WSIB Claims
Administrative Tribunals
Filing a claim with the Workplace Safety and Insurance Board (WSIB) can seem daunting. If you've been injured on the job, it's crucial to document everything related to your injury, including medical appointments, treatments, and any time missed from work.
CIVIL | TRIBUNALS | PERSONAL INJURY | CRIMINAL
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Filing a Workplace Safety and Insurance Board claim, while navigating the process can be complicated. Our job is to help you navigate the challenges of the WSIB process.
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There is no problem too big or too small for us to handle. At every stage of the process, we strive to provide you with the best resolution in the shortest time possible.
Cordaie Paralegal Services offers a comprehensive range of legal services through its satellite offices in Ontario. We assist clients with Workplace Safety and Insurance Board claims who are owed money or seeking benefits. Our team is experienced in WSIB claims. We can handle cases of any complexity.
Are you in need of representation?
You can contact our firm for assistance with claims against the Workplace Safety and Insurance Board. WSIB matters, including monetary compensation, medical coverage, or other benefits, can be handled by our firm. In this difficult time, we will be able to help you with our experience and knowledge of the system.
Now is the time to call!
If you need legal representation and want a competent team, we can help. We handle all stages of WSIB matters - from filing a claim to representing you and even filing an appeal. You can reach us seven days a week if you have any questions!
Get in touch with us now to find out how we can assist you and to discuss your unique situation. With no commitment, we offer a free initial assessment.
Covered by WSIB?
If you have suffered an injury while on the job, it is important to understand your rights and options for compensation.
The Workplace Safety and Insurance Board (WSIB) in Canada provides support to workers who have been injured on the job, including coverage for medical expenses, lost wages, and rehabilitation services. It is crucial to report any injuries to your employer and file a claim with the WSIB as soon as possible.
An experienced workers' compensation paralegal can help guide you through the process and ensure that you receive the benefits you are entitled to. Remember, you have the right to a safe and healthy work environment, and if you have been injured, you deserve fair compensation.
Need a Worker's Rights Firm?
Looking for a worker's rights firm in your area? We've got you covered. If you have been denied a Workplace Safety and Insurance Board (WSIB) claim, mistreated by a case manager, or have another problem with WSIB, Cordaie Paralegal Services can help. With our low rates, we can help you get the justice you deserve.
It's difficult to know where to turn when you're dealing with any sort of issue. Our team is here to help! We have years of experience helping people just like you get what they deserve from their cases. Our team will be with you every step of the way, so you don't have to worry about us being too expensive or not being able to handle your case.
We also offer high-quality counsel and support along with affordable representation. You can return to your life quickly and effectively with our help. We will negotiate your benefits swiftly and efficiently with the WSIB on your behalf. Our team is capable of handling all your concerns.
No matter if you are an injured worker, a family member, or a friend, WSIB claims are complicated. You won't have to worry about getting what you deserve when we work for you.
We are an established licensed paralegal firm, unlike other firms you may find online. Our team of professionals can assist you throughout every step of the process. Compare our rates to those of our competitors. It's not about cutting corners when it comes to saving you money. It's just about saving you money. Simple as that.
What else do you need to know?
We have everything you need in one place - fee schedules, FAQ, and why hire us.
The majority of our rates can be found on our website. Bundled and unbundled services are available. Hiring us means you'll know what to expect when it comes to transparent, fast, easy, professional service.
Our team is here to help you with your legal issues. We have provided an overview of the types of cases we handle. In addition, we have provided a frequently asked questions page on our website.
It is important to understand the facts of your case if you have a legal matter. Choosing an experienced legal counsel who can craft a strategy for your case is the best way to proceed.
WSIB
Some information you should know about the Workplace Safety and Insurance Board.
No Matter What, File a Claim
If you have been injured at work, you should file a Workplace Safety and Insurance Board (WSIB) claim. Even if you are still working at your regular job and are not losing any wages, we recommend you do this.
There are several reasons why you should claim:
- Depending on the benefits, medical expenses may be covered
- If your injury worsens, you may need to seek medical attention
You can expect WSIB to decide your claim within 12 weeks. A written decision must be provided to you by them. If a worker's compensation decision is made in your favour, you may be eligible for benefits.
