or in combination with one another (or also in combination
with an argument that the worker’s condition has deteriorated since the last pension assessment).
As noted above, a compelling reason for trying to increase the pension would be to bring the
worker into the “severely impaired” category.
The chart in Appendix 13-E provides examples of successful Tribunal appeals based on some of
the grounds for challenge mentioned below. However, it is strongly suggested that this chart be
used simply as a starting point in a thorough search for potentially useful Tribunal decisions.
8.3.1 Expanding the Areas of Rating
You should always be aware of the possibility of expanding or adding to the areas of disability
rated by Board doctors. There are two basic situations to watch out for and they are as follows:
1) Disabilities Not Rated / Unrecognized
If a worker has suffered multiple injuries at the time of the accident and permanent
disabilities are a result, make sure all the disabilities have been rated. For example, a
worker suffers injuries to the low back, neck, and shoulder areas as a result of a fall at
work. Because the low back injury is by far the most serious, the neck and shoulder are
overlooked at the time of rating. A situation of this kind is easy to remedy. A simple
letter pointing out the oversight should result in an assessment of the neck and shoulder
On the other hand, if the neck and shoulder injuries were not reported at the time of
accident (or continuity of symptoms or treatment since the accident is not clearly
established), the Board may dispute the relationship between disabilities in those areas
and the work accident. Entitlement will have to be established before a pension rating is
Board doctors’ assessments may also overlook evidence of a disability in an area adjacent
to the area of injury which has been rated. A worker with a neck and shoulder disability
for example, may be rated for the neck problems only, while the shoulder is overlooked.
A pension assessment to recognize the impairment of function in the shoulder could be
2) Disability Secondary to the Original Injury
Another situation to watch out for is where another disability develops as a result of the
original one. One example would be where as a result of a knee or leg injury, problems
develop in the low back or hip area or again in the other knee because of awkward gait.
The additional disabilities will be rated for pension purposes if it can be established that
their development is causally related to the knee disability that was the direct result of the
accident. (See Chapter 7: Entitlement Issues, Section 3.5.1.)
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If the secondary disability is chronic pain or fibromyalgia, it is important to be aware of
the Board’s and the WSIAT’s treatment of such cases. The issue will be whether pension
“stacking” will be permitted. The Board’s policy on chronic pain does not allow for
stacking of pensions.22 However, the Tribunal has held that where one accident leads to
two or more distinct disabilities, then stacking is permitted (see Chapter 10: Chronic
Pain, Section 7 for a detailed discussion and relevant caselaw).
8.3.2 Challenges to the Factual Basis of the Rating
The opinion of a non-Board doctor on the actual percentage rating of a disability carries little
weight as a rule. As was noted earlier, Board doctors are generally considered to be the only
ones who can properly assign judgment-ratings (although the Tribunal has done so in a number
However, the medical findings and observations on which Board doctors base their ratings do
not have any privileged status. The factual basis of the rating can be challenged with medical
evidence from an outside physician (see Appendix 13-D for a sample letter of request for a
There are two kinds of enquiries which can be pursued:
1) Are the specific findings outlined in the pension assessment report accurate? The Board
doctor may, for example, have rated a disability on the basis of a 20% loss of mobility
whereas outside medical evidence establishes a 50% loss (see Decision 613/88I for an
example of this).23
2) Has the pension assessment overlooked some aspect of clinical impairment associated
with the permanent disability? When requesting a medico-legal report, consider asking
the examining physician whether there are some limitations in activity that were not
noted in the Board’s assessment.
For example, in Decision 603/88,24 the Board doctors rated an upper arm disability at 5% for
weakness of the elbow without considering pain radiating into the shoulder when lifting heavy
objects or doing repetitive movement. The Panel increased the award to 10%. In Decision
877/93, the Board doctors rated an eye injury at 0%, since the worker’s vision could be brought
into this range with corrective lenses. However, they overlooked a number of disabling side
effects resulting from sensitivity to bright light. The award was increased to 10%.25
Impairment associated with sustained or repeated use is generally overlooked by Board doctors.
