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:
– 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
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.
My claim was denied. What do I do now?
The Workplace Safety and Insurance Act, allows injured workers to appeal a decision within 6 months from the date of the decision letter. However, there is an exception, some decisions only provide you with 30 days to appeal.
It is important to read the letter carefully. The appeal deadline date is usually on the second page of the decision and is in bold type. More importantly, it is advisable to have the appeal process start as soon as possible.
The appeal process does not start until the WSIB receives the intent to object form.
We would be happy to assist you submit this form in order to protect your right to appeal.
What does the Institute for Injured Workers help with?
We have assisted injured workers with their appeals before both the WSIB and WSIAT (Tribunal) for over 35 years. The process for receiving WSIB benefits can be a long and complicated legal battle, that very few people understand, but we do.
We can help you understand what information is required to win your appeal and get the benefits that are so important to you and your family.