Types of Benefits Offered by the WSIB
Loss of Earnings (LOE):
- Pays for wages you didn't receive due to your injury
Healthcare Benefits:
- Physiotherapy, medication, orthotics, braces, crutches, canes, wheelchairs, hearing aids, or other aids or assists that are necessary for you to recover from your injury
- The cost of replacing clothing damaged by wheelchairs and braces
- Costs associated with your doctor's visits, medical treatment, and travel to get to your doctor or therapist approved by WSIB
Non-Economic Loss (NEL):
- Your injury may be covered by WSIB if it is severe and permanent
- It is sometimes referred to as a "permanent impairment benefit"
Other Benefits:
- As a result of your injury, WSIB may also cover other costs. If that you are unable to return to your old job, these costs may include expenses that help you return to work, such as training or education
You may also be able to get:
- Due to your injury, you weren't able to earn wages
- Due to your injury, you didn't save for retirement
- Education or training that will assist you in finding a job if you cannot return to your previous job
- If you are permanently disabled, you may qualify for an independent living allowance
WSIB sometimes pays directly for your costs. The case manager (CM) will determine if WSIB covers your receipts.
Permanent Impairment Benefit
WSIB may also pay you for the impact of your permanent injury. As an example, you will never again be able to move the part of the body that was injured the way you used to. Permanent impairment benefits or non-economic loss benefits (NEL benefits) are not based on lost earnings or abilities to work.
You may need to ask for this benefit if the WSIB says you are fully recovered while you and your doctor disagree. If this occurs, WSIB should be informed by your doctor.
If your permanent injury is severe, the WSIB may refer you to a different doctor. However, WSIB will typically assess this based only on the reports in your file. You may appeal the WSIB's decision if you feel you should be assessed, or if you disagree with the assessment you received.
Loss of Earnings Benefits
Make sure the Workplace Safety and Insurance Board (WSIB) knows your income.
Loss of earnings benefits (LOEs) are what these payments are called. In addition to providing information about your injury to the WSIB, you also provide information about your wages, including overtime, shift premiums, and wages from other jobs. From the first day, you are absent from work due to your injury, your employer is supposed to pay you all your wages.
You will be compensated by the WSIB for your lost earnings after the first day of your injury. It is not full pay, however. You will get 85 percent of your usual take-home pay after deductions. Overtime pay may be included in your usual pay after deductions if the overtime was mandatory or regular. The calculation may not include overtime that is not regularly worked.
Upon termination of LOE benefits
Returning to work and earning the same or more as before your injury will end your loss of earnings (LOE) benefits.
Additionally, you stop receiving LOE benefits if WSIB determines that you could earn the same or more than before your injury if you take on one of the available jobs that you are both physically capable and qualified to do. Unless you were 63 or older when you were injured, LOE benefits end when you reach 65. A person who was 63 or older at the time of their injury can qualify for LOE benefits for up to two years.
Are You Covered by WSIB
An injury or disease does not necessarily have to be caused by your work. However, it must be a significant factor. The job you do may be causing your back pain, for example, if you lift something heavy at work.
Work-related Problems That Start When You Aren't There
You could have been injured at work even if your problem started while you weren't at work. A heart attack at home or lung cancer after working in mines could be related to your job, for instance.
Over Time, Developing Injuries
An injury might occur during an accident at work, such as falling from a ladder. A disease or injury could develop over time. If you haven't been in an accident or don't experience back pain constantly, you might not associate it with your job.
However, there are several reasons why you may be experiencing back pain:
- Lifting heavy objects at work
- A repetitive twisting motion you do at work
A Worsening of the Old Conditions
An old medical condition may return or worsen as a result of your work. You might have had asthma attacks before you worked at your job, for example. Now that you work with chemicals, your asthma is returning.
As a Result of One Injury, Another Occurs
Work-related injuries can lead to other injuries. A knee injury at work can result in a back problem because the knee injury changes how you walk. Work-related injuries include back problems.
Trauma - Both Physical & Psychological
It is possible to sustain a work-related injury either physically or psychologically. In other words, you can get an injury to your body. In addition, you can be injured emotionally or mentally.
As an example, you may have broken your leg at work because you fell off a ladder. The injury may also cause you to develop a psychological condition if you change to your life as a result.
Stress that is defined as traumatic or chronic mental stress can also lead to a work-related psychological injury.
Report Your Injury
Injuries must be reported. Benefits are determined by the WSIB.
Benefits under workers' compensation include:
- Injury-related wages you didn't receive
- Costs of healthcare
- Costs associated with travelling to your doctor or therapist
- Due to your injury, you can't get retirement income
- If you are unable to return to your employer's job, you can take a "work transition assessment" to find work
- Your injury might also qualify you for workers' compensation benefits if you are permanently disabled
You may also be able to get:
- If you have a severe permanent disability, you are entitled to an independent living allowance
- Expenses for braces and wheelchairs that damage clothing
You should file a claim even if you continue to work:
- Medical expenses might be covered by benefits
- Injuries can become permanent or worsen over time
Alternative Options to WSIB
If worker's compensation does not cover your type of employment, you may be able to sue for:
- Injuries that prevented you from getting paid your wages
- Your injury-related expenses
- Contact us for a free consultation. You have a limited amount of time to file a lawsuit, so don't waste it.
