WSIB

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Your Duty as a Worker
Know When to Contact Your Union Rep

WSIB
What is the Workplace Safety and Insurance Board?
What does the WSIB do?

Coverage
Who is covered?
What is covered?

OBLIGATION TO CO-OPERATE
What is this “obligation to co-operate?

FILING A CLAIM
When should I file a claim?
Is there a time limit?
How do I file a claim?
What is a claim number?
Can I re-open a claim?
How do I prove continuity of complaint?

BENEFITS
What benefits do I receive?
What are loss of earnings (LOE)?
For how long do I get the LOE benefit?
Am I automatically entitled to full benefits?
What are partial benefits?
What is my long-term benefit rate?
What happens if I cannot go back to my old job?
How often are benefits reviewed?
What about retirement?
Do I pay tax on benefits?
Are benefits adjusted for the cost of living?
What if a worker dies as a result of a job?
What happens if there is a permanent impairment?

Medical and Other Services
Are medical costs covered?
May I choose my own doctor?
Can I change doctors?
Are special medical services paid for?
Does the Board pay travel expenses?

Going Back to Your Old Employer
I was injured before 1998. Do I have re-employment rights?
What happens if I refuse a job?

Labour Market Re-Entry Plan
What is a labour market re-entry plan?

Appeals
Who has the right to appeal a WSIB decision?
Can my employer appeal?
How do I appeal?
Is there another level of appeal?
What are the time limits?

Do you have more questions?

Your Duty As A Worker

If you are injured on the job, no matter how minor, you must:

  1. Promptly obtain first aid.
  2. Promptly tell your union rep and your employer. If possible, ask to have a union rep present when
    you report the injury to the employer.
  3. Report how, when and where the accident occurred and give names and addresses of witnesses.
  4. Choose a doctor.
  5. Make sure your doctor promptly gives the necessary information to the Board.
  6. Keep in touch with your union rep.
  7. Co-operate with the Board and your employer in all reasonable return-to-work and health care initiatives.
  8. Keep a copy of all your papers and notes of your conversations about your claim and injury.

Know When to Contact Your Union Rep

Contact your rep

  • as soon as possible after you have an accident
  • before your 13th week on benefits
  • about going back to your old employer (re-employment)
  • before you appeal
  • whenever you have questions.

WSIB

What is the Workplace Safety and Insurance Board?

The workers’ compensation system was set up in Ontario in 1915 so that people injured at work would receive compensation, no matter how the accident happened or who caused it. In 1998, the government set up the Workplace Safety and Insurance Board (WSIB) to replace the Workers’ Compensation Board. The WSIB continues the no-fault system. The WSIB is designed to protect Ontario’s workers and employers from financial loss caused by workplace accidents. The WSIB is funded by employers. Workers do not pay into the system.

What does the WSIB do?

The Board pays workers injured on the job a percentage of lost wages and all medical expenses. It offers services and programs to help injured workers make an early, safe and successful return to work.

Coverage

Who is covered?

All construction employers and most other employers must be covered by workers’ compensation. Firms in industries that are not automatically covered, like banking, insurance or independent contractors and operators, can apply for coverage.

What is covered?

The WSIB covers accidents that happen at work and illnesses caused by conditions at work. This includes:

  • an intentional act that is not done by the worker
  • a chance event caused by something physical or natural
  • disablement caused on the job, such as a disease or chronic condition.

OBLIGATION TO CO-OPERATE

What is this “obligation to co-operate?

Workers’ compensation law has always required an injured worker “to co-operate” with the Board. However, there used to be discussion about what co-operation meant. When there was a disagreement,
the Board usually reduced benefits but did not stop them completely. The new law has many more sections in which a worker must “co-operate.” It also allows the Board to cut off benefits if a worker does not co-operate. Workers must co-operate by:

  • providing information needed to settle a claim
  • participating in health care
  • going to health exams that the Board and employer request
  • taking part in early and safe return-to-work or in a labour market re-entry assessment or plan.

FILING A CLAIM

When should I file a claim?

You should apply for benefits if the injury needs more than first aid or if you will lose time from work beyond the day of the accident. Your employer must report the accident within three days.

Is there a time limit?

You must file a claim as soon as possible and no later than six months from the date of your accident or from the date you find out you have an occupational disease.

How do I file a claim?

There are three ways to apply for WSIB benefits.

