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MATERIAL CHANGE IN CIRCUMSTANCES
What Is the Requirement to Report a Material
Change in Circumstances?
If you are claiming or receiving benefits from
the Workplace
Safety and Insurance Board (WSIB), you must advise them
about any material change in circumstances that affects your entitlement
to benefits within 10 calendar days of it happening. The 10 days
include the day of the change. A surviving spouse, same-sex partner
or dependant who may receive benefits must also report a material
change to WSIB.
What Is a Material Change in Circumstances?
A material change in circumstances is any change
that affects: whether WSIB has to pay you benefits, how much
WSIB has to pay you, or whether WSIB has to give you services. The
following are some common examples of changes that you must report
to WSIB.
Changes in
Your Medical Status
- your work-related injury gets better or
worse,
- your doctor changes your treatment or thinks
you need an operation,
- your treatment stops,
- you need an assistive or prosthetic device
for the first time, or you must change a device that you already
have.
Changes in Your Earnings or Income
Changes in Your Work Status
- your hours of work or your job duties
change,
- you lose your job,
- you retire or decide to stop looking
for work.
Changes in Your Availability for,
or Co-operation in:
Health Care, Early and Safe Return to Work Activities, or Labour
Market Re-entry Programs
- you cannot work because of a medical condition
unrelated to your work injury,
- you change your address or leave the province,
- you go to prison,
- your work visa ends or you receive a deportation
order.
Changes in Your Optional Insurance
Coverage
- your actual earnings
are different from the optional insurance coverage you chose (for
example, a person who is not automatically covered by law under
the workplace insurance system, but who applies to WSIB for such
coverage has optional insurance).
Changes in a Dependant's Entitlement
to Benefits
- a dependant child turns 19 years old and
continues to go to school.
What If You Are Unsure Whether a Change in Your
Situation Is a Material Change?
If you are not sure whether something is a
material change, report it anyway and let WSIB decide.
How Should You Report a Material Change?
If you have a representative, you can request
that (s)he advise your WSIB decision-maker about the change. The
best way to tell your WSIB decision-maker about a material change
is by telephone. You can also do this by regular mail, courier,
fax, or in person, as long as the report reaches WSIB within 10
calendar days of the change happening. Write down when and how you
reported the information to WSIB and keep this note for your records.
Do not leave it up to friends, relatives or your employer to report
a material change for you. When you know about a material change
ahead of time, such as a planned return to work in a week's time,
it is a good idea to tell WSIB about the change as soon as you know
about it, instead of waiting until the last moment.
What Will Happen After You Report a Material
Change?
The decision-maker will review the information
you provided and will decide if it affects your right to receive
benefits or services. The decision-maker will then let you know
about the decision.
What Happens If You Fail to Report a Material
Change or If You Do Not Report It on Time?
If you do not report a material change
or if you report it too late, WSIB may treat the amounts that you
received after the date of the change as a benefit-related debt
(previously called an overpayment). WSIB will ask you to repay this
money or will deduct it from any future benefits you receive. If
necessary, WSIB can go to court to collect these amounts from you.
If WSIB believes that you intentionally failed to report the change,
your case may be sent to its Special Investigations Branch (SIB).
The SIB will investigate your case and may charge you under the
Provincial
Offences Act or the Criminal
Code. If a court finds you guilty, you can receive a
large fine or even go to jail. If you believe that WSIB is thinking
of charging you, you should seek help from a criminal lawyer immediately.
Are Any Benefits Exempt From the Requirement
to Report a Material Change?
Yes. If WSIB is paying you temporary disability
benefits, permanent disability benefits, or survivors' benefits
for an accident that happened before 1990, then you are not required
to report a material change.
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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 7 - January 2003
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