Employer Benefits
Your employer might also have other benefits that you can get, such as:
- Sick leave or some other “wage loss benefit”, which is money that replaces wages you don't get while you're injured
- Short-term or long-term disability insurance
- Healthcare benefits, such as physiotherapy, chiropractic care, medications, crutches, and other medical devices
Other Types of Benefits
If you aren't covered by workers' compensation, you may qualify for other benefits, such as:
- Employment Insurance Sick Benefit
- Employment Insurance Regular Benefit
- Canada Pension Plan Disability Benefit
- Ontario Works
- Ontario Disability Support Program
Contact us for a free consultation to learn about your options if you're not covered by WSIB.
Injury Assessment Requested by Your Employer
A medical assessment may be required by your employer if:
- You are out of work due to a work injury
- You are working but have not returned to your regular duties
You are assessed at work to see what you are capable of doing. It is the employer's responsibility to cover the cost of the assessment as well as any related costs, for example, parking fees, if the employer requests the assessment. If your employer hasn't explained why they want you to take the assessment, ask them. The assessment might help you if you think it will be helpful to you.
If you aren't sure whether the assessment would be helpful, ask your doctor if you are medically ready. Suppose your employer wants to take you to a person to test how much you can lift (this is called a "functional assessment"), but your doctor thinks it's too soon for you to experiment.
Don't Go if You Don't Want To
You must inform your employer if you do not wish to participate in the assessment. WSIB will decide whether you need to leave your job if your employer asks them to. To avoid losing your job, tell your employer why you don't want to leave. The WSIB should also know why you do not want to go.
A doctor may not have provided enough information about your injury and restrictions to your employer, so your employer may want you to undergo an assessment. If your doctor provides more information, you can see if it changes your employer's mind. When the WSIB decides that you need an assessment, you must go, otherwise, you could lose your benefits.
You Don't Have to Go if You Don't Want To
If you aren't sure what to do, ask your doctor if an assessment is necessary or if you are medically safe to undergo one. Your doctor may think it's too early for you to lift even if your employer sends you for a "functional assessment".
Choosing not to participate in the assessment must be communicated to your employer. You should also explain your reasons for refusing to go to your employer. If your employer requests the WSIB to decide if you must attend, it will be up to the WSIB. The WSIB must decide whether you are required to attend the assessment within two weeks of being asked by your employer.
Consult Your Physician or Therapist
If you don't know whether the assessment that your employer wants will be helpful, you can ask your doctor or therapist. You should take notes if they explain why you shouldn't go, so you can tell your employer and the Workplace Safety and Insurance Board (WSIB) why you won't go.
WSIB Regulations Must be Followed
If you are required to go to an assessment, your employer can request that the Workplace Safety and Insurance Board (WSIB) determine whether you have to go. When claiming benefits, the WSIB finds out if an assessment is needed and if it is related to your injuries, diseases, or conditions. A WSIB assessment is sometimes required by the company.
If an assessment will help you, your employer or the WSIB may suggest it to you:
- Getting back to work early and safely is important to you
- Resolve differences between health professionals about your injury
- Your injury, diagnosis, whether it was work-related, your impairment or your physical limitations should be explained.
If it will be helpful for you, the WSIB can also ask you to go for an assessment:
- Regain employment in a suitable field
- Access treatment as soon as possible
The Importance of Cooperating
It is your responsibility to cooperate with the WSIB if they ask you to attend a medical appointment or assessment. You may lose your benefits if the WSIB decides that you aren't cooperating and don't have a good reason for this.
Appealing a WSIB Decision
While the WSIB decides whether to give you benefits, if you appeal because the WSIB claims you were not cooperating, the benefits could be stopped.
Employer Forcing Me to Take Wages or Sick Pay
You may be discouraged from filing a claim for workers' compensation benefits (WSIB) by your employer. Making a claim may seem more difficult than taking wages or sick pay. If you are eligible for workers' compensation benefits, you should file a claim. The reason is that workers' compensation benefits don't just cover wages you don't earn because of your injury. Medical treatments, medical equipment, and other costs associated with your injury can also be covered. Claim if your injury becomes permanent or worsens in the future. If you have a benefit plan at work, you may also be able to get benefits through it.
