NEL redetermination expedited after year-long delay to assess medical information

A worker contacted the Commission in June 2019 to complain that her request for a redetermination of her non-economic loss (NEL) award was not moving forward.

She made the request in early 2018 and a case manager responded with correspondence that outlined the medical information required to consider a redetermination of the worker’s NEL award.

According to the claim file, the worker’s doctor had submitted a report in June 2018 with the requested information. The worker asked the case manager for a status update in October 2018, only to be told that updated medical information was required again. She complained to a manager, who echoed that updated medical information was required. However, it was unclear to the Commission why the NEL redetermination hadn’t proceeded based on the doctor’s report submitted in June 2018.

The Commission spoke to a manager who said the updated information previously sent by the doctor was not useful because it did not include information on the worker’s range of motion. The Commission pointed out that some range-of-motion information was in fact included in the report. In response, the manager agreed to have the case manager review the report and determine if the file could be referred to the NEL Department.

Soon thereafter, the claim was referred to the NEL Department. The Commission followed up with the WSIB and asked if they had considered expediting the NEL review, given the year-long delay in taking action on the medical information. The manager agreed to reach out to the NEL Department to see if the file could be reviewed on a priority basis. Two weeks later, the NEL rating was completed, resulting in a 5% increase and a payment of just over $2,500 to the worker.