Policy 2.1.5R2 - Clothing Allowance

Effective Date: See “Application”, page 2
Date Issued: July 6, 1998
Date Approved by Board of Directors: June 12, 1998
Topic: Clothing Allowance
Section: Health Care
Subsection: Workers' Expenses

Policy Statement

1. Provided the conditions to entitlement set out in sections 2 and 5 of this policy are met, a worker is entitled to a clothing allowance in the following circumstances:

a) as the result of a work related injury:

(i) the worker has been prescribed by a medical specialist a prosthetic device for an amputation at or above the wrist or at or above the ankle; or

(ii) the worker has been prescribed by a medical specialist a back brace, which is defined as a device which has a rigid frame or is made from rigid material (e.g. thick plastic) for supporting the back but does not include soft belts or corsets lacking a rigid frame or components of rigid materials; or

(iii) The worker has been prescribed by a medical specialist a major joint brace which is defined as a device which has a rigid frame or is made from rigid material (e.g. thick plastic, rigid polymers, metal or leather) for supporting a major joint but does not include soft belts or sleeves lacking a rigid frame or components of rigid materials; or

(iv) The worker uses a wheelchair; and

(b) the use of the prosthetic device, back brace, major joint brace or wheelchair is causing excessive or premature wear to the worker's clothing.

Note: A 'Schedule of Orthotic and Prosthetic Devices Eligible for Clothing Allowance' is attached.

2. (i) Generally, as a condition to entitlement, it must be determined that, in the opinion of the Board, the worker has or is likely to have a permanent medical impairment as a result of a work related injury.

(ii) However, in some cases, the Board may determine that a worker should be provided with an orthotic or prosthetic device, of the type described in the Schedule to this policy (a "prescribed device") for short term use even though the worker does not and is not likely to have a permanent medical impairment as a result of a work related injury. In such cases, and provided the worker satisfies the other conditions of entitlement set out herein, the worker is entitled to the payment of a clothing allowance, in the annual amount determined in accordance with this policy, on a one-time basis. An application by any such worker for the payment of a clothing allowance in subsequent years will be considered upon receipt of a completed Clothing Allowance Declaration Form and of medical evidence acceptable to the Board substantiating the need to wear the prescribed device for a period longer than one year as a result of a work related injury.

3. A worker is entitled to a clothing allowance in the amounts as outlined in the following table:

Annual Clothing Allowance By Condition

Prosthetic
Device Back
Brace Uses a
Wheelchair Major
Joint
Brace

Upper
Body $350.00 $350.00 NA $350.00

Lower
Body $400.00 NA NA $400.00

Both $750.00 NA $750.00 $750.00

NA = Not Applicable

Note: The amounts in the table are additive within columns but not between columns within the same row. If the worker is eligible for more than one benefit, the worker will receive the higher of the benefit amounts to a maximum of $750.00 per year.

4. The annual clothing allowance will be effective on July 1st of every year. Awards made during the year will be prorated on a monthly basis.

5. The worker is required to complete the "Clothing Allowance Declaration" form (see copy attached).

Application

This Policy replaces Policy 2.1.5R issued on May 2, 1997. With the exception of subsection 2 (ii), this Policy is effective April 3, 1997 and is applicable to clothing allowances effective July 1, 1997 and thereafter (i.e. the Policy takes effect beginning with the 1997/98 clothing allowance ‘benefit year,’ which runs from July 1, 1997-June 30, 1998). Subsection 2(ii) applies to all workers for whom the Board approves a prescribed device on or after June 12, 1998 and to all workers who were, on that date, continuing, as the result of a work related injury, to wear a prescribed device which was previously approved by the Board.

References

Workers' Compensation Act (Chapter 10, Acts of 1994 - 95), Section 102.