Workers' Compensation Coverage
Check to see if your employer pays WSIB contributions. If they do, then you are covered. Your coverage will also apply if they don't pay their contributions but are supposed to. If you are unsure of whether you are covered or your employer is unable or unwilling to tell you:
- Consult your union representative, if you are a member
- You can contact the WSIB directly
The workers' compensation system does not apply to certain industries. There are a few industries that do not have to participate in workers' compensation. WSIB offers "optional coverage" for employers in these industries.
Among these industries are:
- A bank, a trust company, and an insurance company
- Medical and chiropractic practices in the private sector
- An independent daycare facility
- Agencies that provide travel services
- Hair salons and barbers
- Embalming and funeral directing
- The trade union movement
- A club (such as a health club)
- Photojournalists
- A taxidermist
If your employer offers optional coverage, you should ask them about it. In case you are still uncertain, you may want to file with the WSIB to determine if you are covered.
Do Not Be Discouraged From Making a WSIB Claim
Your employer may have a sick benefits plan through an insurance company. Instead of claiming workers' compensation benefits, they may ask you to take wages or sick pay. However, filing a claim for workers' compensation benefits is important if you're eligible.
Coverage Under Workers' Compensation
Benefits from workers' compensation cover wages you don't earn while injured. In addition, they may cover medical treatments, medical equipment, and other expenses you incur after an accident. All of these things are important for your recovery and return to work after an injury. Workplace Safety and Insurance Board (WSIB) will work with you and your employer if you have a more serious injury. You should also file a claim in case your injury worsens or is permanent.
Workers' Compensation May Be a Good Option
There may be a benefits plan offered by your employer that pays for other benefits such as:
- If you are injured, you receive "wage loss benefits", which replace the wages you would normally receive if you were not injured
- Long-term disability insurance or short-term disability insurance
- Healthcare benefits, including physiotherapy, chiropractic care, medications, crutches, and other equipment
Workers' compensation and workplace benefits should be applied if you have a benefit plan at work if you're not sure what caused your illness or injury. Your injury will give you a better chance of having some income while you are not working. Tell the insurance company that you were injured at work and that you are also claiming workers' compensation benefits if you claim for sick benefits through your employer's benefits program. Injuries are not officially considered work-related until they are accepted by the WSIB. A claim for sick benefits will probably have to be repaid to the insurance company if this happens. A claim for benefits is decided by the Workplace Safety and Insurance Board (WSIB).
The Next Steps After Reporting
Fill out the Worker's Report of Injury/Disease (Form 6) to report the injury or accident to the Workplace Safety and Insurance Board (WSIB). Although your doctor or employer has already reported the injury to the WSIB, you should still complete this form since it allows you to describe the accident from your perspective.
After an injury or accident, you should perform this as soon as possible. Your injury is reported to the WSIB, which opens a claim. The claim number and the person to contact will be sent to you within one week of reporting. Keep notes of all your conversations.
Obtain Your Claim Number
The WSIB can be contacted by anyone who was injured. WSIB will send you a Form 6 if your employer or doctor reports the injury or accident before you do so that you can complete and submit it to them. Your employer receives a copy as well. The WSIB requires that forms and documents be filed and that the rules regarding filing be followed. After filing Form 6 with the WSIB, you should receive a letter from the organization. Ask about your claim if you have not received a letter from the WSIB.
As a result of the letter, you will receive:
- A claim number
- The name of a contact person who will be looking after your claim
Case Managers
In most cases, your contact person also makes decisions about your claim, such as what benefits you can receive or whether you can return to work. An individual in this position is known as a case manager. Your claim number and their name should be noted, as you may need them frequently. You will be asked for your claim number whenever you contact the WSIB.
As Soon As Your Claim is Decided, Wait
Your case manager's first and most important decision will be whether your injury is work-related. If your case manager determines that your injury was caused by your work, there will be other decisions they must make. Among other things, they decide what kind of benefits you'll receive and how much. You may also be able to return to work if they decide it is safe for you to do so. If your case manager tells you about a decision they are making, ask them to put it in writing.
Keep Notes
Each time you speak with someone at the Workplace Safety and Insurance Board (WSIB), they will document the conversation. As well as their notes, you should keep your own. The reason why you must do this is that if you disagree with any decision made by the WSIB, you can appeal it.
You should include information such as:
- Date and time of any calls you make to the WSIB
- Your contact's name
- The topics you discussed
Request a Copy of Your WSIB File
WSIB can provide you with a copy of your file if you request it in writing. Sign, date, and include your claim number in the letter. Usually, your file will be sent to you within one to two months after you request it. Your file should be prepared by the WSIB and they should notify you in writing. Contact the WSIB if you do not receive confirmation of your request within three weeks of your request.
