Lesson 3

Question 1

1.1 Explain who has jurisdiction over the EI program.

Answer 1

EI falls under federal jurisdiction and operates under the legislated authority of the
Employment Insurance Act (the “EI Act”).

Question 2

What body provides oversight to EI

Answer 2

The Canada Employment Insurance Commission (CEIC) is the body that provides much of the oversight of EI. Its
mandate is to annually monitor and assess the EI program,

Question 3

1.1 What body handles the delivery of EI

Answer 3

The actual delivery of the EI program is handled by Employment and Social Development Canada (ESDC), through Service Canada.

Question 4

1.2 Identify the responsibilities of WC Boards/Commissions. (7)

Answer 4

• responsible for their own jurisdiction for the administration of WC
• Collect contributions from ERs
• pay benefits to EEs
• decide level and nature of adequate compensation for all work related injuries
• determine eligibility for compensation and rehabilitation
• establish rules and regulations and appeals procedures
• exclusive jurisdiction to deal with all matters pertaining to injuries that arise out of or in the course of employment

Question 5

1.3 Describe how EI program is funded

Answer 5

Through ER and EE premiums

Question 6

What does CEIC stand for

Answer 6

The Canada Employment Insurance
Commission

Question 7

1.3 List three factors that affect the setting of premium rates for EI

Answer 7

(a) Assumptions of future demographic and economic conditions

(b) Current Premium rates, which are intended to be sufficient to cover expected EI benefit payouts

(c) The funded status of the EI Operating Account, since the objective for the EI Operating Account is to operate on a break-even basis.

Question 8

1.4 Explain how a WC assessment premium is generally calculated

Answer 8

Generally calculated as a rate per $100 of assessable earnings (the assessment rate)

Generally include most earnings types.

Question 9

Earnings from what kinds of work/income sources are included in assessable earnings for WC (7 in all jurisdictions and 5 from many jurisdictions)

Answer 9

In all jurisdictions:
- salary or wages
- overtime
-tips
-commission
-bonuses
-advances on future earnings
- vacation pay

For many jurisdictions this also includes:

• profit sharing
• paid layoff
  -maternity or sabbatical leave
• taxable benefits
• ER contributions to employee benefits

Question 10

1.5 Identify factors that influence WC assessment rates (4)

Answer 10

• recent accident cost experience in industry class
• financial position of the WC board commission
• prevailing economic and labout conditions
• current adjudication policies

Each WC board/commission has its own unique method of calculation the amount of premiums to be collected from employers to fund the program reflecting its own situation

Question 11

1.5 Identify 3 factors that employers actual assessment rates depend on

Answer 11

• The industry classification of the employer
• whether the WC Board/Commission applies experience rating to that employer
• The existence of any safety based program incentives in place in the jurisdiction

Question 12

1.6 Explain the impacts of industry classification

Answer 12

WC boards/commissiong have the power to group industries according to their hazard potential.

Jurisdictions use either NAICS or their own internal processes to classify employers and then combine individual industrial classifications into larger rate groups.

Rate groups typically include similar industries although unrelated ones can be included on the basis of risk

Question 13

What is NAICS

Answer 13

The North American Industry Classification System from stats Canada that is used by some WC boards/commissions as a framework for classifying employers. Other boards have their own internal methods.

Question 14

1.7 Describe experience rating as it applies to the WC system

Answer 14

The rate that an employer contributes is affected by the experienced claims.

Question 15

1.7 What is prospective experience rateing

Answer 15

considers an employers past experience relative to the rate group and the applies a discount or surcharge to future rates

Question 16

1.7 what is a retrospective experience rating system under WC

Answer 16

Assesses an employer based on expected experience and then at year end reconciles with actual experience and issues a refund or an invoice for the difference

Question 17

1.8 Explain the tax treatment of EE and ER contributions to EI and EI benefits paid

Answer 17

ER premiums contributions are deductible from taxable income.

EE premiums also give rise to a tax credit.

All EI benefits are subject to income tax

Question 18

1.9 Outline the tax treatment of WC benefits (3+1 exception)

Answer 18

WC benefits aren’t taxable, assignable, or attachable except in Quebec where up to 50% of the income replacement benefit may be garnished to pay alimony

Question 19

2.1 List 5 kinds of employment listed as insurable under the EI act

Answer 19

1) Employment in Canada under any written or implied contract where earnings are received from an employer

2) Employment in Canada as described in 1) by His Majesty in right of Canada

3) Service in the army or police

4) Employment included by regulations in the EI act

5) Employment in Canada of an individual as the sponsor or coordinator of an employment benefits project

Question 20

2.1 List 6 kinds of employment that may be included as insurable employment in addition to those specifically listed in the EI act

