Frequently
Asked Questions
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- How
and when do 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,
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.
- What
should I do if my employer refuses to report my accident to WSIB?
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.
- Does
the Office of the Worker Adviser (OWA) charge for services?
No. The OWA provides free and confidential services
to non-unionized injured workers and their survivors.
- What
can the OWA do for me?
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.
- What
if I belong to a union?
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.
- What
if my union will not represent me?
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.
- Is
the OWA part of the Workplace Safety and Insurance Board (WSIB)?
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).
- Can
the OWA see my WSIB claim file?
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.
- Can
I see what is in my WSIB claim file?
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.
- 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 the employer disagrees
with a
WSIB decision made in your claim. See OWA Fact Sheet 4 called Employers
and Claims.
- What
if I am hurt in another province?
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
- What
should I do if I cannot return to my pre-injury job?
You should request modified work from your accident
employer. For more information, see OWA Fact Sheet 10 called
Early and Safe Return to Work.
- Is
my employer required to hold my job for me while I am on WSIB?
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.
- What
if my employer has no modified work available?
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.
- What
if my employer offers me modified work that I cannot do?
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.
- Can
my employer change my hours on modified duties?
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.
- Am
I eligible for WSIB benefits if I was hurt at work without an obvious
accident?
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.
- Who
should I contact at WSIB about delays in my claim?
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.
- What
can I live on while waiting for WSIB to pay?
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:
- What
should I do if my Claims Adjudicator does not return my calls?
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.
- I
am not happy with the Claims Adjudicator assigned to my file.
Can I request the Adjudicator be changed?
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.
- Can
I refuse to answer my Adjudicator's questions?
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.
- Am
I required to answer phone calls from my employer while recovering from
my
work-related injury?
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.
- Once
I am receiving benefits, how long should I keep in touch with WSIB?
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.
- What
can I do if my compensable condition is deteriorating while in school
under
my LMR 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 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.
- What
can I do if I cannot find work after completing training under my LMR
plan?
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IMPORTANT NOTICE
Due to changes to the Workplace
Safety and Insurance Act which took effect on July 1,
2007, the answer to Question 26 is no longer up-to-date. A revised
and up-to-date answer will be posted as soon as it is available.
For further information about the changes to the Act,
see the What's New section on the OWA
Home Page.
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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.
- Are
appeal deadlines in WSIB letters firm?
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.
- How
do I file an appeal?
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.
- Can
I appeal directly to WSIAT?
No. All issues involving benefits and services
denied by WSIB must first be considered by an Appeals Resolution Officer
at WSIB.
- Can
my employer dispute the benefits WSIB has allowed?
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.
- Do
I need a lawyer to represent me in my appeal?
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.
- How
can I get a copy of the policy that my Adjudicator mentions in a decision
letter?
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
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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.
The Frequently Asked Questions contain general information only.
They are 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
Ces Questions fréquentes sont aussi disponible en français
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