WSIB files usually contain:
- Notes of every conversation you had with someone at the WSIB, your employer or witnesses
- WSIB letters sent to you
- Copies of any letters you write
- Documents related to your claim, such as medical reports
Dealing With the WSIB Case Manager
At the Workplace Safety and Insurance Board (WSIB), the person who handles your claim is usually the same person who makes decisions about your claim. The person in charge of your case is called a case manager.
You may be asked questions by your case manager about:
- Worker's Report of Injury/Disease (Form 6) you sent in about your accident
- Injuries you have
- Your current capabilities
You must answer the questions honestly. Other WSIB employees may also contact you, such as a nurse consultant, return-to-work coordinator, or work transition specialist. If you don't understand, get help. When you don't understand what the case manager tells you or writes to you, ask them to explain it differently. The WSIB should be informed if you have difficulty speaking, hearing, or writing for any reason. They are required to make sure you understand what's happening with your claim according to the law. It may be necessary to translate into a language you are familiar with.
Your decision will be made as soon as possible. You should hear from the WSIB within two weeks if you have been approved for benefits. There can be a delay of 12 weeks or more if your claim is complicated.
If a decision will take more than two weeks, the case manager should let you know:
- What is the status of your claim?
- Your injury and your claim for benefits are being considered by the WSIB
WSIB problems
You can contact the manager of the case manager if you have concerns about how your claim is being handled. If you have concerns about the case manager or manager, you can contact the Fair Practices Commission.
Work Together With the WSIB
Your Workplace Safety and Insurance Board (WSIB) case manager may ask you questions about the report you provide about your accident. Employers and the WSIB must cooperate if you want to receive benefits. If the WSIB decides that you're not cooperating and that you don't have a good reason for it, they may reduce or take away your benefits and services until you cooperate.
Defining cooperation
To cooperate, you must:
- Be sure to provide the WSIB with any information they request so they can decide about your injury
- Make sure your employer knows about your injury as soon as possible
- If you were injured and have been off work, talk to your employer about returning to work
- When you return to work, cooperate with the WSIB and your employer, either doing your regular job or undertaking different tasks your employer may be able to assign you
- Take the steps your doctor and other health professionals suggest to get well
- Attend any medical appointments that the WSIB requires
Worker's Report of Injury/Disease (Form 6) is also part of cooperating. As a result, you consent to health professionals treating you providing information to the WSIB and your employer about what you can do after an injury.
If you make any important changes to your:
- Well-being
- Capabilities
- Earnings
- Status of employment
- Return to work availability
It may affect your right to receive WSIB benefits. In the event of a change, you should notify your case manager within 10 days.
Don't be afraid to ask for help if you don't understand. When you don't understand what the case manager tells you or writes to you, ask them to explain it differently. If you have difficulty speaking, hearing, or writing, please let the WSIB know. Your claim must be explained to you clearly by them per the law.
Case Manager or Decision Problems
Having trouble reaching your case manager
Write a note to your case manager if you leave a message and they don't call back. Your call dates and times should be included.
Alternatively, you can mail or fax your note. If you think you're being treated poorly, keep detailed notes of the conversations or incidents that led you to believe this. Make contact with the manager of your case manager. You can speak with the manager of the case manager if you don't feel that they are treating you properly. Consider that the case manager will probably continue to be the person making decisions about your claim when deciding whether to complain.
Leave a detailed message on the manager's voicemail:
- Identify yourself
- The claim number you have
- Your call's purpose
Disagreement with a decision made by the WSIB
An appeal can be filed if you don't agree with a decision made by the WSIB. There is a difference between this and complaining about the WSIB.
Copies of your files should be obtained
Get a copy of your WSIB file to keep for yourself. It is also possible to review the file to determine whether you want to appeal the decision of the case manager.
WSIB files contain the following information:
- Keep a record of any discussions you have with someone at the WSIB, your employer, or witnesses to your injury
- Please find attached a copy of the Board's letters
- A copy of all the letters you write to the Board
- Your claim's medical reports and other documents
Please contact the WSIB if you would like a copy of your file. Ensure that you include your claim number in your letter and request a copy of your file. Sign and date your letter. After you request a copy of your claim file, you usually receive it within two months.
You should receive a letter from the WSIB notifying you that a copy of your file is being prepared. Please call WSIB if this hasn't been done within three weeks of when you requested your file.
The Fair Practices Commission Can Be Contacted
An employee of the Workplace Safety and Insurance Board (WSIB), such as a case manager or manager, can file a complaint with the Fair Practices Commission if they feel they have not been treated fairly. WSIB is owned by the Commission, but the Commission is located outside its office. Assuring that WSIB operations are fair is its job. Remember that you can appeal WSIB decisions if you do not agree with them. Not being treated fairly is not the same as complaining about it to the Commission.
