WSIB: Denied Claims Process

WSIB stands for “Workplace Safety & Insurance Board”. Most businesses in Ontario are mandated to register with the WSIB within 10 days of hiring their first employee ( a worker, whether be full-time or part-time). If your employer is covered by WSIB, and you have endured an injury or illness as a result of your workplace / work duties, you are legally entitled to WSIB Benefits.

WSIB Benefits

There are a range of benefits you are entitled to access through your workplace WSIB insurance:

  • Benefit for Loss of Earnings
  • Benefit for Non-Economic Loss (for when your injury or illness had lead to long-term impairment)
  • Loss of Retirement Income
  • Health Care Benefits (such as Physiotherapy or alternative therapies not covered by OHIP)
  • Health Care Equipment and Supplies
  • The Occupational Disease and Survivor Benefits Program (for more serious occupational illnesses such as Cancer, Asbestosis, noise-induced hearing loss, etc.)
  • Benefits for Seriously Injured Workers (most often available to those individuals who have succumbed to permanent disability and impairment)
  • Compensation Amounts for Survivors (if a worker has died on the job, spouses of the deceased worker are entitled to this benefit)

WSIB Claim Process

Upon sustaining an injury or falling ill due to an occupational hazard, it is advised that you promptly file a claim with WSIB. When filing this claim, like you would with any other insurance company, you are requested to provide all relevant information to your injury or illness, as well as any other further information requested by the WSIB. This information is used to determine the benefits to which you are entitled to. Furthermore, you will be asked to have your primary health care provider, who is aiding you at this time, to fill out the designated forms that outline the scope of what you can and cannot do upon return to work. This “functional abilities information” is then released to your employer, with consent from you, outlining the types of activities you can carry out safely at this time. This form is very important to insure ultimate safety while managing your work related injury or illness.

WSIB Denied Claim

Once a WSIB Claim is submitted, you will receive a letter from the WSIB informing you of the decision in your claim or that filed by your employer. If you disagree with this decision (such as a denied claim or refusal for full benefit coverage), WSIB requests that you respond in writing as soon as possible, outlining why you disagree with the situation, any facts you think may have been overlooked during the review process, and request that the decision be reconsidered. If a resolution is not found in your dispute to the initial WSIB denied claim, you then have the option to file a formal appeal.

WSIB Formal Appeal

As a worker facing a denied WSIB claim, you are considered in the formal process as the “objecting party”. Upon receipt of a denied claim, and after writing a formal letter asking for reconsideration, you may complete a “Intent to Object” form. It is advised at this time that you consult with a disability claims lawyer.

Once a formal appeal is launched, there is a certain amount of paper work and in person meetings that will be required. This is often the time when a huge amount of stress is imposed on an employee objecting a denied claim, and further takes place during a time when one should be resting and optimizing treatment for their injury/illness.

The “Intent to Object” form can be filled out by a legal representative that you have chosen to handle your case. You want to make sure that you are working with a disability lawyer who knows the “ins’ and outs’” of the WSIB claims process, as well as your legal rights to short-term disability or long-term disability. They will be able to apply their tactical knowledge to appealing your denied claim, and will aid in writing / filling out any WSIB forms in which you are required to outline your reasons for objection.

Denied WSIB Claim: What Next?

If you have submitted a WSIB claim, providing all sufficient information and filing the proper forms, and have been confronted with a denied claim, you have options and should contact a lawyer who is familiar with WSIB claims (disability attorney).

Whether looking for long-term disability or short-term disability support, if you have found yourself in this situation as a result of your workplace and/or workplace duties, you have legal rights that should be fought for.

By contacting a WSIB claims attorney, you are standing up for your rights and will have access to full support from a legal team ready to face this denied claim with you. As an injured worker, TSF Law understands the amount of pressure, and even at times harassment and bullying you may endure from the WSIB to return to work. No employee should return to work and find themselves in a demeaning situation with their employer. It is a known fact that some employers “accommodate” employees who seek WSIB benefits with tasks they are unable to excel in, thus giving them reason to fire you. We will fight against and prevent such hardship from happening.

TSF Law does not want you to face any of this alone. Our legal team will pursue full coverage and offer full support when facing a denied WISB claim. If you have any questions or concerns regarding a denied WSIB claim, feel free to contact us for a free consultation.