Highlights of Noteworthy Decisions

Decision 2092 19
02/12/2019
L. Petrykowski
  • Board Directives and Guidelines (experience rating) (NEER)
  • Experience rating (NEER)
  • Transfer of costs (NEER)

A 67-year-old worker suffered a shoulder injury in April 2016. The Board granted LOE benefits for periods in 2016. He received some health care benefits in 2017. The Board granted a 20% NEL award for permanent impairment in 2017. The worker retired in 2017. The employer appealed a decision of the Appeals Resolution Officer denying the employer's request to remove future claim costs from the worker's claim for the purposes of the employer's NEER experience rating record.

The employer submitted that there was no future LOE entitlement under the claim, as recurrence would not affect the claim because the worker had retired and had achieved MMR, and the worker would not be receiving any LMR, thereby removing any future training component from the projection of future costs.
According to Board Operational Policy Manual, Document No. 13-02-02, on NEER, the Board bases NEER calculations on lifetime costs of each claim, broken down into three parts: actual benefits up to the date of calculation; projected future costs for the lifetime of the claim; and overhead.
The Vice-Chair reviewed a detailed explanation of the NEER program provided by the Board's Experience Rating Advisor. The value of projected future costs is based upon: the type of benefits paid; the duration of lost time benefits; claim activity; and maturity of the claim. Once a claim incurs loss of earnings for one week or more, there will always be a calculation of projected further cost.
The Experience Rating Advisor also explained how the worker's claim in this case was processed for the purposes of the NEER program. Loss of earnings benefits were paid for more than one week in 2016. The claim was considered inactive in 2017, as only health care benefits were paid.
The Vice-Chair found that the Board correctly calculated the costs of the worker's claim for NEER purposes. This was consistent with the applicable Board policy. There was no basis for an exception from the application of projected future claim costs under the NEER program.
The employer submitted that the worker can no longer be entitled to additional benefits. However, the Vice-Chair agreed with the ARO that circumstances associated with a potential significant deterioration or recurrence can lead to additional claim benefits being provided to the worker in the future. Further, regarding the employer's concern about age, MMR, LMR participation and retirement, none of those are valid factors that warrant an exception to the policy.
The employer was not entitled to removal of future costs of the claim. The appeal was dismissed.