Your complaint will be considered by the Commission if:
- It took the WSIB a long time to deal with your claim, for example, your case manager didn't return your calls after many attempts
- WSIB didn't explain your claim to you in an understandable way
- Poor behaviour by WSIB staff, such as rudeness and impoliteness
- Your claim was ignored by the WSIB even though it had important and relevant information
Complaint procedure
You can file a complaint with the Commission. Complaints should include:
- A delay, someone's behaviour, something the WSIB said to you, what the WSIB did or didn't do that you would like the Commission to investigate
- Information about what happened, who was involved, and when it occurred
- In addition to the names of the people at the WSIB who you contacted, please describe what you did to resolve the issue
- If you have a complaint, how would you like it handled?
Recommendations from the Commission
WSIB may be asked to take the following action after reviewing your complaint:
- Correct something they didn't do or correct a delay
- Reasons for a decision should be given in more detail
- Please accept my apology
- Establish a protocol or procedure
- Service standards should be reviewed
- Consider training your staff more
If you wish to appeal, the Commission cannot decide your compensation or force the WSIB to make a certain decision.
Getting Money & Treatment While Awaiting a Decision
The Waiting Time
It might take the Workplace Safety and Insurance Board (WSIB) two weeks to respond to your claim. A WSIB decision can take 12 weeks or more if your injury or claim is complicated. Appealing a decision can take years, and the decision might not be what you wanted.
Some Options
In the case of not getting paid or receiving treatment, even two weeks can be a long time to wait. As you wait for the WSIB to make a decision, talk to your employer and doctor about what you can do. If you're off work due to an injury, you might be covered by loan insurance. You may be eligible for government assistance, such as Ontario Works (OW), the Ontario Disability Support Program (ODSP), or Canada Pension Plan Disability Benefits (CPP). Our team can help you decide what steps to take while you're waiting for the WSIB to decide about your claim. Contact us today for a free consultation.
Consult Your Employer
As you wait for the WSIB to decide about your claim, your employer may be able to provide you with some income. Although you're injured, your employer may be able to give you duties to do. You can then continue working and getting paid by your employer. Depending on your employer's benefit plan, you may be entitled to paid sick leave or wages you don't receive while injured if you cannot stay at work. Physiotherapists and chiropractors may also be covered by your employer's benefits plan, allowing you to get treatment. The WSIB might reimburse your employer for your treatment if your WSIB claim is approved if your employer does not have a benefit plan.
Consult your doctor
If you are injured, your doctor should be able to explain to your employer what activities you can still do. WSIB's Functional Abilities Form can be used for this purpose. WSIB will pay your doctor's fees. If your injury prevents you from performing part or all of your regular job duties, you can discuss these options with your employer. Additionally, your doctor might be able to suggest exercises or treatments that are free of charge.
Take a look at other insurance options
Disability Insurance
There is a possibility that you have disability insurance through your job. If you are claiming workers' compensation benefits because you were injured at work, you must tell your insurance company. You will not be able to get money from both your insurance company and the Workplace Safety and Insurance Board (WSIB) if you have suffered the same injury. When the WSIB accepts your claim, it means that your injury is work-related, because insurance companies only cover injuries or disabilities that are not work-related.
Although your claim is not officially work-related until the WSIB accepts it, you should be able to claim with your insurance company while you wait.
Once the insurance company approves your claim, and the WSIB later approves it, you will probably have to sign an "assignment of benefits" form. Hence, when you receive workers' compensation benefits from the WSIB, the WSIB will probably take money out of your payments to pay back the insurance company. The WSIB sometimes makes it difficult to tell if this has been done. As a result, you may have to do this if the WSIB doesn't reimburse the insurance company.
Insurance of other types
Your bills may be covered by other types of insurance if you are injured. In addition to mortgage insurance, you might also have credit card insurance, auto insurance, and other personal loans insured. Your loan payments may be made for you if you have this type of insurance or delayed until you can make them.
Consider Other Types of Assistance
Employment Insurance
It is possible to apply for sick benefits through Employment Insurance (EI). Depending on your eligibility, you may be able to receive EI sick benefits for up to 15 weeks. Regular EI benefits might be available to you in some circumstances. Get started on your application as soon as possible.
Programs for social assistance
The Ontario Works (OW), Ontario Disability Support Program (ODSP) and Canada Pension Plan Disability Benefits (CPP) may provide financial assistance if your income is low. Inform them that you have applied for workers' compensation. When you apply for EI, OW, ODSP, or CPP, mention that you have a work injury and have applied for workers' compensation.