Decision 532/8926 illustrates the shortcomings of a medical assessment based on a one-time
testing of restriction in movement or loss of function. In that case, the panel increased a worker’s
award for wrist disability to reflect an inability to “sustain a grip or use his hand for repetitive or
sustained activity” from 5% to 10%. The panel found that this factor had not been rated by the
Board doctor, noting that the assessment had been based on a “static” testing of grip strength and
use of the hand rather than a “dynamic” one. This approach has been followed in more recent
13-11 Permanent Disability Awards
8.3.3 Challenges to the Determination of the Arrears Date
In all cases where a pension is either awarded after a long delay or increased due to
deterioration, it is well worth checking OPM, Document 18-07-05 to confirm that the Board has
determined the arrears date correctly.
8.3.4 Challenges to the Way in which the Schedule or
Other Rating Guide Has Been Applied
It is very difficult to challenge the standards applied by Board doctors (as opposed to
challenging the medical facts to which they apply those standards), because we know next to
nothing about these standards. There is some information available on the rating of back
disabilities (see Section 8.6) but it is of limited value.
The standards applied by Board doctors in the rating of knee disabilities were successfully
challenged in Decision 68/90.28 The panel in that case found that the rating, although in keeping
with the usual standards applied by Board doctors, was not in keeping with the rating system as a
whole and increased the pension to 16%. As part of the Tribunal’s process, the Board was
requested to conduct a re-assessment, which had already increased the award from the original
8% to 12%. The panel’s conclusion was based on a comparison of the limitations on activities of
daily living associated with the knee disability (rated at 8%) and equivalent limitations for a
back disability carrying a 15% rating. This case should have practical implications for
successfully challenging Board ratings of knee disabilities in general. The reasoning by which
the panel arrived at its conclusion may also be usefully applied to the pension rating of other
disabilities (although a challenge of this kind would require a lot of work and a very “receptive”
WSIAT panels are more likely to review Board doctors’ application of the rating schedule for
psychological disabilities (which also applies to disabilities associated with chronic pain and
fibromyalgia). It was held in Decision 389/91,29 that the nature of that schedule makes it easier
for non-Board doctors and the Tribunal to review the correctness of a Board doctor’s
The chances of challenging how a Board doctor arrived at a rating are also better when the
disability is being rated according to a rating guide other than the Ontario Rating Schedule or
other schedule developed by the Board. Many diseases are rated according to outside guidelines
such as the American Medical Association (AMA) guidelines. These are usually more detailed
and can be applied by outside experts. The chances of successful challenge to ratings based on
guidelines of this kind should therefore be greater.
The WSIAT may also be prepared to review the reasoning (or lack thereof) underlying the rating
if medical evidence establishes that the clinical impairment and consequent impact on activities
of daily living has a greater range than indicated by the impairment benchmark used by the
In Decision 407/88, a leg injury had been rated by the Board at 50% by applying the benchmark
figure of 50% for above-knee amputation. The panel found (on the basis of very detailed and
persuasive medical evidence) that the worker’s limitations on activities of daily living were
greater than would be the case for such an amputation and increased the pension to 70%.30 This
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is the same reasoning applied by the Tribunal in Decision 876/8831 where a pension for tinnitus
was increased from 2% to 27% (see Chapter 8: Occupational Disease, Section 184.108.40.206).
