Appeals

 

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.

For more information, see Appeals at the WSIB. 

If you disagree with an ARO decision, you can appeal it 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 judicially reviewed by the Ontario Superior Court of Justice, Divisional Court. 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.

 

February 2013

IMPORTANT INFORMATION
 
This publication contains general information only. It is not legal advice about a particular situation and is not intended to replace advice from a qualified representative. This publication was last updated on the revision date listed above.