FAQs: Workplace Insurance

 

For quick reference, these FAQs are divided into several areas:

Filing a claim with the WSIB
Your WSIB file
Communicating with the WSIB
Work reintegration
WSIB decision makers
Appeals
Other questions

 

Filing a claim with the WSIB

What is workplace insurance?

The workplace insurance system provides benefits and services to workers who have been injured at work or who have illnesses related to work. Workplace insurance is also called workers’ compensation.

To qualify for workplace insurance benefits, you must meet the requirements set out in the Ontario law that governs workplace insurance. This law is called the Workplace Safety and Insurance Act, 1997 (WSIA).

If you are covered by the WSIA, you cannot sue your employer in court for your injuries. Workplace insurance is a "no-fault" system. This means you can get workplace insurance benefits without proving that your employer was to blame for your injury or disease. Even if you think that the accident at work was your own fault, you are still entitled to benefits and services from the WSIB in almost all cases.

 

When should I report an injury at work?

You should report a work-related injury to your employer as soon as possible. If you require more than first aid treatment both you and your employer are required to report the work-related injury to the Workplace Safety and Insurance Board (WSIB). First aid treatment that usually would not require reporting to the WSIB includes things such as:

  • putting on a bandage

  • applying heat or cold to your injury

  • applying an over-the-counter cream to your injury

If you have told your employer about your injury and it requires more than first aid, your employer is required to send an Employer's Report of Injury/Disease (Form 7) to the WSIB within 3 business days of the injury. Your employer is also required to give you a copy of the Form 7.

If you are injured at work, you should seek medical attention right away. If your injury requires more than first aid, tell the person treating you to send a Health Professional’s Report (Form 8) to the WSIB.

 

Is there a deadline to report my injury to the WSIB?

Yes. You must file a claim with the WSIB no later than six months from the date of your workplace accident or the date you discover you are suffering from an occupational disease. For more information, see Filing a WSIB Claim.

 

How do I report my workplace injury to the WSIB?

To apply for workplace insurance benefits you should complete, sign and send in a Worker's Report of Injury/Disease (Form 6). You can get this form on the WSIB website or you can phone the WSIB toll-free at 1-800-387-0750.

When you are completing a Form 6, you need to provide the WSIB with detailed information about your accident. You must also provide your employer with a copy of the completed Form 6 that you sent to the WSIB.

eFiling: If your employer filed an Employer's Report of Injury/Disease (Form 7) and the WSIB has assigned a claim number to your accident, the WSIB will send you a letter asking you to file a Form 6. You may complete and file an eForm 6 on the WSIB website. You must print the eForm 6 before filing it as you are required to give a copy to your employer.

 

What should I do if my employer refuses to report my accident to the WSIB?

Report your work-related injury promptly to the WSIB on your own. You can phone the WSIB at 1-800-387-0750 to report your injury and explain your difficulties with your employer. You can also report your injury by completing a Worker's Report of Injury/Disease (Form 6) and sending a copy to the WSIB.

After you have reported your injury to the WSIB, the WSIB will contact your employer to obtain the Employer's Report of Injury/Disease (Form 7).

It is also important to tell your doctor about your injury and request that he or she send a Health Professional's Report (Form 8) to the WSIB on your behalf.

 

What should I do if I was hurt at work in another province?

If there is a worker adviser office in the province where your injury occurred, you should contact them for assistance. You can visit the following website for a list of worker adviser offices across Canada.

 

Can I get workplace insurance benefits from the WSIB if I was hurt at work without an obvious accident?

Yes. Under the WSIA, a disablement, which is a condition that happens over time as a result of your work, is considered to be an accident. An example of such a condition is carpal tunnel syndrome. You can file a claim for a work-related accident that is a single chance event or a disablement.

The WSIA also covers occupational diseases. An occupational disease is a disease that was caused by some aspect of your job. Often, occupational diseases are caused by exposure to chemicals or substances in the workplace. Examples are asbestosis or mesothelioma from exposure to asbestos at work. 

 

Should I file a workplace insurance claim with the WSIB if I think I am an independent operator?

Yes. Some independent operators are covered by the WSIA.

If you work in the construction industry and are an independent operator, as of January 1, 2013 you are considered a worker under the WSIA. This means you can claim benefits from the WSIB if you get injured at work. For more information see Who is Covered by the Act?

If you work in an industry other than construction, you may or may not be considered a worker under the WSIA. Some people who think they are independent operators actually fall under the definition of a worker under the WSIA. If you think you are an independent operator and you have been injured at work, you should still file a claim with the WSIB. That way, if you are covered by the WSIA, you will meet the WSIB’s time limit for registering a claim. For more information on how the WSIB determines if you are a worker under the WSIA, see Organizational Test for Workers.

If your claim with the WSIB is denied, you can contact the OWA for assistance.