Answer 20

1) Employment outside or partly outside Canada that would be insurable employment if it were in Canada

2) The entire employment of a person who is engaged by one employer partly in insurable employment and partly in other employment

3) Employment that is not employment under a contract of service if it appears to CEIC that the terms and conditions of service and the nature of the work performed by persons employed in that employment are similar to the terms and conditions of service and the nature of the work performed by persons employed under a contract of service

4)Employment in Canada by Her Majesty in right of a province if the government of the province waives exclusion and agrees to insure all its employees engaged in that employment

5) Employment in Canada by the government of another country or political subdivision if that country consents

6) Employment in Canada by an international organization if the organization consents

Question 21

2.1 List 8 types of employment excluded by the EI act

Answer 21

1) Employment of a casual nature other than for the purpose of the employer’s trade or business

2) Employment of a person if such person controls more than 40% of the voting shares of a corporation

3) Employment in Canada by her majesty in right of a province

4) Employment in Canada under an exchange program if the employment is not remunerated by a Canadian employer

5) Employment in Canada by an international organization

6) employment that is an exchange of work or services

7) Employment excluded by regulations made under certain subsections of the EI Act

8) Employment if the ER and EE are not dealing with each other at arms length

Question 22

2.2 Outline 7 eligibility criteria that must be met to receive regular EI benefits

Answer 22

1) Their employment qualifies under the EI definition of insurable employment

2) They have lost their job through no fault of their own

3) They have paid EI premiums

4) They have been without work and pay for at least 7 days in the last 52 weeks or since the start of their last EI claim whichever is shorter

5) They have worked the required number of hours based on where they lived and the unemployment rate in their area

6) They are actively looking for work and keep a record of ERs contacted

7) They are ready willing and capable of working each day

Question 23

2.3 Describe how the amount of EI benefits is determined

Answer 23

The regular benefit is 55% of average insurable earnings although it may be up to 80% for low income families.

Question 24

2.3 Describe how the duration of the benefits period for EI is determined

Answer 24

Based on the number of hours worked under insurable employment and the unemployment rate in the area.

Duration ranges from 14 weeks to 45 weeks

Question 25

2.4 Describe how additional earnings received by an individual receiving ER benefits affect the amount of their EI benefits

Answer 25

While collecting regular, parental, maternity, sickness, compassionate care or caregiving benefits, claimants can keep 50¢ of benefits for every dollar earned, up to
90% of the claimant’s previous weekly earnings (roughly 4.5 days of work).

Earnings above this threshold are deducted from EI benefits, dollar for dollar.

Question 26

2.4 What are they two kinds of earnings usually made while a claimant is receiving EI

Answer 26

money received from an employer when a claimant leaves their job (called “separation payments”)

money earned while collecting benefits from such sources as return-to-work and callback pay; self-employment earnings; money received as payment for wrongful dismissal and income from an employment pension, military or police pension; or a Canada Pension Plan/Québec Pension Plan
(CPP/QPP) pension

Question 27

2.5 Outline circumstances under which an individual must repay EI benefits and the maximum clawback amount

Answer 27

An individual whose annual net income for the taxation year (including EI benefits) exceeds 1.25 times the maximum yearly insurable earnings must repay some or all EI benefits received. The clawback amount is the lesser of either 30% of the EI benefits received or 30% of the amount of net income exceeding 1.25 times the maximum yearly insurable earnings

Question 28

2.5 What two things does EI benefit repayment not apply to

Answer 28

1) Special benefits

2) Regular benefits paid to individuals who received less than one week of regular benefits in the previous ten years.

Question 29

3.1 Describe the special benefits provided through the EI program and QPIP (5)

Answer 29

1) sickness
2) maternity
3) parental leave
4) compassionate care
5) caregiving leave

Quebec residents are not eligible for maternity or parental leave due to the existence of QPIP

Question 30

3.1 What are the eligibility requirements for special benefits from EI (1 general)

Answer 30

• a major attachment to the workforce meaning 600 insurable hours in the qualifying period
• self employed individuals may register for EI benefits

Question 31

3.1 Describe QPIP benefits

Answer 31

Quebec parental, adoption, maternity, paternity or parental leave

Question 32

3.1 What are the 6 requirements for eligibility for QPIP

Answer 32

1) Be a parent of a child (born or adopted)

2) Have contributed to the plan as an EE or self employed worker

3) Have experienced an interruption in earnings due to birth or adoption

4) Have insurable earnings of at least $2000 during the reference period

5) Be a resident of Quebec at the start of the reference period

6) In the case of a self-employed worker, have resided in Québec on December 31 of the year prior to the start of the benefit period.

