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Employment Insurance Regulations (SOR/96-332)

Regulations are current to 2019-08-28 and last amended on 2019-03-17. Previous Versions

PART IIIReduction of Premium for Employers with Wage-Loss Plans (continued)

Standards

 A Weekly Indemnity Plan shall meet the following requirements:

  • (a) an insured person who is employed by an employer and covered by the plan becomes eligible to claim benefits under the plan in respect of an illness or injury on or before the first day of the month following

    • (i) the last day of a period of not more than three months of continuous employment beginning on the day of commencement of the employment, or

    • (ii) if the plan is based on an hour-bank principle, the day on which the person has an accumulation of not more than 400 hours of active employment;

  • (b) if an insured person is required to serve an elimination period during which no benefit is payable under the plan, that period

    • (i) does not exceed seven consecutive days beginning with the first day of the period of incapacity due to illness or injury, or

    • (ii) does not exceed 14 consecutive days beginning with the first day of the period of incapacity due to illness or injury if, before the day on which section 208 of the Budget Implementation Act, 2016, No. 1 comes into force, the plan provides for an elimination period that exceeds seven consecutive days and the employer benefits under subsection 62(1) from a reduction of the employer’s premium rate in respect of that plan;

  • (c) benefits are paid in full under the plan regardless of

    • (i) the amount of the benefits that are payable to an insured person under the Act, and

    • (ii) the amount of the benefits, payable from any other source, that do not constitute earnings under section 35;

  • (d) the benefits payable to an insured person under the plan are equivalent to an amount that is equal to or greater than 55% of the insured person's normal weekly insurable earnings;

  • (e) subject to the elimination period referred to in paragraph (b), full benefits payable to an insured person under the plan are reinstated

    • (i) in the case of the recurrence of an illness or injury, after three months of active employment following their most recent absence due to that illness or injury or, where the plan is based on an hour-bank principle, after the accumulation of the first 400 hours of active employment by that person following their most recent absence due to that illness or injury, and

    • (ii) in the case of a new illness or injury, after one month of active employment following their most recent absence due to another illness or injury or, where the plan is based on an hour-bank principle, after the accumulation of the first 150 hours of active employment by that person following their most recent absence due to another illness or injury;

  • (f) in any case not referred to in paragraph (e) and subject to the elimination period referred to in paragraph (b), benefits are payable under the plan in respect of an illness or injury until the earliest of

    • (i) the end of a period of at least 15 weeks during which the benefits are paid,

    • (ii) the end of the period of incapacity due to the illness or injury,

    • (iii) the date the insured person retires, and

    • (iv) the date of the insured person's separation from employment for any reason other than illness or injury, where notice of the separation was given before the onset of the illness or the occurrence of the injury; and

  • (g) the only conditions precluding the payment of benefits under the plan to an insured person to whom they would be otherwise payable are conditions that preclude payment to an insured person

    • (i) who is not under the care of a licensed physician,

    • (ii) whose illness or injury is covered by federal or provincial laws respecting workers' compensation, the Canada Pension Plan or An Act respecting the Québec Pension Plan, where amounts paid under those laws or Acts constitute earnings under section 35,

    • (iii) whose illness or injury is intentionally self-inflicted,

    • (iv) whose illness or injury results from service in the armed forces,

    • (v) whose illness or injury results from war or participation in a riot or in a disturbance of the public order,

    • (vi) who becomes ill or is injured during a leave of absence or a period of paid vacation,

    • (vii) who is in receipt of benefits under section 22, 23, 23.1, 23.2 or 23.3 of the Act,

    • (viii) whose illness or injury is sustained while committing a criminal offence,

    • (ix) who is engaged in employment for a wage or profit during any period for which the person claims benefits under the plan,

    • (x) who becomes ill or is injured after having lost employment by reason of a stoppage of work attributable to a labour dispute at the place where the person was employed, if the person's right to benefits under the plan is reinstated on their return to active employment,

    • (xi) who is an inmate of a prison or similar institution,

    • (xii) who is not entitled to benefits payable under the Act because the person is not in Canada,

    • (xiii) whose illness results from the use of drugs or alcohol and who is not receiving continuing treatment for the use of drugs or alcohol,

    • (xiv) whose illness or injury, resulting from a motor vehicle accident, is covered by a provincial plan described in paragraph 35(2)(d),

    • (xv) who is receiving a retirement pension from the employer,

    • (xvi) who is absent from work because of plastic surgery performed solely for cosmetic purposes, except where the need for surgery is attributable to an illness or injury, or

    • (xvii) who, in the case of a recurring disability, is receiving benefits under a group long-term disability plan that contains a reinstatement provision, where the reinstatement period under that plan does not exceed six months.