 

How can I pay for my living costs while I am waiting for the WSIB to pay me?

You may qualify for other benefits while you are waiting for a workplace insurance claim decision. However, you may be required to pay back these other benefits if you later receive benefits from the WSIB. To find out if you are eligible for other benefits, you can contact the following:

  • your employer regarding short-term sickness benefits

  • your insurance company, if you have paid for disability insurance

  • Service Canada regarding Employment Insurance (EI) sickness benefits or Canada Pension Plan (CPP) disability benefits

  • your local Ontario Social Assistance Office for information on Ontario Works or the Ontario Disability Support Program (in the blue pages of the phone book or from the Ministry of Community and Social Services website).

 

Your WSIB file

Can I see what is in my WSIB file?

Yes. You can get a copy of your WSIB file by sending a letter to the WSIB asking for a copy, or by objecting to a WSIB decision. For more information, see Getting Your WSIB File.

 

Can the OWA see my WSIB file?

Yes. However, the OWA must have your written authorization to get a copy of your WSIB file. You may also provide us with a copy of the file if you already have it.

 

Can my employer see my WSIB claim file?

Yes. Your employer may request a copy of your claim file if you appeal a WSIB decision or if your employer disagrees with a WSIB decision made in your claim. For more information, see Employers and Claims.

 

Communicating with the WSIB

Once I am receiving benefits, how often should I keep in touch with the WSIB?

You must report any "material change in circumstances" to the WSIB. This includes any change in:

  • the medical status of your work-related injury

  • your earnings or income

  • your work status, or

  • your ability to co-operate with various programs

For dependants, you should also report any changes in the dependant status of children.

If you are not sure whether you should report a change, it is always best to report the change to the WSIB. For more information, see Material Change in Circumstances.

 

Can I refuse to answer questions from the WSIB?

No. You should answer all questions asked by the WSIB. The law imposes an obligation on workers to co-operate and to provide any information required by the WSIB to adjudicate a claim. This is particularly important when discussing a work transition assessment or plan. For more information, see Duty to Co-operate.

 

Work reintegration

Is my employer required to hold my job for me while I am receiving WSIB benefits?

If you have worked with your employer for at least 12 continuous months and your employer regularly employs 20 or more workers, then there is an obligation to re-employ you after a work-related injury. Special rules apply to construction workers, seasonal workers, trainees, temporary help agency workers and contract workers. For more information, see Re-employment.

 

How long does my employer’s re-employment obligation last?

If your employer has a re-employment obligation, your employer must try to re-employ you until the earliest of the following:

  • two years after the date of your injury

  • one year after the WSIB advises your employer that you are able to perform the essential duties of your regular job

  • the day that you turn 65 years of age

 

Am I required to answer phone calls from my employer while recovering from my work-related injury?

Yes. You must cooperate with your employer and the WSIB at all times. Both you and your employer have a duty to communicate with each other throughout the period of your recovery. Even if your employer has an obligation to re-employ you, you must still co-operate in early and safe return to work activities.

If you refuse calls from your employer, the WSIB may decide you are not co-operating and may terminate your benefits. For more information, see Early and Safe Return to Work.

Your employer cannot harass you, however. If you feel you are being harassed by your employer, you should contact your WSIB decision maker.

 

What should I do if I cannot return to my pre-injury job?

If you are unable to perform your pre-injury job, but are able to do some other kind of work, you can ask your employer for an accommodation, or a modification, that will help you return to work. Your employer must offer you the first suitable employment that becomes available. Work is considered suitable if it is safe, productive, within your functional abilities and, to the extent possible, restores your pre-injury earnings. For more information, see Returning to Work.

 

Can my employer change my hours when offering me suitable alternative work?

Yes. If you are unable to perform your pre-injury job, your employer can offer you some other kind of work with a different schedule or a different number of hours per day than your pre-injury job. However, the modified duties and hours of the new work have to be suitable and within your functional abilities, and to the extent possible must restore your pre-injury earnings. If the change in hours results in a decrease or an increase in earnings, you should notify the WSIB immediately. A decrease or an increase in earnings is a material change in circumstances that must be reported to the WSIB within 10 days and may result in an adjustment to your loss of earnings benefit. For more information, see Material Change in Circumstances.

 

What if my employer offers me work that is not safe or suitable?

You can refuse to do work that you think is unsafe or unsuitable. You should, however, contact the WSIB immediately to let them know your concerns. A Return to Work (RTW) Specialist may try to negotiate changes to the work to make it safe or suitable. You and your employer may be asked to evaluate the work or the workplace, or you may be required to take part in a functional abilities evaluation. If you still disagree and refuse to try the work, the WSIB will make a decision.

Unless the work is clearly unsafe for you or others, it is usually best to try the work offered by your employer to see if you can do it. If you are unsure whether the work is suitable or safe, discuss it with your doctor and a qualified representative. For more information, see Early and Safe Return to Work.