Where the rating in question is the result of a pension re-assessment, it may be challenged based
on a comparison of the objective findings contained in the Board doctor’s reports on file. For
example, in Decision 176/92, a 20% back pension was confirmed by the Board despite a medical
finding of more extensive and intrusive pain and treatment. The Tribunal panel increased the
award to 25%.32
8.3.5 Challenges to the Benchmark in the Rating Schedule or Guide
If a challenge to the way in which Board doctors apply the Ontario Rating Schedule is difficult,
a challenge to the benchmark figures themselves is, by comparison, next to impossible. There
are essentially no published cases to date where the validity of a benchmark figure in one of the
Board’s schedules has been successfully challenged at Tribunal.33
In its leading case on pension assessments, the WCAT indicated that while it would require very
compelling reasons to reject any part of the schedule, it should be open to hear evidence
designed to show that a particular benchmark figure is not in fact “a reasonable basis for
estimating the impact of injuries on the earnings capacity of workers”.34
8.4 Multiple Injuries / Enhancement Factors
Where an impairment exists bilaterally in limbs (both elbows or both knees, for example), the
Board adds an enhancement factor (also called multiple factor) to the sum of the pensions in
each limb. The enhancement factor is equivalent to half the value of the pension with the lesser
At the WSIAT, the application of the concept of an enhancement factor is not limited to bilateral
impairments but extends to multiple impairments involving any parts of the body.
The Tribunal first adopted this broad approach in Decision 831/88, a case involving disabilities
of the left and right knee, the left shoulder, and right foot.36 Subsequent panels have reasoned
that the application of an enhancement factor is really an elaboration of the whole person
concept and recognizes that the total impairment of the worker may be greater than the sum of
all individual impairments.
The whole person approach at the WSIAT is not to be confused with the approach of the same
name used by the Board when assessing pensions involving impairment of a chronic pain nature.
The concept is frequently applied by the Tribunal in rating pensions for impairments of mixed
“organic” and “non-organic” nature. But unlike the Board, where this concept is used to keep the
overall pension low, the WSIAT applies the concept in a manner designed to reflect, as well as
possible, the total impairment of the worker.
There are still relatively few published cases where the enhancement factor concept has been
applied to multiple injuries of an organic nature. In one case, the panel granted a worker an
additional 10% award to recognize the enhancement effect of multiple disabilities (30% back,
10% left leg, 5% right leg, and 5% neck) by comparing the overall impairment to a 60% totally
immobile spine or 60% for two totally immobile hip joints in the Ontario Rating Schedule.37 In
another case, it was held that, combined, a 5% elbow disability and 25% shoulder disability
13-13 Permanent Disability Awards
resulted in total functional loss of use of the upper extremity.38 The panel awarded a total
pension of 35% on the basis that the two disabilities together were equivalent to a frozen
shoulder, an injury which carries a rating of 35% in the Ontario Rating Schedule.
8.5 Dominant Arm
The Board’s rating schedule makes no distinction between a disability in the dominant arm and a
disability in the non-dominant arm. It is arguable that a functional loss in the average worker’s
dominant hand should attract a higher rating because it has a greater impact on that worker’s
ability to carry out daily or occupational activities than does a loss in the non-dominant one.
In the Tribunal’s leading case on pension assessments, the panel indicated that the rating
schedule’s failure to distinguish between dominant and non-dominant hand seemed
“fundamentally inconsistent with the schedule’s design of providing percentages that reflect the
impact of the disability on an average unskilled worker’s earning capacity”.39 It further
suggested that this was one aspect of the rating schedule which might be useful for the Board to
review. However, this argument has been firmly rejected in subsequent cases.40
8.6 The Rating of Low Back Pensions
In the course of the hearings in the WCAT’s leading case on pensions, Dr. W. E. Young, a
Board doctor, was called to testify regarding the rating process in general and the rating of low
back injuries in particular. The category of back injuries is the one with the largest number of
pensions. It is, therefore, useful to highlight here the points of interest covered in Dr. Young’s
testimony regarding back ratings:41
• A person rated at 10% for a low back injury is “someone who has mild symptoms on an
organic basis, who obviously can’t do heavy lifting but has reasonably good tolerance for
activities such as standing and walking. The physical findings would indicate mild
restriction of back movements, perhaps to two-thirds of normal on all planes. No signs of
nerve root irritation and no evidence of any neurological injury”.
