You should report a work-related injury to your employer as soon as possible. If you require more than First Aid, both you and your employer are required to report the work-related injury to WSIB. If you have told your employer about your injury, your employer is required to send an Employer's Report (Form 7) to WSIB within 3 business days. You must file a claim with WSIB no later than six months from the date of your workplace accident in order to receive benefits. For more information, see OWA Fact Sheet 3 called Filing a Claim and/or consult the WSIB Website.

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Report your work-related injury promptly to WSIB on your own. You can phone WSIB at 1-888-606-7676 to report your injury and explain your difficulties with your accident employer. You can also report your injury by completing a Worker's Report (Form 6) and sending a copy to WSIB. Information about the Form 6 is available on the WSIB Website.

After you have reported the injury to WSIB, then WSIB will contact your employer to obtain the Employer's Report (Form 7). Also, it is important is to tell your doctor about your injury and request that (s)he send a Health Professional's Report (Form 8) to WSIB on your behalf.

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No. The OWA provides free and confidential services to non-unionized injured workers and their survivors.

The OWA can help you by:

• Providing information and advice on workplace insurance and the appeal process.
  
  
• Representing non-unionized injured workers and survivors at all levels of workplace insurance appeals.
  
  
• Assisting with early and safe return to work and labour market re-entry.
  
  
• Referring injured workers to appropriate community resources.
  
  
• Providing free information materials.
  
  

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The OWA is prohibited by the Workplace Safety and Insurance Act (the "Act") from representing unionized injured workers. You should contact your union for assistance. The OWA can, however, help you if you were injured in a unionized workplace, but are no longer in that workplace. For more information, please see OWA Fact Sheet 1(b) called Getting Help from the Office of the Worker Adviser.

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In some situations, smaller locals may not have staff trained to assist with WSIB claims. For unions affiliated with the Ontario Federation of Labour (OFL), you may contact the OFL directly at 1-800-668-9138 for alternate referrals.

No. The OWA is an Agency of the Ontario Ministry of Labour and, as such, is independent of the Workplace Safety and Insurance Board (WSIB).

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

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You can get a copy of your WSIB claim file by requesting it in writing from WSIB, or by objecting to a WSIB decision. For more information, please see OWA Fact Sheet 5 called Your Claim File and How to Get It.

Yes. Your employer may request a copy of your claim file if you appeal a WSIB decision or if the employer disagrees with a WSIB decision made in your claim. See OWA Fact Sheet 4 called Employers and Claims.

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You should contact the Worker Adviser Office in the province where your injury occurred. You can visit the following website for a list of Worker Adviser Offices across Canada:

http://www.labour.gov.bc.ca/wab/location_can.htm

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You should request modified work from your accident employer. For more information, see OWA Fact Sheet 10 called Early and Safe Return to Work.

If you have worked with your employer for at least 12 continuous months and the 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. There are a number of details pertaining to this re-employment obligation. For more information, see OWA Fact Sheet 11 called Re-employment.

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You may be eligible for a labour market re-entry assessment that tests your ability to do other work and may also recommend training to help you return to work. See OWA Fact Sheet 12 called Labour Market Re-entry.

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You should consider the situation very carefully before refusing modified work. If you refuse modified work then WSIB may decide you are not cooperating and terminate your benefits. See OWA Fact Sheet 10 called Early and Safe Return to Work.

Yes, your employer can offer modified duties with a different schedule or a different number of hours per day than your pre-injury job. However, the modified duties and hours have to be suitable and within your functional abilities. If the change in hours results in a decrease or an increase in earnings, you should notify WSIB immediately. A decrease or an increase in earnings is a material change in circumstances that must be reported to WSIB within 10 days and may result in an adjustment to your Loss of Earnings benefit. For more information, see the OWA Fact Sheet 7 called Material Change in Circumstances.

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Yes. In the Act, the word "accident" includes disablement, which is a condition that emerges over time as a result of your work. An example of such a condition is carpal tunnel syndrome. The Act also covers occupational diseases. For more information, please see OWA Fact Sheets 3 and 14 respectively, called Filing a Claim and Occupational Disease.

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You should contact your Claims Adjudicator about delays in your claim. The name of your Claims Adjudicator appears on correspondence you have received from WSIB. If you do not have any WSIB correspondence, call WSIB and provide your name and the name of your accident employer. WSIB can then provide you with the name of the Claims Adjudicator assigned to your case.

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

You should follow-up with your Claims Adjudicator by mail or fax, indicating in writing the dates and times of your calls. If you still receive no response, you should contact the Adjudicator's manager. If you reach the manager's voice mail, you should leave a detailed message identifying yourself, providing your claim number, and the reason for your call.

