Chronic Pain Update

We are committed to providing regular updates about our progress with chronic pain claims. Each month, we’ll provide updates here on the website and on our toll-free recorded phone message (1 866 365 4400). We appreciate your patience as we continue to work through chronic pain claims. Our goal is to complete this work as quickly as possible.

The Supreme Court of Canada ruled that workers with chronic pain must be individually assessed to determine if they are eligible to receive workers' compensation benefits for chronic pain.

Chronic Pain Milestones

     April 2004

The WCB set up a Transitional Services Team (TST) to learn about managing chronic pain files and established a process for review. The team has 22 people, including 12 case workers.

     July 2004

Chronic pain regulations were enacted by government.

     September 2004

WCB policies outlining how chronic pain claims will be assessed came into effect.

     September 2004

The WCB began reviewing chronic pain claims.

     April 2005

The WCB Announced a streamlined process for adjudicating chronic pain claims and began hiring 70 additional employees to review chronic pain and learn about preventing and managing chronic pain.

     June - July 2005

New employees are hired and training occurs.

Chronic Pain Review Timeline

Each injured worker having their claim reviewed has been placed within a group to help us advise when the claim will be reviewed. Groups are determined by accident date. The groups are 10E or individuals who received chronic pain benefits under section 10E of the Workers’ Compensation Act; pre-Hayden or injuries before 1990; and new Act or injuries after 1990.

We will be working across all groups at the same time. Within each group, the order is determined by appeal date or accident date. Appeals are being done starting with the oldest first. In order to be considered as a chronic pain appeal file, the appeal must have been filed with the Supreme Court of Canada, the Nova Scotia Court of Appeal, the Workers’ Compensation Appeals Tribunal or the WCB Internal Appeals Department before the Supreme Court’s decision on chronic pain.

For claims having no appeal, the claim will be processed by accident date, starting with the oldest first.

We are on track to complete chronic pain claims within specified timelines. All chronic pain claims are scheduled to be completed no later than the end of 2007.  Click here to download a document outlining the groups and timelines.

The WCB had committed to stakeholders to complete all decisions for workers receiving benefits under section 10E of the Workers’ Compensation Act by the end of 2005. As indicated in the table above, 99.4% of these claims are complete.  The remaining small number of claims could not be completed because there was not enough information on the workers’ files with regard to chronic pain to allow the WCB to make a decision.  The WCB contacted all of these workers in November and December and asked them to forward any information they have pertaining to their chronic pain.  To date several workers have responded to this request.  A review of their claims are in progress.

In the WCB's 2003 annual report we estimated it would cost about $168 million to provide workers on the chronic pain list with benefits. Once we have reviewed enough files, and have a better sense of the actual costs of decisions, we will review our original estimates and revise our projections accordingly. Revised projections appeared in our 2005 annual report.

Chronic Pain Review Process

Below is the process generally followed when reviewing claims:

• When your claim is received, it is assigned to a case worker.

• The case worker reviews all claims to determine if you meet the eligibility criteria:

• Had a compensable injury as a result of work;
• Has chronic pain as defined in the Workers’ Compensation Act;
• Has chronic pain caused by the original compensable injury;
• Has medical evidence showing chronic pain developed on or after April 17, 1985; and
• The evidence confirms you are eligible to receive benefits and services related to chronic pain.

• If you do not meet the criteria, the case worker will write a decision and notify you that you will not be reviewed for chronic pain benefits and services.

• If you do meet the eligibility criteria, the case worker will notify you and your employer that a claim review has begun. You will then be sent a Client Information Questionnaire to complete. If you are a recipient of 10E benefits, you will not be required to complete the questionnaire.

• If information is missing from your claim file, the case worker will contact you to obtain the required items, such as medical information, physiotherapy or other specialized reports, etc.

• The case worker then arranges for medical or health care assessments, if needed.

• The case worker sends a request to a WCB Medical Adviser for a pain-related impairment (PRI) assessment and a PRI rating is assigned.

• The case worker determines if the following are applicable to your claim:

• Impact to Clinical Rating Schedule (CRS) pension;
• Wage replacement;
• Reimbursement for medical aid.

• Finally, you are notified with a decision about your claim.

75% gross average weekly pre-injury earnings x total permanent impairment

(“Total permanent impairment” equals the 3% or 6% pain-related impairment plus any permanent medical impairment rate, if applicable.)

Workers injured after March 23, 1990 will receive benefits based on the Earnings Loss system:*

30% x 85% net average weekly pre-injury earnings x total permanent impairment

(“Total permanent impairment” equals the 3% or 6% pain-related impairment plus any permanent medical impairment rate, if applicable.)

*A worker injured after March 23, 1990 who is found to have a PRI may also be considered for an extended earnings-replacement benefit (EERB).