Health and Safety

Steps in filing a WSIB claim

Never approach the Employer without your Union Representative

 

  1. Once a person is injured/ill at work, they get medical attention right away—be it a hospital or Family Physician
  2. Treating Physician -most cases- will then fill out a Form 8. Physician then will usually only give you page 2 of the Form 8. THIS FORM NEEDS TO BE SENT TO THE EMPLOYER.
  3. Contact your Union Representative AS SOON AS POSSIBLE as they will accompany you on your return to work.
  4. The Employer has three (3) days from the filing of the Form 8 to produce a Form 7. This form is the Employer’s version of events.
  5. The injured/ill worker, is required to fill out a Form 6. Take important caution with the final page of this report, pg four (4). IT IS IMPORTANT TO FILL THIS FORM OUT WITH A UNION REPRESENTATIVE. This is the workers version of events and the more WSIB has knowledge of what the person’s work duties are, the better they will be able to piece things together. WSIB will however, also call the worker shorty after receiving the Form 6 to go over the events.
  6. WSIB will make a decision – usually within the first 3-4 weeks of receiving the information. Sometimes earlier depending on the complexity of the case-sometimes much later.
  7. Upon communication of acceptance, the worker will then be given entitlement to benefit treatment for the number of weeks that WSIB allows (usually anywhere between 4-8 weeks. Further weeks of health care can be requested by treating Physician if needed). If there is LOST TIME, then the worker -if approved for lost time by WSIB – will be given 85% of their wages for the time away from work.
  8. However, further to point #7, the Employer usually will pay the employee as to not have any lost time go against the Company.

 

MODIFIED DUTIES

Upon returning to work with the Form 8, your Employer will offer modified duties. Please have a UNION REP present for this. The modified duties MUST be within your restrictions laid out in the Form 8 from the attending Physician.

 

Never approach the Employer without your Union Representative

 

 


Returning to Work

What is work reintegration?

Work reintegration, or WR, is the WSIB’s new approach to getting injured workers back to work after an injury.

Work reintegration replaced the old system of early and safe return to work and labour market re-entry (ESRTW/LMR). WR refers to the complete process of returning workers to work with their employer or preparing them to find a job with another employer in the labour market.  It includes all of the stages of return to work under the old system:  ESRTW, LMR and re-employment rights, where they apply. 

 

When did this change take effect?

Work reintegration came into effect on December 1, 2010.  As of September 2011, all eligible injured workers should be receiving services under this program. 

 

How is work reintegration similar to the ESRTW/LMR system?

Workers and employers have many of the same responsibilities under WR as they had under the old system. Workers and employers must co-operate in:    

  • early and safe return to work, and
  • work transition (formerly LMR)

Employers must also re-employ workers who have re-employment rights.  For more information, see Early and Safe Return to WorkWork Transition and Re-employment

 

How is work reintegration different than the ESRTW/LMR system?

Work reintegration differs significantly from the previous ESRTW/LMR system in the following ways:

  • Return to work with the injury employer is now the priority 

WR focuses on getting workers back to work with their employers, both in the short- and the long-term.  Under WR, the WSIB tries to find suitable and available work with the injury employer prior to exploring other options.

  • Workers may be retrained for a job with their injury employer

Under WR, it is now an option for workers to be retrained for suitable work with their employer that is different from their pre-injury job. See Work Transition for more information. 

  • The WSIB will play a more active role in the return to work process

If a worker is capable of some work and has not returned to work by the 12th week after the injury, a Return to Work (RTW) Specialist from the WSIB will meet with the worker and employer to develop a return to work plan. The WSIB will play an active role in monitoring return to work and providing advice to workers and employers.

  • Greater emphasis on accommodation in the workplace

The WSIB now emphasizes employer obligations under the Ontario Human Rights Code to provide accommodations, or make changes to the workplace, to ensure that workers can do their job (or any suitable work offered) and remain in the workplace. 

  • Increased protections for worker benefits

The WSIB is now required to explain what will happen if workers do not return to work after the WSIB says they can do the job their employer offered.  The WSIB must explain this prior to reducing benefits. For more information, see Duty to Co-operate.  

 

What happens if I cannot return to my pre-injury job?

If you are able to return to work but cannot do your pre-injury job, you can ask your employer for an accommodation, or a modification, that will help you return to work. 

 

What kinds of accommodation can I get in order to help me return to work?

An accommodation is anything that helps to remove barriers to working.  Some examples include:

  • work station readjustments (such as providing a sit-stand stool)
  • technical aids (such as voice-activated software, hands-free head-set)
  • flexibility or changes in work schedules, or
  • job redesign (such as changing your job description to remove/add certain tasks) 

Accommodation is available in all stages of work reintegration.  The WSIB can order your employer to accommodate you in your return to work.  Your employer can only refuse to accommodate you if they can show that it would result in undue hardship. 

For further information about accommodation, please consult the resources on the Ontario Human Rights Commission website related to accommodation of disability. 

 

What happens if I cannot return to my pre-injury job with accommodation?

If you cannot do your pre-injury job even with accommodation, the WSIB will assign a Work Transition (WT) Specialist to your case to help develop a plan for your long-term return to work. 

The WT Specialist can arrange for a work transition assessment, in order to find a suitable occupation (SO) for you.  See Work Transition for more information. 

