Blog

You are currently viewing WorkSafeBC Personal Optional Protection

WorkSafeBC Personal Optional Protection

What is WorkSafeBC Personal Optional Protection?

Personal Optional Protection (“POP”) coverage is an optional workplace disability insurance that protects self-employed proprietors and partners in a partnership.[1]   Proprietors and partners are not automatically covered under the Workers Compensation Act (the “Act”).   Section 4(2) of the Act provides that WorkSafeBC (the “Board”) may direct that the compensation provisions of the Act apply to an independent operator or an employer (on terms specified in the Board’s direction) as if the employer/independent operator was a worker.  The Board may provide such coverage through its POP program.  The Assessment Manual addresses various aspects of POP coverage.[2]

Although optional, it is highly recommended that individuals in these groups purchase POP coverage.   Once purchased and in the event of a work-related injury, the individual is entitled to the same compensation benefits as a worker, subject to the amount of POP purchased.  Such benefits include health care, wage-loss, and rehabilitation benefits.

People can choose how much wage-loss coverage they want to purchase.  In 2021, the minimum monthly coverage a person can purchase is $2,500 and the maximum coverage is equal to the person’s current monthly earnings or $8,333, whichever is less.  If an individual is injured at work, the Board generally pays wage-loss benefits based on 90 percent of net average earnings (the average amount remaining after probable deductions).  The amount a person receives from the Board depends on the selected coverage amount.  For example, if minimum coverage ($2,500) is purchased, the approximate monthly wage-loss benefits received will be approximately $1,972.  Similarly, if the maximum is purchased ($7,500), the approximate monthly wage-loss benefits received would be approximately $5,176.

The cost of the POP coverage depends on the selected monthly amount of coverage and the net premium rate.  Premium rates are based on the nature of one’s business.  To calculate how much you will pay monthly for your coverage, multiply the monthly amount you selected with your net premium rate. 

Because POP coverage is an insurance plan to replace lost wages and cover medical care, the amount a person purchases should reflect their actual earnings.  Since POP coverage may be the only source of income if you can’t work due to a work-related injury or illness, be sure to apply for enough coverage.  It is often seen that people buy the most minimum coverage available, even when they earn double or triple that amount.  At the time of purchasing, this may seem like a wise decision (let us be honest, no one wants to spend more than they have to); however, it may have significant long-term impacts.  For example, if your regular earnings are over $5,000 per month and you purchase the minimum coverage amount ($2,500), the maximum you will receive is approximately $1,972 per month.  This amount may not be enough to cover even your basic living expenses.   Professions (such as long-haul truck drivers) with a high risk of psychological and physical injury should seriously consider purchasing higher insurance.  A simple decision to purchase POP coverage equivalent to your actual earnings will protect you and your family from major economic loss, in the event of a workplace injury.

What Personal Coverage Does and Does Not Do

WorkSafeBC Personal Coverage, previously known as Personal Optional Protection, can be important for business owners, partners, proprietors, independent operators, and others who may not be automatically covered as workers. It can provide protection if you are injured while performing work connected to your business, but it does not mean every injury, wage loss, or later dispute will be straightforward.

A common issue is that people purchase coverage without fully understanding what WorkSafeBC will look at if a claim is made. The coverage amount, the nature of the work being performed, the medical evidence, and whether the injury is accepted as work-related can all affect the claim.

This matters because a person may believe they have coverage, but still run into problems if WorkSafeBC questions the injury, the work connection, the earnings information, the medical restrictions, or the period of wage loss.

If WorkSafeBC accepts your coverage but denies your claim, limits your benefits, or says your ongoing symptoms are not related to the injury, it may be worth speaking with a WCB lawyer in BC before an appeal deadline expires.

Why the Coverage Amount Matters

The amount of Personal Coverage you choose can affect wage-loss benefits if you are injured. If coverage is too low, the benefits may not reflect your actual business income or financial needs. If coverage is too high, WorkSafeBC may still review whether the amount is supported by your actual earnings and business records.

Before applying for or renewing coverage, it can help to think about:

  • Your actual role in the business
  • Your typical duties
  • Whether you perform physical work
  • Whether you work at multiple sites
  • Your past income
  • Your current business records
  • How much income you would lose if you could not work
  • Whether your coverage amount reflects your real exposure

For people who work in construction, trades, transportation, contracting, consulting, caregiving, cleaning, delivery, or hands-on business roles, the coverage decision can have real consequences if an injury happens.

What Can Go Wrong After a Personal Coverage Claim Is Filed?

Even when a person has Personal Coverage, WorkSafeBC may still make decisions that affect the claim. Having coverage does not guarantee that every injury will be accepted or that benefits will continue for as long as the person feels unable to work.