  1. You can sign the employer’s Report of Injury/Disease (Form 7)
  2. You can fill out and sign the Worker’s Report of Injury/Disease (Form 6).
  3. Your Doctor can complete and send a Form 8 (Health Professional’s Report)

To get benefits, you must agree to allow your doctor to give information about your functional abilities to your employer. Functional ability information describes what you can do at work and what you cannot do because of your accident. It does not include information about your medical condition. When you sign the Form 6 or Form 7 you agree to let your doctor fill out the functional abilities form and give a copy to you, your employer and the Board. If you do not sign one of these forms, the Board will pay no more than two weeks of benefits. If you sign the employer’s Form 7, it does not necessarily mean that you agree with what the employer said on the form. You may send more information to the Board. If you have signed your employer’s Form 7, make sure you fill out a Form 6. If the Board does not send you a Form 6, phone and ask for one. If you think your employer has not reported your accident, call the Board and ask for a Form 6. When you fill out Form 6, give as much detail about the accident as you can. Using a Form 6 is important, as it lets you tell your version of the accident. The employer must give you a copy of the Form 7 it sends to the Board. If you fill out a Form 6, you must give your employer a copy.

What is a claim number?

You will get a letter from the Board giving you a claim number. This does not mean your claim has been accepted. It means that the Board knows about your claim and has opened a file for it. Use this number every time you contact the WSIB about your claim.

Can I re-open a claim?

If a compensable injury recurs or flares up, or if it is more serious than originally thought, you can ask the Board to re-open the claim. You will need to establish continuity of complaint, ongoing difficulties, since the original accident.

How do I prove continuity of complaint?

You must give the Board:

  1. a list of co-workers (names, addresses and phone numbers) with whom you have talked about the injury
  2. a list of doctor’s visits about the injury and
  3. a list of your complaints to the employer about the injury.

It is important, when you return to work, to report each recurrence of pain to the employer and your
doctor.

BENEFITS

What benefits do I receive?

You are paid a loss of earnings (LOE) benefit from the day after the injury or when the loss of earnings begins.

What are loss of earnings (LOE)?

Loss of earnings replaces the temporary benefits and future economic loss awards (FEL). LOE benefits are paid at 85% of your net average earnings (NAE) before the injury, less any earnings after the injury up to an annual maximum. Net earnings are your take-home pay (what is left after taxes and deductions).

For how long do I get the LOE benefit?

The benefit is paid until one of the following conditions applies:

  1. you no longer have a loss of earnings
  2. you turn 65
  3. you are no longer impaired
  4. you do not co-operate in returning to work or in health care.

Am I automatically entitled to full benefits?

No. You will get full benefits only if you are unable to return to modified work or if your employer does not offer suitable work. You are entitled to full benefits if your injury makes it impossible for you to work or if you have not yet returned to work but are co-operating in health care and return-to-work activities.

What are partial benefits?

If you return to work at a wage loss or if you are ready to return to work after an assessment or plan, you are entitled to partial loss of earnings benefits. Partial LOE benefits are 85% of the difference
between your pre-injury net average earnings and your post-injury NAE earnings. Post-injury net average earnings may be what you earn. Or they may be what the Board says (deems) you are able to earn. The Board uses deemed earnings if you have completed a labour market re¬entry assessment or plan and are ready to take a job. The job may be a different one.

partial loss of earnings benefits =pre-injury net average earnings – post-injury earnings x 85%

What is my short-term benefit rate?

The Board calculates your short-term (12 weeks) rate based on your rate of pay. It includes your pay from all your employers at the time of the accident. For the first 12 weeks off work, you will receive 85%
of your net (take-home) wages. Vacation pay is included only if it is paid as a percentage of base rate
on each cheque. Regular overtime is included only if it has been earned in each of the four weeks before
the accident.

Contact your rep before your 13th week on benefits.

What is my long-term benefit rate?

After 12 consecutive weeks of benefits, the Board automatically changes your benefit rate to one based on your long-term earnings. The long-term rate includes all your earnings for the two years before the accident. It takes into account periods of unemployment, seasonal layoffs, unemployment benefits and jobs worked at the same time.

It is important to contact a union representative before the 13th week to make sure that the Board
includes all your sources of income.

What happens if I cannot go back to my old job?

It is possible that your injury will be permanent and you will return to a different kind of work that pays less. The system sees this as a loss of earnings. In this case, the Board decides what your earnings ability is and calculates the difference between your earnings before the accident and what your earnings will be after the accident. This difference is the total partial loss of earnings. After an assessment, the Board will determine your new job goal and its projected wage. This process is known as “deeming.”

How often are benefits reviewed?

Benefits can be reviewed up to once a year for six years and at any time during that period if there is a
change in your material circumstances, such as a change in income, return-to-work status or medical
condition.

After six years, LOE benefits can be reviewed only if there was a change in circumstances that was not reported, or if there has been a deterioration in the compensable condition.

You must report any change in your medical condition, income, or availability for work or rehabilitation within10 days. Failure to report can lead to fraud charges.

What about retirement?