  • SOR/2003-393, s. 11
  • SOR/2013-102, s. 15
  • SOR/2016-314, s. 5
  • SOR/2017-226, s. 13

 A Special Weekly Indemnity Plan shall meet the following requirements:

  • (a) the plan must be provided or financed, in whole or in part, by an employer that is Her Majesty in right of a province, a provincial Crown corporation, a municipal authority or a public authority of a province or an institution primarily controlled, supported or financed by a province;

  • (b) the plan must satisfy all the requirements of section 63, except the requirements of paragraphs 63(e) and (f);

  • (c) subject to the elimination period referred to in paragraph 63(b), full benefits payable under the plan to an insured person are reinstated after one month of active employment following their most recent absence due to illness or injury; and

  • (d) in any case not referred to in paragraph (c) and subject to the elimination period referred to in paragraph 63(b), benefits under the plan are payable with respect to the insured person's illness or injury until the earliest of

    • (i) the end of a period of at least 52 weeks during which the benefits are paid,

    • (ii) the end of the period of incapacity due to the illness or injury,

    • (iii) the date the insured person retires, and

    • (iv) the date of the insured person's separation from employment resulting from any reason other than illness or injury, where notice of the separation was given before the onset of the illness or the occurrence of the injury.

 A Cumulative Paid Sick Leave Plan shall meet the following requirements:

  • (a) the plan must satisfy all the requirements of section 63, except the requirements of paragraphs 63(e) and (f);

  • (b) the plan must credit an insured person covered by the plan, after the completion of the period referred to in subparagraph 63(a)(i) or after the accumulation of the number of hours referred to in subparagraph 63(a)(ii), with one or more days of paid sick leave for each subsequent full month of active employment, of which at least one day per month is available only for the insured person’s illness or injury, while the insured person remains at home because of pregnancy or to care for a child or children referred to in subsection 23(1) of the Act or while the insured person is providing care or support to a family member referred to in subsection 23.1(2) of the Act, to a critically ill child or to a critically ill adult;

  • (c) notwithstanding paragraph (b), the plan may

    • (i) allow the paid sick leave credit referred to in that paragraph to be prorated in relation to the total period of active employment in a month,

    • (ii) preclude the accumulation of paid sick leave for a month in which the insured person has not been actively employed for at least twice the number of hours in the insured person's normal work week, and

    • (iii) allow the insured person to use paid sick leave while remaining at home because of pregnancy or to care for a child or children referred to in subsection 23(1) of the Act or while providing care or support to a family member referred to in subsection 23.1(2) of the Act, to a critically ill child or to a critically ill adult.

  • (d) where eligibility to use paid sick leave is deferred in the case of an insured person who is employed on a temporary basis or is serving a probationary period, it cannot be deferred for a period greater than 12 months beginning on the day the insured person commences employment or joins the plan;

  • (e) the days of paid sick leave available only in respect of the insured person’s illness or injury, or while the insured person remains at home because of pregnancy or to care for a child or children referred to in subsection 23(1) of the Act or while the insured person is providing care or support to a family member referred to in subsection 23.1(2) of the Act, to a critically ill child or to a critically ill adult, that are not used for those purposes must be accumulated at the rate prescribed in paragraphs (b) and (c), and the maximum number of days of paid sick leave that may be so accumulated is not less than 75 working days; and

  • (f) subject to the elimination period referred to in paragraph 63(b), benefits are payable under the plan with respect to the insured person's illness or injury until the earliest of

    • (i) the end of a period of at least 75 working days during which the benefits are paid,

    • (ii) the end of the period of incapacity due to the illness or injury,

    • (iii) the exhaustion of all accumulated paid sick leave,

    • (iv) the date the insured person retires, and

    • (v) the date of the insured person's separation from employment for any reason other than illness or injury, where notice of the separation was given before the onset of the illness or the occurrence of the injury.

  • SOR/2003-393, s. 12
  • SOR/2013-102, s. 16
  • SOR/2017-226, s. 14
 
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