Pension Re-assessment

 

(For Accidents Before January 2, 1990) 

What is a pension re-assessment? 

  • The Workplace Safety and Insurance Board (WSIB) completes a pension re-assessment when it must decide whether your permanent work-related disability has become worse. 

  • If the WSIB decides your permanent disability has become worse, your pension may be increased. 


When can I apply for a pension re-assessment? 

  • If the WSIB did not consider all your work-related medical problems when the amount of your pension was first decided, you should request they do this before you ask for a re-assessment.  The WSIB will automatically re-asses your pension if they agree you have another disability that was not previously considered. 

  • The WSIB can re-assess your pension even when you have not experienced a new accident or injury. 

  • The WSIB recognizes that many medical problems can become worse over time.  As a result, the WSIB will re-assess workers many years after their first assessment as long as there is medical evidence the condition has become worse. 

  • The WSIB may hesitate to do a re-assessment if less than one year has passed since their doctors examined you. 

The WSIB has the authority to increase or decrease your pension after a re-assessment. You should not apply for a re-assessment unless both you and your doctor are certain your condition has become worse.  


How can I apply for a pension re-assessment? 

  • You should get a copy of the last pension assessment report from your WSIB claim file (see Getting Your WSIB File for more information) and ask your doctor, or preferably a specialist, to compare your present condition with your pension assessment report. 

  • If the doctor agrees your condition has become worse, ask him/her to send a report to the WSIB, including the following information:  the physical findings, what your condition is now (the diagnosis), how your condition may change (the prognosis), any recommended further treatment, and an explanation of how your condition has become worse since the last pension examination by the WSIB. 

  • If your doctor does not believe your medical condition has become worse, then do not apply for a re-assessment. 


Who makes the decision? 

  • Once a report is received from your doctor, the WSIB doctors will review your file and decide whether they should re-assess your pension. 

  • Because this process usually takes several months, it is a good idea to contact your WSIB Case Manager about one month after your doctor submitted the report.  You need to ensure the report was received by the WSIB. 

  • The Case Manager will advise you if you need to be re-examined, make arrangements for you to visit the WSIB doctors, and decide whether the WSIB will increase or decrease your pension. 

  • You should call your Case Manager if you have any questions. 


What if the WSIB denies a re-assessment? 

  • If your Case Manager denies a re-assessment you can request a reconsideration of the decision. 

  • The WSIB will decide whether to confirm the earlier decision or to ask a senior WSIB doctor to examine you. 

  • If your Case Manager confirms the WSIB decision, you can appeal to a WSIB Appeals Resolutions Officer (ARO). To start the appeal, you have to send an Intent to Object Form to the WSIB explaining why you believe the decision is wrong.  For more information, see Appeals at the WSIB. 

  • If the Appeals Resolution Officer denies you a pension re-assessment, you can file an appeal to the Workplace Safety and Insurance Appeals Tribunal (WSIAT).  Keep in mind that even the WSIAT can decide to decrease rather than increase your pension award.  For more information, see Appeals at the WSIAT. 

  • Appeals involving pension re-assessments are usually quite straightforward and you may wish to pursue them on your own.  You should collect the information suggested above and submit it to the WSIB or the WSIAT. Your doctor must agree there is objective evidence to support that your condition is worse.  


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.