Question 33

3.2 Outline the duration period for EI & QPIP maternity benefits

Answer 33

EI payable for a maximum of 15 weeks

QPIP for a maximum of 18 weeks and paternity is payable for 5 weeks
.

Question 34

3.2 Outline the duration period for EI (2) and QPIP (2) parental benefits (max Total & max to one for EI)

Answer 34

Standard EI parental benefits are 40 weeks but have a maximum of 35 weeks for one parent

Extended EI is over 69 weeks but one parent can’t receive more than 61 weeks

QPIP is payable for 32 weeks and adoption benefits are payable for a maximum of 37 weeks

Question 35

3.2 Outline the duration period for EI sickness benefits

Answer 35

15 weeks

Question 36

3.2 Outline the duration period for EI compassionate care benefits

Answer 36

26 weeks

Question 37

3.2 Outline the duration period for EI caregiving benefits

Answer 37

35 weeks for a child 15 weeks if caring for an adult

Question 38

4.1 Explain the premise behind EI-approved wage loss replacement plans

Answer 38

EI is the second payer after STD or illness/injury plans

Question 39

What ER sponsored plans that provide coverage for an illness or injury under EI qualify the sponsor for a reduction in EI premiums

Answer 39

Weekly indemnity and cumulative sick leave plans

Question 40

4.1 What are the criteria for approval for EI approved ER sponsored plans that provide coverage for an illness or injury under EI qualify the sponsor for a reduction in EI premiums (7)

Answer 40

1) coverage must start no more that 3 months of employment or if on hourbank 400 hours

2) Coverage must be on a 24 hour basis

3) He waiting period for payment of benefits may not exceed 7 days

4) The plan must be the first payer

5) Benefits must be at least equal to EI

6) Full benefits for new disabilities must be reinstated no later than one month after the employee returns to work

7) Employers must share the EI premium reduction with employees

Question 41

4.2 A wage indemnity can contain limits to the payment of benefits that will not prevent the ER qualifying for an EI premium reduction. Identify 17 scenarios where it is acceptable that benefits aren’t payable to EEs

Answer 41

1) EE not under physician care

2) covered under WC or CPP/QPP

3) Intentional self infliction

4) Result of injury from armed forces

5) results from war or a riot

6) occurs while on vacation of paid leave

7) EE is on EI special benefits

8) occurred while committing a criminal offence

9) engaging in work for wages while receiving disability

10) during strike or lockout

11) EE is in prison

12) EE is outside canada

13) resulted from drug or alcohol use and the person isn’t getting treatment for their continued use

14) resulted from motor accident and getting insurance benefits

15) EE is getting a retirement pension from the same ER

16) EE undergoes cosmetic plastic surgery without prior illness or injury necessitating

17) EE receives benefits for recurring injury under LTD

Question 42

4.3 Describe cumulative sick leave plans and provisions.

Answer 42

Provide coverage based on sick leave credits accumulated by the member.

May also provide maternity, parental, compassionate or caregiving benefits

Question 43

4.3 Describe cumulative sick leave plans (2)
and provisions that qualify for a EI reduction (2)

Answer 43

Provide coverage based on sick leave credits accumulated by the member.

May also provide maternity, parental, compassionate or caregiving benefits

Must also meet the same 6 criteria as WI plans

At least one day sick leave must be credited for each month worked

Question 44

4.3 Describe additional requirements for cumulative sick leave plans and provisions that qualify for a EI reduction 4 points

Answer 44

1) Period of sick leave credit may be prorated in relation to the total period of employment

2) Eligibility to use sick leave may be deferred due to temporary employment or probationary period for up to 12 months

3) There may be a cap on unused sick days but it may not be less than 75

4) the number of sick days must be at least 75 unless a shorter period applies as a result of the person’s termination or retirement or recovery.

Notice of termination must have been given prior to the injury or illness

Question 45

4.4 Under the EI act a fraction of premium reductions must be passed on to EEs. Explain the premise and the fraction

Answer 45

5/12

The intention is to maintain the same ratio of EE to ER cost as EI premiums normally have

Question 46

4.5 What is the Supplemental Unemployment Benefit (SUB) in EI

Answer 46

The SUB plan supplements EI benefits during temporary periods of unemployment without affecting the EEs level of EI benefits

May be due to a work stoppage, illness, training, injury, or quarantine

Question 47

4.5 What advantages are there to registering a SUB plan with service canada (2)

Answer 47

EE’s weekly earnings during periods of unemployment can be increased without resulting in a deduction from EI benefits

Payments from a registered SUB Plan aren’t considered insurable earnings for EI purposes