 

What if my employer has no suitable work available?

If you and your employer are not successful in arranging your return to suitable work, and you have a permanent work-related impairment, you may be eligible for a work transition (WT) assessment that looks at your ability to do other work. The WT assessment may also recommend training to help you return to work in another suitable occupation (SO). The WSIB will work with you and your employer to identify a job or jobs for you. For more information, see Work Transition.

 

What can I do if my compensable condition is deteriorating while I am in school under a work transition plan?

First, go see your doctor for an assessment of your condition. If your condition has deteriorated, your doctor should file a Health Professional's Report (Form 8) with the WSIB. Second, contact your WSIB Work Transition Specialist and advise him/her of the change in your medical condition. As this is a material change in circumstances, you must advise your Work Transition Specialist of the change within 10 calendar days.

If you are unable to continue your WT plan, the WSIB should discuss your condition and restrictions with you and your doctor. The WSIB should make every reasonable attempt to revise your WT plan and provide accommodations so you can continue.

For more information, see Material Change in Circumstances and Work Transition.

 

WSIB decision makers

Who makes the decisions about my claim at the WSIB?

There are a number of decision makers at the WSIB. The person making decisions about your claim will change as you move through the different stages of the claim. The name and title of the decision-maker will be on the letters that you receive from the WSIB.

Some of the decision makers at the WSIB include:

Name of decision maker

Makes decisions about

Eligibility Adjudicator

whether your injury is related to your work

Case Manager

what benefits and services you are entitled to

Nurse Consultant

which health care ser​​​vices are allowable in your claim

Return to Work (RTW) Specialist

issues around your returning to work with your employer

Work Transition (WT) Specialist

your suitable occupation (SO) and what, if any, retraining you need to do the suitable occupation

Appeals Resolution Officer (ARO)

issues that have been appealed

 

Who should I contact at the WSIB about delays in my claim?

You should contact the person who is making decisions about your claim. That person’s name and phone number will be on the letter that you most recently received from the WSIB. If you do not have a recent WSIB letter, call the WSIB at 1-800-387-0750 and provide your name, your claim number, and the name of your accident employer. The WSIB can then provide you with the name of the decision-maker assigned to your case.

 

What should I do if my WSIB decision maker does not return my calls?

You should follow-up with the decision maker by mail or fax, and ask them to call you back. In your written request, you can indicate the dates and times of your calls that have not been answered. If you still receive no response, you should contact the decision-maker’s manager. To find out the name of your decision-maker’s manager you can either ask your decision-maker or phone the main WSIB number at 1-800-387-0750. If you reach the manager's voice mail, you should leave a detailed message with your name, your claim number, and the reason for your call.

 

I am not happy with the WSIB decision maker assigned to my file. Can I request that the WSIB decision maker be changed?

You can make a request, however the decision maker will probably not be changed unless their behaviour towards you is extremely unprofessional. If you simply disagree with a decision on your file, you will not get a new decision maker. Instead, you may appeal the decision. It is important that you meet the time limit to appeal the decision. For more information, see Appeals at the WSIB.

If you think the decision maker is not acting professionally with you, it is a good idea to keep detailed notes of the conversations or incidents that have caused you concern. If you feel the treatment you received is unacceptable, you can speak to the manager of the decision maker. In deciding if you should complain to the manager, it is important to keep in mind that the decision-maker will probably continue to be the person making decisions on your file.

If you feel the conduct of both the decision maker and the manager is unprofessional, you may contact the Fair Practices Commission at 1-866-258-4383. The Fair Practices Commission is responsible for ensuring that administrative practices and services of the WSIB are fair, reasonable, appropriate and equitable.

 

Appeals

What should I do if I disagree with a decision in my WSIB claim?

Operating Level decisions

If you do not agree with an Operating Level decision in your claim, you should complete an Intent to Object Form and send it to the WSIB. You should also review the Worker Instruction Sheet for filing out the form. This form will start the WSIB’s appeal process. You can get the Intent to Object Form on the WSIB’s website, or you can ask the WSIB to send you a form by mail.

Please note that your decision letter will have an appeal deadline date listed near the bottom of the decision. You must send the Intent to Object Form to the WSIB before the date listed on your decision letter. You must send an Intent to Object Form to the WSIB each time that you disagree with a WSIB decision. For more information, see Appeals at the WSIB.

Appeals Services Division decisions

Final decisions of the WSIB are usually made by Appeals Resolution Officers (AROs) in the Appeals Services Division. If you do not agree with a final decision of the WSIB, you can appeal to the Workplace Safety and Insurance Tribunal (WSIAT). You must complete the WSIAT Notice of Appeal (NOA) form and return it to the WSIAT within 6 months of the date of the final decision from the WSIB. You may obtain the NOA form from WSIAT by calling 1-888-618-8846. You should include a copy of the decision you are appealing along with the NOA form. For more information, see Appeals at WSIAT.