Schedule of Prosthetic and Orthotic Devices Eligible for Clothing Allowance

The following are the prosthetic and orthotic devices that when worn give rise to eligibility for the Clothing Allowance under Policy 2.1.5:

1. Any prosthesis that a client has as a result of a compensable injury in accordance with Policy 2.1.5

2. Any wheelchair that a client uses as a result of a compensable injury in accordance with Policy 2.1.5

3. With respect to Back Braces, a Harris type brace (rigid frame) or one of the following braces are considered eligible for the clothing allowance:

- EIM Lumbar Stabilizer
- Model P-160: Custom Plastic Body Jacket with Anterior Thoracic Extension (TLSO)
- Model P-165: Custom Plastic Body Jacket with Anterior Thoracic Extension and Cervical Orthosis (CTLSO)
- Model P-150: Custom Plastic Body Jacket (LSO or TLSO)
- Model L-25: Hyperextension TLSO with Swivel Sternal pad
- Model 107: Norton Brown LSO
- Model B-52: TLSO
- Model L-30: Hyperextension TLSO with Deltopectoral Pads and Pelvic Bar
- Model L-31: Adjustable Flexion Orthosis (LSO)

or similar type brace that is custom made, or any other back brace that the Workers Compensation Board deems appropriate for the purpose of Policy 2.1.5.

4. With respect to knee braces, braces that are custom made or one of the following knee braces are considered eligible for a clothing allowance (manufacturer's name is in parentheses):

- Ottawa Knee Stabilizing Orthosis
- Double Graphite Knee Orthosis (Karl Hagar Limb & Brace Ltd.)
- MVP Knee Brace (Innovation Sports)
- Orthotic Controller (Orthotec)
- C.Ti.2 Custom Functional Brace (Innovation Sports)
- Donjoy ACL Brace (Donjoy)
- Donjoy PCL Brace (Donjoy)
- Donjoy Gold Point (Donjoy)
- Poli Axial GII (Generation Orthotics)
- Lennox Hill Brace (Lennox Hill Inc.)
- Townsend Knee Brace (Townsend)
- Talon Knee Brace (Sutter Corp.)

or permanent leg brace, or any other knee brace that the Workers Compensation Board deems appropriate for the purpose of Policy 2.1.5.

5. Any other prosthetic, orthotic or assistive device, not in this schedule, that the Workers Compensation Board deems appropriate for the purpose of Policy 2.1.5.

Clothing Allowance Declaration Form

I,________________________ wish to receive the Clothing Allowance in relation to my injury as detailed under the claim number specified above as I am currently in possession and use of:

1) Major Braces: _____ Back _____ Leg _____ Shoulder _____ Other

2) Wheelchair: _____

3) Artificial Limb: _____ Upper Body _____ Lower Body _____ Both

4) Other: ______________________________

DECLARATION:
I hereby declare that I use my Prosthetic/Orthotic device or wheelchair regularly resulting in excessive/premature wear to my clothing. I am fully aware that giving false information on this Application and Declaration may result in the discontinuation of my Clothing Allowance.
Note: The giving of false information may result in the discontinuation of benefits and is considered an offence under the Workers' Compensation Act.

____________________            ____________          _________________
             Signature                                Date                                      Phone

For Office Use Only:

PMI:       _____ Yes       _____ No
Type of Brace ____________________       Purchase Date: _____________
Effective Date of Clothing Allowance: ______________________________

__________________                                        ______________________
                 Signature                                                                          Date

Definitions:

Back Brace:
A device which has a rigid frame or is made from rigid material, e.g. thick plastic, for supporting the back.

Prosthetic Device:
An artificial device designed to replace a missing part of the body.

Orthotic Device:
An artificial device applied externally to modify structural and functional charicteristics of the body.

Major Joint Brace:
A major joint brace is defined as a device which has a rigid frame or, is made from rigid material, e.g. thick plastic, rigid polymers, metal or leather for supporting a major joint.
Note: This does not include soft belts or sleeves lacking a rigid frame or components of rigid materials.