Returning the money
For the same period, you cannot collect workers' compensation and other benefits such as EI, OW, ODSP, or CPP. You'll have to pay back your EI, OW, ODSP, or CPP benefits once you get your workers' compensation benefits. You may also receive Loss of Earnings benefits from the WSIB after deducting what you have already received from another source. If you want your workers' compensation benefits to be used to reimburse EI, OW, ODSP, or CPP, you'll probably have to sign an "assignment of benefits" form. It may be necessary for you to pay back the money directly if the WSIB doesn't do this.
A WSIB Decision You Don't Like
At the Workplace Safety and Insurance Board (WSIB), a case manager makes decisions about your claim and what benefits you will receive. Usually, this is the same person who handled your claim. You can take two steps if you disagree with your case manager's decision.
Reconsideration
Ask the WSIB for a reconsideration of its decision if you have new information that you think might change its decision. Please do this as soon as possible. The case manager should be able to hear your reasons for disagreeing and any important details you think he or she missed or misunderstood. Documents and information that the case manager did not have before can also be given to them.
You can appeal the decision
Alternatively, you can request another WSIB member to review your decision. An appeal is what this is called. A form called an Intent to Object Form must be submitted to start an appeal. The Intent to Object Form must be submitted for each decision you wish to appeal. You can get the form on the website or by phone, and you can submit it by the deadline on the decision letter you received from the WSIB. Our team can help you complete your appeal process. Contact us for a free consultation.
Depending on the type of decision, the deadline to submit the Intent to Object Form varies:
- A decision about returning to work must be made within 30 calendar days
- Any other decision will take six months
Even if you are waiting for an answer about your reconsideration request, you must submit your Intent to Object Form before the deadline. WSIB deadlines are very strict, so submit your Intent to Object form on time.
Asking for a "Reconsideration" after your decision has been made
It may take the Workplace Safety and Insurance Board (WSIB) 12 weeks or more to decide your claim. A written decision must be sent to you. Ask them to send you their decision in a letter if they tell you over the phone. The WSIB decision will tell you if you will receive benefits. Check the letter to ensure you understand it. You might want to ask a friend or family member to help you read the letter. You could also ask the WSIB for an explanation of the decision if you don't understand it. A case manager is responsible for this.
The case manager should explain any decision they make if you don't agree with it. You can ask the WSIB to reconsider the decision if you are still not satisfied with the decision. Please take action as soon as possible. Explain your disagreement and any important points you think the case manager missed or misunderstood. Also, you can provide new information and documents to the case manager
A reconsideration request usually takes about 14 days to be answered. The case manager can review the decision if it is not changed by someone else at the WSIB. An appeal is what we call this. An appeal must be started by submitting an Intent to Object Form.
Complete the Intent to Object form
A form called the Intent to Object Form must be submitted to appeal a decision. For each decision that you wish to appeal, you must submit an Intent to Object Form. Intent to Object Forms are available online or by calling the Workplace Safety and Insurance Board (WSIB). Filling out the form is explained on the form.
Please provide the following basic information:
- Claim number
- Date of the decision you disagree with
- Your reasons for disagreeing
Submit Your Intent to Object Form On Time
After you receive your decision letter and decide you disagree with the decision, you should send your Intent to Object Form as soon as possible. We're here to help. Contact us for a free consultation.
Depending on the type of decision, the deadline to submit the Intent to Object Form varies:
- Return to work decision within 30 calendar days
- For any other type of decision, it will take six months
The decision letter will specify how long you have to appeal. Regardless of whether you have received an answer regarding your reconsideration request, you must submit your Intent to Object Form by the deadline. If you want to appeal a WSIB decision, make sure you submit your Intent to Object Form by the deadline. You might lose your right to appeal if you miss the deadline. It is still possible for you to write the Workplace Safety and Insurance Board (WSIB) and explain why you missed it. A decision may still be appealable. Your appeal deadline can be extended by the WSIB.
An extension of the deadline may be considered by the WSIB if:
- A serious health problem was affecting you or a member of your immediate family
- The illness or death of you or a member of your family forced you to leave the province or country
- The time limit for appealing wasn't explained to you
Reasoning with the WSIB
WSIB might extend the deadline for the reasons listed above. In addition to these reasons, the WSIB can take into account other factors. However, you need to provide a good reason for not appealing the decision promptly.
The Appeal Process Must Be Followed
The Workplace Safety and Insurance Board (WSIB) will send you a letter once you submit your Intent to Object Form. You can request a reconsideration of the original decision even if you did not request one. In most cases, the letter includes a copy of your claim file and a form asking for your appeal readiness. If you are ready to appeal, you use this form to notify the WSIB.
