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APPENDIX 3
Sample Request for Clothing Allowance
< Date >
< Your Adjudicator's Name >
< Your Adjudicator's Address >
Dear Mr(s). < Adjudicator's Name >,
| Re: |
<
Your Name > |
| WSIB
Claim No.: |
<
Your Claim Number > |
I am writing to request a clothing allowance for the replacement of
damaged clothing.
As you know, I wear a WSIB authorized/supplied
< name of device >. I have worn this device
for a full year since receiving my pension/NEL award. I usually
wear this device for < insert number >hours
a day. Wearing this device damages my clothing in the following
way(s):
- < List one way in which your clothing
has been damaged. >
- < List another way in which your
clothing has been damaged. >
- < Etcetera … >
If you need additional information, please
feel free to contact me. Thank you for your consideration of this
request. I look forward to your reply.
Yours truly,
< Sign Your Name Here >
< Type/Print Your Name >
< 123 Your Street >
< Your City, Ontario >
< X0X 0X0 >
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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 Workers' Kit 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 Trousse du travailleur
est aussi disponible en français
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OWA Workers' Kit 2 - March
2006
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