 

Is the appeal deadline in a WSIB letter a final deadline?

Yes, the appeal deadline is a final deadline and should be taken very seriously. Do not wait until the last minute to act if you disagree with a WSIB decision.

If you miss an appeal deadline, you will usually not be allowed to proceed with your appeal. In some circumstances, however, the time limits may be extended. For more information on requesting a time limit extension, see Appeal Time Limit Extensions: WSIB and Appeal Time Limit Extensions: WSIAT 

 

How can I get a copy of the policy that is mentioned in a decision letter?

Current WSIB policies are available on the WSIB website. Any older policies that apply to your claim are not available in this manner.

If you are unsure which policy was used to make a decision in your claim, it is appropriate to call and ask for that information. Make sure you get the policy number (for example, 11-02-02), the name of the policy (for example, Lost Time Claims) and the date of the policy (for example, June 2008).

If you would like a copy of a policy that is not on the WSIB website, you can get it from the following sources:

WSIB Reference Library
17th Floor, Simcoe Place
200 Front Street, Toronto, Ontario

Ontario Workplace Tribunals Library
505 University Avenue, 7th Floor
Toronto, Ontario
WSIB
1-800-387-0750
Email: opb@wsib.on.ca

 

Can I appeal directly to the WSIAT?

No. All WSIB decisions about benefits and services must first be reviewed by an Appeals Resolution Officer (ARO) at the WSIB.

 

Can my employer dispute the benefits the WSIB has allowed?

Yes. Your employer can object to the WSIB’s decisions in your claim. This includes which benefits and services you are entitled to or even whether you are entitled to any benefits or services at all. The same appeals system applies to you and your employer, including the time limits. For more information, see Employers and Claims.

 

Can my employer use information about me that it finds on the Internet?

Yes. If it is relevant to your claim, your employer could submit evidence obtained online to challenge your entitlement to benefits. Your employer, or a potential employer, may be able to find out a lot about you through a simple Internet search. This is especially true if you use social networking sites like Facebook, MySpace, LinkedIn, or Twitter.

Text or pictures you post on the Internet could give the wrong impression about your medical condition or your ability to work, especially if taken out of context. This could affect your WSIB claim or your ability to find a job.

 

Here are a few things you can do to protect yourself:

Make sure you understand and use the privacy controls on social networking sites like Facebook, MySpace, LinkedIn or Twitter.

Before you post anything, think about how others might view it. If it could give the wrong impression about your injury, health, employability, or other compensation-related matter, do not post it. 

The following websites provide information on how to protect your privacy on the Internet:

Fact Sheet: Social Networking and Privacy, Office of the Privacy Commissioner of Canada

Reference Check: Is Your Boss Watching? Privacy and Your Facebook Profile, Information and Privacy Commissioner of Ontario

 

Do I need a lawyer or licensed paralegal to represent me in my appeal?

Workers are not required to have a lawyer or licensed paralegal represent them in a WSIB or WSIAT appeal. Many workers across the province are represented by the Office of the Worker Adviser, community legal clinics or unions, all of which provide services free of charge.

If you feel you need to speak to a lawyer or licensed paralegal, you can contact the Law Society Referral Service and request a referral to a lawyer or licensed paralegal with expertise in workplace insurance appeals. The Law Society Referral Service can be contacted at 1-800-268-8326 or 416-947-3330. The Law Society Referral Service will provide you with the name of a lawyer or licensed paralegal that will offer a free consultation of up to 30 minutes.

Whether you win or lose your appeal, you are still required to pay your own legal fees to lawyers and licensed paralegals, as the WSIB does not cover legal fees. You may, however, be eligible for a legal aid certificate to pay your legal fees.

 

Will the OWA represent me in my workplace insurance appeal?

The OWA represents non-unionized injured workers and their survivors on appeals at the Workplace Safety and Insurance Board (WSIB) and at the Workplace Safety and Insurance Appeals Tribunal (WSIAT). The OWA may represent you in your appeal, depending on our resources and on the nature of your workplace insurance problem.

Whether the OWA represents you or not, we will help you identify any time limits you have to meet in your case. We will also help you file the proper appeal forms with the WSIB or the WSIAT in an effort to preserve your appeal rights.

For more information, see Getting help from the OWA.

 

Other questions

What if I have a question that isn’t answered here?

If you have a question that is not answered in the FAQs, you can contact the OWA for more information.

You can contact the Office of the Worker Adviser about workplace insurance matters by phoning toll-free:

1-800-435-8980 (Service in English)
1-800-661-6365 (Service in French)
1-866-445-3092 (TTY)

 

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.