 

Can I appeal a WSIB decision on work reintegration?

Yes, but you must send an Intent to Object Form to the WSIB within 30 days of the date of the decision.  If you disagree with a decision by your Return to Work Specialist or Work Transition Specialist, it is a good idea to send the Intent to Object Form to the WSIB and explain why you disagree.  If you miss the 30 day deadline you can ask the WSIB for an extension.  See Appeal Time Limit Extensions: WSIB.

 


Appeals

 

Contact your Union Representative to review this process

 

If you disagree with a decision in your workplace insurance claim, you can ask a different decision-maker to review the decision and decide whether it is correct. This review process is called an appeal.

There are two separate organizations that make decisions and decide appeals in workplace insurance claims. They are: 

  • the Workplace Safety and Insurance Board (WSIB)
  • the Workplace Safety and Insurance Appeals Tribunal (WSIAT) 

If you disagree with a decision in your claim, you must first appeal it within the WSIB to an internal branch called the Appeals Services Division (ASD).  If you disagree with the decision made by the WSIB Appeals Services Division, you can appeal that decision to the WSIAT.   

The Office of the Worker Adviser (OWA) helps non-unionized workers and their survivors with the appeals process and provides representation services at both the WSIB and the WSIAT. The OWA can also help identify appropriate appeal forms and provide advice about meeting time limits. For more information on accessing OWA services, see Getting Help from the OWA.  

 

 

Overview of the Appeals Process

The chart below is a basic overview of the workplace insurance appeals process:​

            WSIB Operating Level 

The Operating Level includes the front-line decision-makers at the WSIB. The initial decisions in a claim are usually made by WSIB staff at this level, including Eligibility Adjudicators, Case Managers, Return to Work Specialists and Work Transition Specialists. 

If you disagree with a decision of the Operating Level, you can appeal it to the WSIB’s Appeals Services Division.

 

            WSIB Appeals Services Division 

Decisions of the Appeals Services Division are usually made by Appeals Resolution Officers (ARO). The appeal process includes either a written or an oral hearing.  After the ARO has reviewed the file material and considered any submissions, he or she will prepare a written decision explaining the result of the appeal. An ARO decision is generally considered the final decision of the WSIB.

Decisions about the method of resolution (i.e. written or oral hearing) and missed time limits are made by Appeals Registrars.

For more information, see Appeals at the WSIB

If you disagree with an ARO decision, you can appeal it to the WSIAT.

With the exception of decisions on the method of resolution, you can appeal a decision that you don’t agree with from the Appeals Services Division to the WSIAT.

 

          Workplace Safety and Insurance Tribunal (WSIAT) 

The WSIAT is an independent organization and is separate from the WSIB. The WSIAT is the final level of appeal for workplace insurance matters. Decisions of the WSIAT are made by a single Vice-Chair or a three-person panel.  Appeals to the WSIAT often include an oral hearing, but may be dealt with through written submissions alone. For more information, see Appeals at the WSIAT.   

In rare circumstances, decisions of the WSIAT may be reconsidered or judicially reviewed. Reconsideration decisions are made by the WSIAT at its discretion if a threshold test is met. Judicial reviews are made by the Ontario Superior Court of Justice, Divisional Court. The OWA can review a WSIAT decision to determine if there is a reasonable chance it will satisfy the high threshold test for reconsideration. The OWA does not usually assist with judicial review applications of WSIAT decisions.

Time Limits

There are strict time limits to appeal any decisions of the WSIB. Most Operating Level decisions must be appealed within six months.  For decisions about return to work, labour market re-entry or work transition, appeals must be submitted within 30 days.  

There are also strict time limits for appealing to the WSIAT. Final decisions of the WSIB (usually ARO decisions) must be appealed to the WSIAT within six months

If you disagree with a WSIB decision and are not sure about the deadline to appeal, you should carefully check the decision letter you were sent. If you are still unsure of the deadline for appealing, you should seek help from a qualified representative and/or send in the proper appeal form as soon as possible.    

If you have missed the time limit to appeal a decision, you can still file an appeal and request an extension of the time limit.  For information on time limit extension requests at the WSIB and the WSIAT, please see 

Appeal Time Limit Extensions: WSIB

Appeal Time Limit Extensions: WSIAT

   

 

Filing an Appeal

In order to appeal a WSIB decision, you must complete and send the proper appeal form.  The form you need to fill out and send is different for each level of appeal.

 

Decision of

Appeal to

Form

Send Form to

​Operating Level

(front-line decision makers)

Appeals Services Devision

Intent to Object Form

​WSIB

​Appeals Services Division

(ARO decision)

​WSIAT

Notice of Appeal Form

​WSIAT

 

 

If you are planning to have a representative assist you with your appeal, it is a good idea to contact them before you submit an appeal form to the WSIB or the WSIAT.

 

 

Submission and Hearing Tips 

The OWA has prepared general information on oral submissions, written submissions and what to do at a hearing. These resources will give you an idea of what will be expected of you during the appeals process. For more information and tips, see: 

Submissions

Hearing Tips

 

Benefit Related Debts/Overpayments 

Sometimes the WSIB will decide that it has made an error in calculating benefits and has paid out too much money to a worker. For information on what to do in this situation, please see Benefit Related Debts/Overpayments.

 

Further reading:

Office of the Worker Advisor

Workplace Safety and Insurance Board