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COMPLETING THE WSIAT NOTICE OF APPEAL
Important:
You have 6 months from the date of a
final Workplace
Safety and Insurance Board (WSIB) decision to appeal that
decision to the Workplace
Safety and Insurance Appeals Tribunal (WSIAT).
You must enclose a copy of the WSIB Appeals
Resolution Officer's (ARO) decision(s) that you are appealing with
the WSIAT Notice
of Appeal (NOA).
For general information about appeals to WSIAT,
see OWA Fact Sheet 25 called "Appealing
to WSIAT".
This document references blocks A to I on the
WSIAT Notice
of Appeal (NOA) as follows:
Block A: If you are a worker
appealing a decision related to your own claim, complete the name,
address and phone number of your employer here.
Block B: If your are a
survivor or dependent appealing on behalf of a deceased worker,
write your name here and complete the contact information for the
worker's employer.
Block C: If you are the worker,
leave this area blank.
Block D: Write the contact information
of your representative in this area.
Block E: If you do not have a
representative, check the box in this area.
Decisions Being Appealed (Page
3 of NOA): Write the date(s) of any decision(s) being appealed and
the corresponding WSIB claim number(s).
Block F: Some WSIB decisions
deal with several issues in the same decision. If you want to appeal
all the issues listed in the Appeals Resolution Officer's decision,
check the box in Block F. Otherwise, go to Block G.
Block G: You may decide
that you only want to appeal some of the issues decided by WSIB.
If you are not sure how to describe the specific issues you wish
to appeal, you may write, "I am appealing the decisions which
denied or reduced my benefits and/or denied me services."
You may also complete the specific issues in
Block G. Some examples of issues are:
- initial entitlement for a workplace injury
- entitlement to loss of earnings benefits
for a period of time
- entitlement to health care benefits
- entitlement to labour market re-entry services
Reasons For Appeal (Bottom of NOA Page 3)
The WSIAT Notice
of Appeal (NOA) asks for specific reasons as to why you
are appealing the decision(s). For example, "the decision was
made without giving sufficient weight to the evidence or without
adhering to WSIB policy and/or the Act."
The following is an example of a specific issue
and the reasons it may be appealed:
Issue: Entitlement to loss of
earnings benefits for a period of time.
Reasons:
- Medical evidence shows that I was totally
impaired during the period in question; or
- Medical evidence shows that I was still
impaired beyond the date that my benefits were cut off; or
- Medical evidence shows that I was partially
impaired during the period and I was not offered suitable modified
work by my employer.
What You Want WSIAT to Do (Page 4 of NOA)
The WSIAT Notice of Appeal (NOA) asks you to
state what you want WSIAT to do if you win the appeal. For example,
"I want WSIAT to order WSIB to grant me the benefits or services
that I have been denied."
Examples of specific orders that WSIAT may
make are:
- entitlement to loss of earnings benefits
(for a specific period)
- initial entitlement to benefits
Block H: The WSIAT Notice of
Appeal form asks you to choose whether you agree or whether you
do not agree to have all the documents in your claim file(s) released
to your employer.
If you AGREE to the release of information,
and your employer decides to participate in the appeal, a copy of
all the material in your file will be sent to the employer. In some
cases, prior employers may be entitled to participate in the hearing,
in which case they will also receive a copy of all the material
in your file. If you agree to the release of your file information,
then date and sign Block H on the WSIAT Notice of Appeal form.
Block I: If you DO NOT AGREE
that WSIAT may release the information in your claim file to the
employer, then date and sign Block I on the WSIAT Notice
of Appeal (NOA) form.
You will be given an opportunity to review
the material in your claim file. If you do not consent to the release
of information, the matter will be placed before a Vice-Chair or
Panel of the WSIAT tribunal for a determination of whether the information
should be released. The WSIAT tribunal Panel or Vice-Chair will
consider whether the documents in question are relevant to the issue
in dispute and may order the release of your claim file to the employer.
Signature: Date and sign in the
box at the bottom of the NOA page 4.
Go to Workers' Kit - Appealing
WSIB Decisions
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IMPORTANT INFORMATION
There are time limits for appealing WSIB decisions. If you
wish to appeal a decision, contact a qualified representative
as soon as possible. For more information on time limits,
see OWA Fact Sheets 24 and 25 called Appealing
to WSIB and Appealing
to WSIAT.
This Fact Sheet contains general information only. It is
not a legal document. To see what the law says, you should
look at the
Workplace Safety and Insurance Act and WSIB policies.
If you require help and do not have a union to assist you,
contact the Office of the Worker Adviser:
- Our toll free telephone
number is 1-800-435-8980 (English) or 1-800-661-6365 (French)
- or visit our website at http://www.owa.gov.on.ca
Cette feuille-info est
aussi disponible en français
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OWA Fact Sheet 31 - June 2005
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