FAQ

 

When can I make a claim for WSIB benefits?

 

As a worker, you can claim benefits for a work-related accident or illness if you have:
 

  -  received health care, and/or

  -  lost time or wages from work beyond the day   of accident/illness, or

  -  continued to work but on partial hours only.

 
If you had to do different work due to the accident/ illness for more than seven days and did not see a health professional, you can also make a claim.
 
 
 
 
What are my reporting obligations?
 

You must notify the WSIB, within 10 calendar days, of any significant change in the status of your claim and eligibility for workplace disability insurance benefits (known as material change). Failing to report a significant change could result in reduction or suspension of your WSIB benefits.

Significant changes include:
 

 - returning to work

 - beginning to receive other income or government benefits

 - significant changes in your medical condition.

 
 
 
What happens when the WSIB receives my claim?
 

After  the WSIB register your claim, a case manager or nurse consultant will call you to find out how you are and to get any information still needed to make a decision on your claim.
When a claim is registered, the WSIB give it an 8-digit claim number. A claims manager considers the information and makes decisions on claims for disability benefits. A nurse consultant monitors the rehabilitation and health care needs of ill or injured workers.
 
 
 
 
What benefits can I receive?
 

Your workplace insurance entitles you to a range of benefits. The benefit most people are familiar with is the replacement of earnings you lose while disabled by workplace illness or injury (benefit for loss of earnings), but a number of other WSIB benefits are available to you.
 
 
 
 
What must I do while receiving benefits?
 

It is to your benefit to cooperate in your return to health and your safe return to work. As a person receiving WSIB benefits it’s also your responsibility.

Most workers are helpful and cooperative in this matter. But in rare cases where a worker is determined by the WSIB to be uncooperative, the worker’s benefits may be reduced or suspended after a continued period of non-cooperation.
 
 
 

To receive WSIB benefits, you must:
 
 
1.  Cooperate in your recovery by following the treatment and health care  prescribed by your health care professionals.
 
2.  Have health examinations as required by the WSIB.  The WSIB may require a healthexam if it will help WSIB make a decision as to your case, or if it will help you re-enter the job market. Your employer may request a health exam if it will provide significant new information regarding your case.
 
3.  Cooperate in your Early and Safe Return to Work program or your Labour Market Re-entry program.
 

4.  Report any material change in your circumstances to the WSIB. 
Some examples of material changes are:

       - any change to your income

      - significant changes in your medical condition

      - returning to work

5.  Provide any information that the WSIB needs to assess your case.
 
 
 
 
 
Worker Appeals
 

If the WSIB makes a decision you do not agree with, your first step should be to discuss the issue with the person who made the decision. By communicating constructively with the decision maker, you can often resolve a dispute early, without going through the substantial time and effort of a formal appeal.

Even when a formal appeal is necessary, the WSIB always encourage a positive and cooperative approach in order to reach a resolution that is fair to everyone involved. 
 
 
Legal advice should be sought when appealing any decision.