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.
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.
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.
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.
- Benefit for Loss of Earnings (LOE)
- Benefit for Non-Economic Loss (NEL)
- Loss of Retirement Income (LRI) Benefit
- Benefit for Future Economic Loss (FEL)
- Health Care Benefits
- Health Care Equipment and Supplies
- The Occupational Disease and Survivor Benefits Program
- Benefits for Seriously Injured Workers
- Compensation Amounts for Survivors
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:
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
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.