Common disputes may involve:

  • Whether the injury happened while doing covered work
  • Whether the person was working at the time of injury
  • Whether the injury is connected to the business
  • Whether wage-loss benefits are calculated correctly
  • Whether the person can return to modified duties
  • Whether medical treatment should continue
  • Whether ongoing symptoms are related to the accepted injury
  • Whether the person has a permanent disability
  • Whether the claim should be reopened later

These issues can be especially complicated for self-employed workers because there may be no traditional employer, supervisor, schedule, or workplace incident report. The worker may need to rely on medical records, invoices, jobsite records, client communications, photos, calendars, or other documents to prove what happened.

Evidence That May Help a Personal Coverage Claim

If you are self-employed or operate your own business, it is important to keep clear records. WorkSafeBC may ask for information about your work, income, job duties, and the circumstances of the injury.

Helpful evidence may include:

  • Medical records
  • WorkSafeBC decision letters
  • Business income records
  • Invoices
  • Contracts or client communications
  • Jobsite notes
  • Photos of the worksite or equipment
  • Calendar entries or work schedules
  • Text messages or emails confirming work activity
  • Treatment records
  • Return-to-work information
  • Notes about symptoms and restrictions
  • Records showing missed work or reduced business activity

If WorkSafeBC denies the claim or limits benefits, the evidence should respond directly to the reason WorkSafeBC gave in the decision letter.

What If WorkSafeBC Says You Can Return to Work?

Return-to-work disputes can happen in Personal Coverage claims, especially when the injured person is self-employed. WorkSafeBC may decide that you can return to some type of work, even if your regular duties are physical, unpredictable, or difficult to modify.

This can create problems if:

  • You cannot perform the main duties of your business
  • Your doctor says you have restrictions
  • You cannot safely lift, drive, stand, bend, or use tools
  • Your work cannot realistically be modified
  • Your pain or symptoms worsen when you try to work
  • WorkSafeBC does not understand what your job actually requires
  • Your business loses income because you cannot perform the work yourself

A return-to-work decision should reflect your real job demands and medical restrictions. If WorkSafeBC makes assumptions about your ability to work, it may be important to correct the record in writing.

For more information, read our page on the WorkSafeBC return-to-work policy.

What If Your Personal Coverage Claim Is Denied?

If WorkSafeBC denies your claim, do not assume the matter is over. You should read the decision letter carefully and identify exactly why the claim was denied.

WorkSafeBC may deny a claim if it says:

  • The injury was not work-related
  • The injury did not happen while doing covered work
  • There is not enough medical evidence
  • The condition is pre-existing
  • Ongoing symptoms are not related to the workplace injury
  • The wage-loss period is not supported
  • You can return to work
  • Treatment is no longer needed

You have 90 days to appeal WorkSafeBC decisions to the Review Division. You have 30 days to appeal Review Division decisions to WCAT. These are firm deadlines and apply to all decisions.

If you are unsure whether a decision should be appealed, speak with a lawyer before the deadline passes.

How a WCB Lawyer Can Help With a Personal Coverage Dispute

A WCB lawyer can help review the WorkSafeBC decision, the coverage details, the medical evidence, and the financial information related to your claim. This can be especially important if you are self-employed and WorkSafeBC does not fully understand your work duties or income loss.

A lawyer may help with:

  • Denied Personal Coverage claims
  • Wage-loss benefit disputes
  • Treatment denials
  • Return-to-work disputes
  • Claim closure decisions
  • Permanent disability issues
  • Reopening old claims
  • Review Division appeals
  • WCAT appeals

For more information about getting legal help, visit our guide to hiring a WCB lawyer.

Do I Need Personal Optional Protection? 

We are often contacted by injured self-employed workers (or dependants of deceased self-employed workers) regarding questions and concerns about exceedingly low payments from WorkSafeBC.  Many of these queries are from self-employed long haul truck drivers (or dependants of the deceased driver) that purchased the minimum amount of POP from WorkSafeBC, which is $2,500.00 as of January 1, 2021 (https://www.worksafebc.com/en/insurance/need-coverage/optional-coverage/personal-optional-protection).

The complaints are quite often similar: “I can’t live off of less than $2,000.00 per month!”  Unfortunately, these workers are told that the level of their compensation entitlement will not increase as it is based on the POP coverage that they paid for.

If you know of anyone (friends, relatives, clients, patients, neighbours, etc.) who is self-employed in B.C., it may be prudent to ask them if they have adequate POP coverage.  Not many can live off of less the minimum coverage.

Please note that the information provided in this post is obtained from the WorkSafeBC website.

If you would like to schedule a consultation appointment with one of our lawyers, please call us at (604) 591-8187.  You can also send a private and confidential message using our contact form or an email to info@gosalandcompany.com.

[1] A proprietor or a partner of a business that is not a limited company may apply for Personal Optional Protection.

[2] See Item AP1-4-3, Personal Optional Protection, of the Assessment Manual.