• The 15% back would be one “with moderate symptoms…[and] restriction of mobility to
approximately half normal on all planes. Perhaps signs of mild nerve root irritation, and
no evidence of any neurological deficit”.
The term “symptoms” refers to such things as the pain and tolerance for “activities which
stress the back such as prolonged standing, prolonged sitting, lifting”.
• The 20% pension would reflect the impairment of someone with moderate symptoms as
well, but with “movement of the lumbar spine conservatively restricted, probably
one-third of normal. There might well be some sign of nerve root irritation on the
straight leg raising test. If there was a neurological deficit it would be minor in degree”.
• The 30% pension would reflect moderate to severe symptoms with “marked restriction of
mobility from either one-third [of normal] to complete restriction…there might well be a
positive straight leg raising test indicating evidence of nerve root irritation”.
• The percentage figure of 30% for a totally immobile lower (or upper) back is not a
maximum rating for the low back (although the panel in Decision 15/90 appeared to be
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unaware of this).42 Low back disabilities have been rated as high as 100%. The severity
of neurological deficit is a key consideration in the rating of back pensions above 30%.
The degree of severity of neurological deficit is measured through observation of the
following (the list is not necessarily exhaustive):
• degree of loss of strength in the legs;
• changes in reflexes;
• wasting of the musculature; and
• loss of sensation.
In Decision 758/96,43 the panel explored these additional factors in arriving at the conclusion
that the worker’s pension should be set at 70%.
It is clear from a number of Tribunal decisions which discuss 60% pensions for low back
impairment, that the common rating for a “failed surgical back” is 60%.44
Dr. Young has also advised that loss of sphincter control of bowel and bladder would justify
increasing a low back award above 30%.45 In 2000, the Board’s Associate Medical Director
advised that incontinence resulting from arachnoiditis/spinal fibrosis warranted a 100% award.46
If you are aiming for an extremely high rating, it is very useful to document back pension
awards as set out in Tribunal decisions. Since many of these decisions reproduce decisions
actually made by a Board doctor, they can be used effectively at lower levels of the adjudicative
process, not just at the Tribunal.
13-15 Permanent Disability Awards
1. The Workplace Safety and Insurance Act continues the pre-1998 Act with modifications,
and that Act continues the preceding Acts with modifications. The transitional provisions
in each Act specify this, specifically s.102 of the WSIA and ss.144-146 of the Workers'
2. Note that in the pre-1990 Act, disability refers to “the loss of earning capacity...that
results from an injury” (s.1(1)) and the term “impairment” is the equivalent of
“disability” under the pre-1990 and pre-1985 Acts.
3. For a fairly comprehensive discussion of the Board’s and the WCAT’s views on
pensions, see Decision 915 (1987), 7 WCATR 1 at 47-71.
4. Administrative delays are not uncommon. As well, ratings prior to MMR may also be
arranged in exceptional situations such as when the worker is leaving the country, is felt
to be 100% permanently disabled, or has refused corrective surgery. For the general
policy on pension ratings, see Operational Policy Manual, Document 18-07-01.
5. Operational Policy Manual, Document 11-01-05.
6. Operational Policy Manual, Document 16-01-03 (noise-induced hearing loss schedule);
Document 15-04-01 (traumatic hearing loss schedule); Document 16-01-07 (ratings for
tinnitus); Document 15-04-02 (psychological disability schedule also used for chronic
7. Supra, note 3, at 48-52.
8. Ibid, at 81.
9. Supra, note 5.
10. Operational Policy Manual, Document 14-05-03.
11. Save for the maximum amount payable for supplementary benefits under s.147(4) which
follows increases in payments made pursuant to the Old Age Security Act.
12. Section 151 of the post-1989 Act, RSO 1990, c.W-11.
13. Section 111 of the WSIA contains the transitional provisions which enacted these
14. Subsection 42(3) of the pre-1990 Act.
15. In Decision 1152/98 (1 September 1998), the panel reasoned that under the pre-1990 Act,
there was no provision for occasional review of pensions. Further, the Board's policy
which allows for the granting of provisional pensions would be rendered meaningless.