The Board sets aside 5% of your long-term loss of earnings benefits. This amount is meant to compensate for the loss of retirement income. It is calculated from the date the worker starts receiving long-term benefits until age 65. This amount is paid in a lump sum.

Do I pay tax on benefits?

No. You do not pay income tax on compensation.

Are benefits adjusted for the cost of living?

Yes, benefits are indexed for cost of living.

What if a worker dies as a result of a job?

If a worker dies from a workplace injury or disease, benefits are paid to the worker’s surviving spouse and dependents. Benefits may be some combination of a lump sum payment, monthly payment and burial expenses. A surviving spouse may be entitled to social rehabilitation as well as a labour market re-entry assessment or plan.

What happens if there is a permanent impairment?

If the injury is permanent, an independent doctor of your choice will assess you for a non-economic loss
award (NEL).

Medical and Other Services

Are medical costs covered?

WSIB covers the costs of medical aid required as a result of a workplace injury. This includes hospital care, medical attention, surgery and approved drugs. If you suffer a compensable injury or disease and do not lose time from work, you are still eligible for medical benefits.

May I choose my own doctor?

Yes, you may go to the doctor of your choice. A referral to a medical specialist, if needed, will normally be arranged by your own doctor or with the WSIB staff doctors. When you visit a doctor, say the problem is work-related. This makes sure that the doctor sends reports to the Board. The employer has the right to send you to a doctor of the employer’s choice, as well. The Board may request an exam by a Board doctor or an independent physician or specialist. If you go to another doctor, make sure the doctor sends a copy of the results of your visit to your doctor.

Can I change doctors?

If you want to change doctors, you must inform the Board and have a reason for the change. If you do
not, your benefits might be suspended or stopped.

References to doctor include other health practitioners such as chiropractors.

Are special medical services paid for?

If needed, special services are provided to help you recover and return to work. These services may
include medical and surgical treatment, physiotherapy or other therapies, including treatment by a
chiropractor.

Artificial limbs and devices such as wheelchairs, motorized scooters, crutches, canes, back supports,
will be supplied and repaired or replaced. In addition, eyeglasses or dentures damaged in an accident will be repaired or replaced. The Board may also pay for damage to clothing or boots.

Does the Board pay travel expenses?

The Board pays for travel expenses for treatment, examinations, hearings, etc.

Going Back to Your Old Employer

I was injured before 1998. Do I have re-employment rights?

Yes, if you meet all of these three criteria:

  • you must have a lost time injury
  • your employer must regularly have at least 20 workers
  • you must have worked for 12 continuous months for that employer.

If you do not meet all three criteria, the employer does not have an obligation to re-employ you.

What happens if I refuse a job?

If you think the work offered is not suitable, you can ask the Board to mediate. If the Board rules against
you, you are considered to be uncooperative, and the Board will stop your benefits. If you think the Work being offered is not within your physical capabilities, contact your union rep immediately and get help.

Labour Market Re-Entry Plan

What is a labour market re-entry plan?

The goal of Labour Market Re-Entry Plan (LMRP) is to make sure that injured workers have the skills and
abilities to re-enter the labour market in jobs that are safe and consistent with their abilities and that are as close to their previous jobs as possible. Labour market assessments or plans can be done through private sector providers. The Board no longer has vocational rehabilitation case workers. Most of the
counselling will be done through private firms. A LMRP can include academic upgrading, skills training and training in job search techniques.

Appeals

Who has the right to appeal a WSIB decision?

You can appeal a WSIB decision about benefits or a claim that was denied. The spouse or a dependent of a deceased worker can appeal a decision about benefits or a claim that was denied. An employer who disagrees with a worker’s claim can appeal.

Can my employer appeal?

Yes, your employer can file an appeal about your claim. In fact, many appeals come from employers.

How do I appeal?

Write to the WSIB saying you disagree with the decision. Add any new information that could influence the decision. If the Board does not change the decision, they will send you a copy of the file and an objection form. Complete this form and return it to the Appeals Branch of the WSIB.
Your file is assigned to an Appeals Resolution Officer. The officer will contact you and your employer. Contact your union rep before you appeal.
Is there another level of appeal?

The final level of appeal is the independent Workplace Safety and Insurance Appeals Tribunal (WSIAT). This tribunal reviews the issues and may resolve them through mediation or a hearing. You cannot appeal about overpayments, lump-sum payments or employer-requested health exams.

What are the time limits?

You must appeal return-to-work or labour market reentry decision within 30 days. You must appeal any other decision within six months. The Board can extend the time limits in some cases, and it can reconsider a decision at any time. The limit for appealing final decisions of the Board to the Workplace Safety and Insurance Appeals Tribunal (WSIAT) is six months.

Do you have more questions?

Contact your union rep or the Provincial Building Trades Council at (416) 679-8887. The workers’
compensation law is complicated.