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You can make a request, however your Claims Adjudicator will probably not be changed unless their behaviour towards you is extremely unprofessional. If you simply disagree with a Claims Adjudicator's decision on your file, you will not get a change of Adjudicator. Instead, you may appeal the Adjudicator's decision. It is important that you meet the time limit to appeal the decision. Please see OWA Fact Sheet 24 called Appealing To WSIB.

If you think the Claims Adjudicator is not dealing professionally with you, it is a good idea to keep detailed notes of the conversations or incidents you have had with the Adjudicator that have caused you concern. If you feel the treatment you received is unacceptable, you can speak to the Claims Adjudicator's manager. To find out the name of the manager, you can either ask your Claims Adjudicator or call the main WSIB number (416-344-1000 or 1-800-387-0750) and request the information. In deciding if you should complain to the manager, it is important to keep in mind that your Claims Adjudicator will probably continue to be the person making decisions on your file.

If you feel the conduct of both the Claims Adjudicator and the manger 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 WSIB are fair, reasonable, appropriate and equitable.

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You should answer all questions posed by your Adjudicator. The law imposes an obligation on workers to co-operate in providing any information required by WSIB to adjudicate a claim. This is particularly important when discussing a labour market re-entry assessment or plan. For more information, see OWA Fact Sheet 6 called Duty to Co-operate.

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The employer has a duty to communicate with you throughout the period of your recovery in an effort to provide you with suitable and available employment. If you refuse calls from your employer, WSIB may decide you are not co-operating and may terminate your benefits. Please note that your employer cannot harass you. If you feel you are being harassed by your employer, you should contact your Claims Adjudicator.

You must report any "material change in circumstances" to WSIB. This includes any change in the medical status of your work-related injury, changes in your earnings or income, changes in your work status, changes in your ability to co-operate with various programs and, for dependants, any changes in the dependant status of children. For more information, see OWA Fact Sheet 7 called Material Change in Circumstances.

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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 WSIB. Second, contact your WSIB Claims Adjudicator and advise him/her of the change in your medical condition. As this is a material change in circumstances, you must advise your Claims Adjudicator of the change within 10 calendar days.

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

For more information, see the OWA Fact Sheets 7 and 12 called Material Change in Circumstances and Labour Market Re-entry.

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Once your LMR plan and training have been completed, your level of ongoing benefits will be based upon the suitable employment or business (SEB) chosen in your LMR plan. WSIB will assume you are able to obtain the job for which you have been re-trained and will reduce your benefits accordingly. A SEB is often chosen in your LMR plan because it is expected to restore your pre-injury earnings. You will not be paid additional WSIB benefits even if you cannot obtain your "deemed" job. Therefore, it is important to ensure that the SEB chosen for you and the LMR plan created for you are for a job you can do and will likely be able to obtain after the training is completed. If you disagree with the SEB or LMR plan chosen for you, then you must object in writing within 30 days of the decision.

For more information, see the OWA Fact Sheet 12 called Labour Market Re-entry.

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Yes, the appeal deadlines are firm. If you miss the deadline, you will usually not be allowed to proceed with your appeal. Do not wait until the last minute if you intend to appeal a decision. In some limited circumstances, however, the time limits may be extended. For more information, see OWA Fact Sheets 24 and 25 called Appealing to WSIB and Appealing to WSIAT.

You must file your appeal before the time limit in the decision letter expires. You should write to WSIB or the Workplace Safety and Insurance Appeals Tribunal (WSIAT), as indicated in the decision letter, stating that you disagree with the decision and want to file an appeal. For more information, see the OWA Workers' Information Kit:  Appealing WSIB Decisions.

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No. All issues involving benefits and services denied by WSIB must first be considered by an Appeals Resolution Officer at WSIB.

Yes. Your employer can dispute all benefits and service issues, including the initial entitlement. The same appeal system applies to both you and your employer, including the time limits. For more information, please see OWA Fact Sheet 4 called Employers and Claims.

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Workers are not required to have a lawyer or consultant represent them in a WSIB or WSIAT appeal. The majority of workers across the province, particularly at the WSIAT level, are represented by Worker Advisers, Community Legal Clinics and Unions, all providing free service. If you feel you need a lawyer, you should contact a lawyer referral service for a lawyer with expertise in workplace safety and insurance appeals (located under "lawyers" in the Yellow Pages). Whether you win or lose your appeal, you are still required to pay your own legal fees to lawyers and consultants, as WSIB does not cover legal fees. You may, however, be eligible for a legal aid certificate to pay a lawyer.

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The current WSIB policies are available on the WSIB website, however, any older policies that may apply to your claim may not be available in this manner.

If you are unsure which policy your Claims Adjudicator has 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 2006).

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 Knowledge Management
(416) 344-4355
E-mail: km@wsib.on.ca