Chronic Pain and Pain-Related Impairment

What chronic pain means here

Chronic pain has a specific meaning in workers’ compensation. Under the Chronic Pain Regulations, chronic pain is pain that either keeps going past the normal recovery time for the injury or is more severe than what the injury would typically cause. However, pain that fits what the injury or medical findings would explain is not considered chronic pain for the purposes of WCB.  The typical pain that is explained by medical findings is considered under Permanent Medical Impairment.  

Chronic pain and permanent medical impairment (PMI) — what’s the difference?

Both are about lasting effects of a workplace injury, but they measure different things and follow different rules.

• A permanent medical impairment (PMI) is a measurable, lasting loss of function from a workplace injury — things like reduced range of motion, loss of strength, loss of sensation, or loss of ability to manage daily activities. The usual pain typical of an injury is reflected in a PMI rating using the American Medical Association (AMA) Guides.
• A pain-related impairment (PRI) recognizes the impact of chronic pain on a worker’s daily life when that pain goes beyond what the medical findings could explain on their own. PRI is assessed in a specific way described below.

A worker can have a PMI, a PRI, both, or neither, depending on their injury and how it has affected them. A worker who experiences pain every day may not necessarily qualify for PRI — qualifying depends on whether the chronic pain criteria are met.

How a pain-related impairment is assessed

PRI is assessed only after a worker has reached maximum medical recovery — the point where further improvement isn’t expected.    

WCB uses the PRI Assessment Tool, a structured assessment that looks at several areas such as:

• Activities of daily living — things like dressing, bathing, preparing food, and getting around.
• Social functioning — how well the worker interacts with family, friends, and the community.
• Concentration — the ability to focus on tasks and follow through.
• Adaptation — how well the worker copes with stressful or unfamiliar situations.  

Based on how the worker’s daily life is affected across these areas, the assessment results in a PRI rating or a determination that the criteria for PRI is not met.

PRI ratings

There are two possible PRI ratings :

• 3% — when chronic pain is having a real impact on daily life, but functioning is generally maintained in most areas.
• 6% — when chronic pain is causing a more substantial impact on daily functioning across multiple areas.

6% is the highest pain-related impairment rating available for chronic pain across all injuries combined. This means a worker’s total PRI rating cannot exceed 6%, no matter how many workplace injuries they have. If a worker already has a PRI rating, that affects what’s available on later claims.

When PRI does not apply

Not every claim that involves pain results in a pain-related impairment. PRI applies only when specific criteria in the Chronic Pain Regulations are met. PRI does not apply when:

• The worker has not yet reached maximum medical recovery. PRI assessment happens after recovery has reached its natural end point, when nothing more is expected to change.
• The pain is explained by the injury or medical findings. Pain that fits what the injury would account for is already considered in any PMI rating — it isn’t separately rated as PRI.
• The chronic pain criteria are not met. Chronic pain has a specific definition under the Regulations. If the criteria aren’t met, PRI assessment does not apply to the claim.

When PRI does not apply, this does not mean WCB doesn’t recognize that pain is real, or that the injury isn’t important. It means the situation doesn’t meet what the law and policy require for a PRI rating.

Reassessment of PRI

A PRI rating can be reassessed if a worker’s situation changes after their initial assessment. A reassessment can result in a higher or lower rating, or no rating at all, depending on how things have changed.

Reassessments are typically considered at least 16 months after the most recent assessment and require updated medical reports with something called objective medical evidence about how chronic pain is now affecting the worker’s daily life.  This means the doctor's report should include things they observed or tested during an exam, like changes in movement, strength, or ability to do daily tasks.

If a worker is unsure whether reassessment makes sense for their situation, they can talk to their case worker. 

Common questions about chronic pain and PRI

I’m in pain every day. Why didn’t I get a PRI rating?

PRI assessment does not depend on how often pain occurs or how much it hurts on any given day. It’s arranged only when the chronic pain criteria in the Regulations are met. Some workers experience daily pain that is fully explained by their injury — in that case, the pain is already considered in the PMI rating and a PRI assessment would not take place.  

Why is the PRI cap only 6%?

The 6% cap is set out in the Chronic Pain Regulations and WCB Policy. It reflects the way the system rates pain-related impairment as a recognized type of permanent impairment — with its own assessment process and available ratings. The cap applies to the worker, not per claim.

Does PRI affect my benefits?

Yes — a PRI rating is included when WCB calculates a worker’s Permanent Impairment Benefit (PIB). Learn more about how PIB is calculated and paid.

Can I appeal a PRI decision?

Yes. Any decision about a PRI rating can be appealed within 90 days of receiving a written decision.  

Workers can find out more about appeals here.  

Employers can find out more about appeals here.