If you want your appeal to be successful, both of these things must be true:
- Whether you wish to have us represent you in your appeal or someone else, has been decided
- The WSIB has received all the information and documentation you have to support your claim, such as medical records
The form does not have a deadline, so you should submit it whenever it is convenient for you. You'll be asked on the form whether you prefer an oral or written hearing, but the final decision will be made by the WSIB. Oral communication can take place in person or over the phone.
Here are two options to consider:
- It is easier to resolve simple issues with a written hearing
- Oral hearings are held within 90 days of the WSIB deciding what type of hearing it wants for you to resolve more complex issues
To deal with your hearing in writing, you must write down your reasons for disagreeing with the decision and submit them with your Appeals Readiness Form. The best way to explain your case directly to the decision-maker is during an oral hearing. You can decide whether your employer will participate in your appeal. Medical records may be requested by your employer if they join the appeal. WSIB will ask you if you want this to happen and why not. After that, the WSIB will decide whether to share your medical information with the employer.
Employer Appeals a WSIB Decision
Workplace Safety and Insurance Board (WSIB) decisions may be appealed by your employer if you receive benefits.
The WSIB will send you a letter explaining how you can participate in the appeal. The letter will include a Worker Participant Form and all the documents your claim has been provided to the WSIB. The Worker Participant Form must be completed and submitted to the WSIB within 30 days of receiving the letter if you want to participate in the appeal.
Usually, it is a good idea to participate in the appeal so that the WSIB knows what you are trying to say. You may be asked to provide your medical information when your employer appeals a WSIB decision. Your opinion on this will be sought by the WSIB. If your medical information is disclosed to your employer, the WSIB will decide whether to do so.
Employers appeal decisions for several reasons
You might not be taken seriously by your employer if you are having difficulty returning to work because of your injury. Also, employers often appeal WSIB premiums because the amount of benefits their employees receive can increase the amount of premiums they pay. A car accident claim can result in your insurance premiums going up.
Participation is up to you
Your employer's appeal may prevent you from getting benefits, so you should participate.
For the Workplace Safety and Insurance Board (WSIB) to make you pay back the benefits you have already received, you meet the following criteria:
- Your injury claim was not truthful
- Not notifying the WSIB within 10 days of important changes to your health, abilities, income, job status, or availability to return to work that may affect your right to benefits
- You didn't return benefits that you knew you shouldn't have received
If you receive benefits after returning to work, your employer may appeal the decision, which could affect your ability to get benefits in the future.
Depending on your situation, you may want to consider participating in your employer's appeal:
- A union representative can assist you
- A representative from the Office of the Workers' Advisor (OWA)
Additionally, there are other services you can take advantage of.
Worker Participant Form to WSIB
Worker Participant Forms must be filled out and returned within 30 days of receiving a letter about your employer's appeal. You can participate in the appeal by filling out this form. Sending the form is a good idea, even if you aren't sure. You can always decide not to participate in the appeal later. You won't receive any further information about the appeal if you don't send the Worker Participation Form. When the appeal process is complete, you will receive a copy of the decision.
Help is available
There are a lot of steps involved in the appeal process. But finding that kind of firm can be difficult. The first thing to consider is whether or not they are willing to work with you—and your case—on a fully devoted basis. This means that they will give you and your case their undivided attention. We will do just that. Contact us today for a free consultation.
Frequently Asked Questions
Here are answers to some common questions.
WSIB Benefits
SELF-REPRESENTATION IS NOT A GOOD IDEA
Helping You Succeed
Representing yourself in court can seem like a convenient and cost-effective option, but it can also lead to several pitfalls. First and foremost, legal proceedings can be complex, and even the most astute and well-read individual may not be familiar with all the rules, procedures and regulations that apply.
This can lead to costly delays, missed deadlines and even dismissed cases. Another pitfall of self-representation is that emotions can run high during legal proceedings, and it can be challenging to remain objective and level-headed. This can lead to making rash decisions, which can negatively impact the outcome of your case.
A paralegal, on the other hand, can provide an objective perspective and help you make informed decisions. Furthermore, a paralegal can help you navigate the legal system, which can be confusing and intimidating for those who are not familiar with it. We can also provide guidance on legal issues, such as what evidence to present, how to cross-examine witnesses, and how to negotiate a settlement.
In conclusion, while self-representation may seem like a viable option, it can lead to several pitfalls. Hiring a paralegal can provide you with the expertise, guidance, and support you need to navigate the legal system and achieve a favorable outcome.
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