16. Subsection 45(11) of the pre-1990 Act.
17. Section 36 of the pre-1990 Act.
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18. Operational Policy Manual, Document 18-07-08.
19. Operational Policy Manual, Document 15-06-07.
20. Operational Policy Manual, Document 17-03-05.
21. (6 February 1992).
22. Operational Policy Manual, Document 15-04-04.
23. (1988), 9 WCATR 352.
24. (1989), 13 WCATR 73.
25. (1994), 29 WCATR 229.
26. (1991), 17 WCATR 38.
27. Decision 262/97I (29 April 1997) and Decision 784/94 (4 June 1997).
28. (1990), 16 WCATR 211.
29. Supra, note 21.
30. Decision 407/88 (1989), 12 WCATR 30.
31. (1990), 13 WCATR 89.
32. (10 November 1993).
33. The Board policy providing pensions for impotence was initially ruled contrary to the
requirements of the Act in Decision 785/88 (10 April 1989). However, this ruling has
since been reversed following a successful application to reconsider (Decision 785/88R
(1992) 21 WCATR 1). In any event, the initial ruling did not involve a question of the
appropriateness of the benchmark but a question of whether impotence results in any
impairment of earning capacity for the average worker.
34. Supra, note 3, at 74.
35. Operational Policy Manual, Document 18-07-02.
36. (1989), 10 WCATR 334.
37. Decision 427/90 (1991), 18 WCATR 196.
38. Decision 565/89 (1990), 16 WCATR 121. For a case dealing with a 50% loss of
functional use of the hand, see Decision 12/92 (13 August 1992).
39. Supra, note 3, at 76.
40. Decision 517/91 (30 January 1992) and supra, note 24.
41. Transcript of the hearing in Decision 915, supra, note 3, at 68-74.
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42. (1990), 13 WCATR 320.
43. (27 June 1997).
44. See, for example, Decision 920/90 (13 November 1991); Decision 750/91 (18 December
1991); Decision 928/94I (29 September 1995); Decision 38/95 (29 February 1996);
Decision 758/96, ibid; Decision 969/98 (20 October 1999); Decision 397/99 (17
45. See Decision 7/88 (15 November 1988).
46. See Decision 1666/03 (29 October 2003).
13-18 Permanent Disability Awards
Chapter 13: Appendices
13A-1 to 2 Letters to Board from worker and from representative requesting pension
13B-1 to 2 Note to doctor from worker explaining the need for an up-to-date medical report
Follow-up letter to Board from worker to ensure request for re-assessment is
13C-1 Letter to Board from representative requesting a pension re-assessment based on
recent medical reports on file
13D-1 to 2 Letter to doctor from representative requesting a medical report regarding wrist,
shoulder, and neck disabilities
13E-1 Examples of successful pension appeals at the WCAT
Letter to Board from worker
requesting pension assessment
Ms. Claims Adjudicator
Workplace Safety and Insurance Board
200 Front St. West
Dear Ms. Adjudicator:
Re: Name of injured worker - Claim number
I am currently receiving a 10% pension for my low back disability. I was last seen by a Board
doctor in 1994.
I feel my disability has become worse in recent years. [Consider mentioning specific
manifestations of deterioration if any are identified in the course of your interview with the
It has now been many years since I was last examined. I believe a new assessment should be
Would you please rule on this matter as soon as possible.
Appendix 13A-1 Permanent Disability Awards
Letter to Board from representative
requesting pension assessment
Mr. Claims Adjudicator
Workplace Safety and Insurance Board
200 Front St. West
Dear Mr. Claims Adjudicator:
Re: Name of injured worker - Claim number
Our office is representing Ms. X in the matter of her claim with the Board. An authorization to
that effect is enclosed.