Question 48

5.1 What are the 5 key principles of the WC System from the Meredith Report?

Answer 48

1) No fault compensation

2) Collective liability

3) Security of benefits

4) exclusive jurisdiction (over work injury insurance)

5) Independent administration (separate from gov’t)

Question 49

5.1 What are the 5 key principles of the WC System reflected in the design of the system?

Answer 49

1) immunity from lawsuits

2) Fair compensation and fair premiums

3) Benefit of the doubt to the worker - all else being equal decisions are in favour of the worker

4) Comprehensive injury prevention and disability management

5) Long term stability, financial security and cost effectiveness is built into the system

Question 50

5.2 Explain how the term “quid pro quo” applies to the WC system?

Answer 50

Employers accepted collective liability and were no longer individually liable.

In exchange

Employees gave up the right to sue the employer and accepted compensation as provided for in the legislation through a system fully funded by ERs

Question 51

5.3 Describe participation requirements for ERs in the WC system (1 req and 2 points)

Answer 51

• compulsory for many ERs in particular industries
• list of exempt industries and occupations varies by jurisdiction
• Some jurisdictions also require a minimum number of EEs for participation

Question 52

5.3 Describe self-insured ERs under the WC system (4)

Answer 52

A WC board/commission may designate some ERs to be self insured

Generally these are federal/provincial governments and public agencies or crown corporations. Also included are large public interprovincial transportation organizations

WC Boards/commissions generally administer claims for self insured organizations and the ERs reimburse them monthly.

ERs may also be asked to maintain a deposit with the Board/commission to cover costs & expenses/

Question 53

6.1 List 4 types of injuries covered by WC

Answer 53

1) Traumatic injuries that happen suddenly

2) Injuries caused by repeated activities including strains, sprains caused by repeated actions (tendonitis caused by word processing duties)

3) Occupational diseases caused by workplace conditions (respiratory problems from chemical exposure)

4) Reinjury and difficulties with an old work related injury

Question 54

6.2 Identify types of benefits provided by WC jurisdictions (4)

Answer 54

• temporary and permanent disability
• rehabilitation benefits
• fatal and dependent benefits
• medical aid/health care related benefits

Question 55

6.3 Describe the two definitions of earnings used by WC Boards/Commissions in the calculation of wage loss benefits.

Answer 55

Either as a percentage of:
1) net eligible earnings or;
2) Gross eligible earnings

Generally earnings are over the last 12 months

Most jurisdictions use net earnings.

Question 56

6.4 Outline eligibility requirements for temporary disability benefits under WC 1 description)

Answer 56

Generally when there is medical evidence that the work related injury has resulted in temporary work restrictions that prevent the EE from resuming pre-accident employment or other suitable employment

Question 56

6.4 Outline eligibility requirements for temporary disability benefits under WC

Answer 56

Generally when there is medical evidence that the work related injury has resulted in temporary work restrictions that prevent the EE from resuming pre-accident employment or other suitable employment

Question 57

6.5 Define Concurrent condition

Answer 57

A concurrent condition is a non-compensable condition that exists at the same time as a compensable condition.

Includes underlying conditions like cancer and diabetes which will affect healing times. Pregnancy may also be in this category

Question 58

6.4 Outline eligibility requirements for partially temporary disability benefits under WC

Answer 58

Partial disability usually means that there is medical evidence indicating they have compensable temporary work restrictions but can return to a modified version of their job or another suitable job

Question 59

6.6 What are the two types of permanent disability benefits in WC

Answer 59

1) economic loss awards - loss of earnings capacity

2) non economic loss awards (loss of enjoyment in life due to disability) - usually a one time lump sum award

Question 60

6.7 Outline types of fatality and dependent benefits provided by WC (4 points)

Answer 60

Can include immediate lump sum benefits, monthly benefits, funeral costs.

The spouse receives a monthly benefit based on the spouses age and the deceased person’s earnings and DOD

In most jurisdictions the spouse also receives a lump sum payment

Dependent children get monthly benefits until age 18 or later if they are in school. This benefit varies significantly by jurisdiction

Question 61

7.1 Describe how the WC board/commissions asses whether an injured worker can return to work

Answer 61

EE’s doctor provides progress reports to the case manager.

The reports are used to facilitate return to work when appropriate.

The WC board works with employers to determine if there are other jobs the EE can do while recovering on a short term basis or for a few hours at a time.

Question 62

What questions may be included in a IME (4)

Answer 62

an Independent Medical Examination may include

1) Is the injury temporary or permanent

2) Is there a permanent disability from the injury/illness

3) Can the EE return to the same kind of work

4) is there anything else that should be done to confirm diagnosis or further treatment to explore

An IME may occur at any point in the EEs recovery