Ms. X is currently receiving a 10% pension for her low back disability residual to her work
accident of 1988. I understand she was rated in 1993 and has not been examined since that time.
It is apparent from the description Ms. X gives of her symptoms that her overall condition has
deteriorated since the pension assessment of 1993. [You may want to give a description of
specific symptoms or restrictions in function based on your interview with the worker.]
In view of the length of time since the last assessment, a new examination at the Board would
seem to make sense.
Would you please make the necessary arrangements to have Ms. X referred for pension medical
examination as soon as possible.
Appendix 13A-2 Permanent Disability Awards
Note to doctor from worker
explaining the need for an
up-to-date medical report
Re: Name of injured worker - Claim number
Ms. X has attended at our office recently for information regarding the pension of 10% she is
currently receiving from the Workplace Safety and Insurance Board.
It appears that Ms. X’s condition may have deteriorated since she was last examined by a Board
medical advisor in 1989. If that is the case, an increase in her pension is warranted. The Board is
not likely to arrange a new pension medical assessment, however, unless they receive an up-to-
date medical report outlining her current symptoms and restrictions.
We have suggested she discuss this matter with you and that perhaps you could arrange a referral
to the appropriate specialist for an up-to-date report on her condition. A copy of the report
should be sent to the Board.
Thank you for your assistance.
[If you are in possession of the Board’s pension
examination report, you should share it with the
doctor and request that the specialist refer to it
when preparing an up-to-date report, noting
changes in the worker’s condition compared to
what is shown in the pension report.]
Appendix 13B-1 Permanent Disability Awards
Follow-up letter to Board from worker
to ensure request for re-assessment
is being considered
Mr. Claims Adjudicator
Workplace Safety and Insurance Board
200 Front Street West
Dear Mr. Adjudicator:
Re: Name of injured worker - Claim number
I am currently receiving a 10% pension for my back disability under the above claim.
I feel my condition has deteriorated and that I should be re-assessed by a Board medical
examiner. Please note that I was last assessed in 1989.
I believe you have received an up-to-date report of my condition from Dr. A.
Would you please make arrangements for a pension medical examination as soon as possible.
I look forward to hearing from you.
Appendix 13B-2 Permanent Disability Awards
Letter to Board from representative
requesting a pension re-assessment
based on recent medical reports on file
Ms. Claims Adjudicator
Workplace Safety and Insurance Board
200 Front Street West
Dear Ms. Claims Adjudicator:
Re: Name of injured worker - Claim number
Our office is representing Ms. X in the matter of her workers’ compensation claim. An
authorization is enclosed.
Ms. X was last seen for pension rating purposes on April 27, 1993. A review of the reports of
recent medical examinations which are on file indicates that her condition has deteriorated since
then. A new pension medical examination is, therefore, warranted.
Dr. T, orthopaedic surgeon, notes in his report of examination (dated March 12, 2002) that
movement was reduced to about 50% of normal with marked lumbosacral tenderness and some
muscle spasm. The pension medical examination report of 1993 indicated two-thirds of normal
range in spinal movements. Further, I note that Dr. T has now recommended that Ms. X wear a
In light of the changes noted by Dr. T in his most recent examination and of the length of time
elapsed since the pension rating was carried out, a pension re-assessment is undoubtedly in
Would you please make arrangements for a review of the pension as soon as possible.
Appendix 13C-1 Permanent Disability Awards
Letter to doctor from representative
requesting a medical report regarding
wrist, shoulder, and neck disabilities
Dear Dr._____ :
Re: Name of injured worker - Claim number
As you know, I am representing Mr. X, who has been followed by you for some time now. An
authorization to release medical information is enclosed.
I realize that you are familiar with the history and have a very complete file. I am enclosing,
however, a copy of memo 120, which is the report of the Board’s medical examination
conducted for pension purposes.
My overall concern is that Mr. X’s pensions are very low in light of the various medical and/or
psychological problems that have followed his February 3, 1988 work accident. The WSIB is
currently paying 10% for right forearm and wrist problems, 5% for the shoulder, and 5% for the
neck. Headaches have been accepted as within Mr. X’s entitlement but he is receiving nothing
from the Board for these. Mr. X has not been examined by the Board for pension purposes since
I have the following questions that I was hoping you could address in a report for me:
1. What is the comprehensive list of all organic problems related to the work accident? Are
there areas of difficulty that you have been aware of aside from right forearm and wrist,
shoulder and neck? Specific findings would be helpful.
2. How do your findings compare with those of the Board as reflected in Memo 120? A
pension re-assessment may be warranted if Mr. X appears to be in worse shape than he
was in 1991.
3. With respect to the right wrist and forearm disability, I would appreciate your opinion on
the following points:
• Would repeated use of the right hand cause Mr. X any difficulty?
• Is there any loss in grip strength or in the ability to sustain a grip?
• Given that Mr. X is right-handed, does the impairment have greater impact on his
ability to carry out daily activities than if it occurred in the left arm?
4. Are the headaches still a problem for Mr. X? Any comments you can offer on how they
would affect Mr. X in his daily activities would be appreciated.
5. Over and above organic disability, are there chronic pain and/or psychological features to
Mr. X’s disability? If yes, please elaborate.
Appendix 13D-1 Permanent Disability Awards
6. Is there any specific treatment or therapy that would be appropriate for Mr. X over and
Needless to say, do not feel that you must restrict information provided to the questions that I
Our office undertakes to promptly honour your account for the preparation of this report.
Thank you for your anticipated assistance.
Appendix 13D-2 Permanent Disability Awards
Examples of successful pension appeals at the Tribunal
On basis of:
Body part /
Aspect of clinical impairment unassessed /
Type of Decision
Disability not rated /
Different application of Schedule
Knee • Different application of Schedule: Standards applied by 68/90 (1990),
Board doctors for the rating of knee disabilities are inconsistent 16 WCATR 211
with the rating system as a whole. Pension increased by 4%.
• Disability not rated or recognized: Instability in knee
9 WCATR 352
Leg • Different application of Schedule: Serious leg (all areas) 407/88 (1989),
injury assessed by WCB at 50% by reference to benchmark in 12 WCATR 30
Rating Schedule for above knee amputation. Pension increased
to 70% on basis of medical evidence establishing impairment
greater than that associated with such amputation.
• Disability not recognized: Pension rated at 10% for leg injury
by comparing it to the Rating Schedule figure for loss of hip 427/90 (1991),
mobility. 18 WCATR 196
Wrist • Aspect of impairment unassessed: Ability to sustain grip and 532/89 (1991),
use hand for repetitive or sustained activity. 17 WCATR 38
Arm • Aspect of impairment unassessed: Partial loss of use of right 517/91
(Forearm) forearm; the WCAT awarded an additional 3% for this (30 January 1992)
• Aspect of impairment unassessed: Pain radiating into the 603/88 (1989),
(Upper arm) shoulder in lifting heavy objects or in doing repetitive 13 WCATR 73
Thumb • Aspect of impairment unassessed: Sensitivity to cold and 680/91
pressure and diminished flexibility and grip. Pension increased (6 November 1991)
from 5 to 7.5%.
Shoulder • Different application of Schedule: 15% rating found 688/91
inadequate; pension increased to 25% by the WCAT. (4 December 1991)
Tinnitus • Different application of Schedule: While 2% rating may be 876/88 (1990),
adequate for majority of tinnitus sufferers, worker's condition 13 WCATR 89
presented unusual circumstances which resulted in a higher
degree of impairment. Pension increased to 27%.
Skin Disorder • Different application of Schedule: 5% increased to 15% 885/91
(Psoriasis) using AMA Guides. (12 February 1992)
Appendix 13E-1 Permanent Disability Awards