How Do I make a WSIB Claim?

1. Report the accident or occupational disease to your employer. This generally means notifying the supervisor, manager and/or health and safety representative.  All incidents have to be reported.  A delay in reporting may mean a denial of your claim.

2. Complete an Employer Incident Report. Ask for a copy. Tell your union steward. List any witnesses.

3. Have the employer complete a Form 7 (Employer’s Report of Injury/Disease).

4. Ensure you receive a copy of Form 7.  Your employer is obligated to provide you with a copy.

5. Inform a coworker or witness.

6. Seek medical attention as soon as possible. Advise the treating health care practitioner that you are being seen for a work-related injury and explain the job duties performed. It is preferable that you see your family doctor since he/she retains your past health record and may better access the injury. However if you cannot see your family doctor immediately or you don’t have a family doctor, you must go to a walk-in clinic or emergency room. A follow-up with your family doctor is necessary.

7. Have the health care practitioner complete a Form 8 (“Health Care Practitioner’s Report) and send to WSIB.

8. If you didn’t get the chance to let your employer know right away about your accident, injury illness or onset of pain, make sure to do it after seeking medical treatment. Remember: your employer and supervisor don’t get to decide whether your accident, injury, illness or onset of pain is work-related or not.

9. WSIB will send you a Form 6 (Worker’s Report of Injury/Disease”). Complete the form with as much details about the accident as you can provide and send it back to WSIB right away. Provide a copy to your employer and make a copy for yourself.

10. If you do not receive a Form 6, phone WSIB toll-free at 1-800-387-0750 and ask them to send you one. Alternatively, you can download the form here. You should also contact WSIB and ask to be sent a Form 6 if you think that your employer has not reported your accident.

11. After you have submitted the correct forms, you should get a letter from WSIB giving you a claim number. This does not mean that your claim has been accepted.It only means the WSIB knows about your claim and has opened a file on it. Use this number every time you contact WSIB about your claim.

12. If you do not receive a claim number, it may mean that the WSIB does not know about your claim, in this event, you should contact WSIB immediately to find out if there is a problem with your claim.

13. If your benefits are delayed, it could mean that the WSIB has not received all the information it needs to make its decision (e.g. the doctor’s or the employer’s report); it could mean that the WSIB is investigating your claim and that a decision will be made later. If you do not received a letter of explanation, call WSIB to find out the reason.

14. If your claim is denied, you should get a letter with reasons why WSIB has decided not to grant you any benefits. You usually have six (6) monthsfrom the date of the decision to notify WSIB in writing that you which to appeal such a decision. The process is explained in the decision letter. Please ensure you note the deadline indicated in the letter as the time limit may vary.

15. In cases where you and your employer are planning for your return to suitable work, functional abilities information will be required. The Functional Abilities Form for Early and Safe Return to Work (FAF) is a tool that provides information about your physical condition and your ability to work. A request for the form should only be initiated by you or your employer and, ideally, should only be completed when you are functionally able to return to work.

16. Your treating health professional will complete the form. This could include a doctor, physiotherapist, or other licensed health care professional. The information gathered highlights what a worker can do after a workplace injury or illness. The form allows the health professional to identify your ability to walk, stand, sit, lift, and perform other work-related tasks. You and your employer can then use this information to plan return to work by identifying jobs that you are capable of performing within the limits set out in the FAF.

17. Note that “Responsibilities of the Workplace Parties in Work Reintegration (WSIB Policy 19-02-02)” states that “The workplace parties (workers and employers) are required to co-operate in the work reintegration (WR) process”.

18. In those cases where education and support have been provided to the workplace parties, but either or both of them refuses to co-operate, the WSIB may - reduce or suspend the worker's benefits, and/or - levy a penalty on the employer that is equivalent to the costs of providing benefits to the worker.

What if you have a health problem caused by job but did not have an actual accident at work?

When the worker did not have an actual accident at work but an injury emerged gradually, it is a gradual onset disablement. Repetitive Strain Injuries typically fall into this category (e.g., Carpel Tunnel Syndrome, Golfer/Tennis Elbow, Tendinitis, Rotator Cuff/Overhead Work). It is still considered a work injury even the worker did not experience an accident in the traditional sense.

While filing a gradual onset disablement claim, the date of injury is established using the date of first medical attention which led to the diagnosis, or the date of diagnosis, whichever is earlier.

What is an occupational disease?

An occupational disease is a health problem caused by exposure to a workplace health hazard.

An Occupational Disease Includes:

• a disease resulting from exposure to a substance (for example, chemicals, dust, fumes or viruses) relating to a particular process, trade, or occupation in an industry (for example, asbestosis from exposure to asbestos in mining, manufacturing or construction)

• a disease peculiar to, or characteristic of, a particular industrial process, trade or occupation (for example, operating drills used in mining or construction or using tools such as chainsaws may result in Hand Arm Vibration Syndrome)

• a medical condition that in the opinion of the Workplace Safety and Insurance Board (WSIB) requires you to be removed from exposure to a substance because the condition may lead to an occupational disease, or

• a disease mentioned in Schedule 3 or 4 of the Regulations to the Workplace Safety and Insurance Act, 1997.

How long do WSIB benefits last?

Various degree of injuries can take from days to years to recover from. As long as you are deemed to be totally disabled and the disability is considered by the WSIB to be temporary, WSIB benefits will continue.

When do loss of earnings payments apply?

The WSIB normally pays the LOE benefit beginning the day after the injury (your employer must pay your wages for the day of the injury), or whenever your loss of earnings begins

The LOE benefit stops:

• If you return to work and your earnings are the same or greater than what you were earning before your injury,

• If you participate in a labour market re-entry (LMR) assessment or plan, and it is deemed that you could potentially have earnings (in suitable employment or business) that are the same or greater than what you were earning before the injury.

• When you turn 65 years old. For workers who are 63 years old or older at the time of the injury, your LOE benefit can be paid for up to two years from this date, as long as you have a loss of earnings because of the workplace injury or disease.

Does the LOE benefit always stay the same?

The loss of earnings benefit is based on your average earnings. For the first 12 weeks the WSIB calculates your benefits based on your take-home pay from all your current employers at the time of the injury. If your recovery lasts longer than 12 weeks the adjudicator will review your long-term earnings and adjust the benefits as needed. 

As well, your LOE benefit may be reviewed by the WSIB every year, or if you report a material change in your circumstances, up until the 6 thyear after the injury. The benefit will not change after that, up until you turn 65 when it stops, unless we learn of a material change that occurred before the six-year-mark, that you did not report to the WSIB.

What is income replacement insurance?

If you miss time from work because of a work-related injury or disease, and lose pay as a result, the WSIB will provide payments for loss of earnings (LOE). The amount paid for loss of earnings is based on 85 per cent of your pre-injury, take-home earnings, less any earnings you may have after the injury. There is an annual maximum.

What is modified work?

Modified Work is any job, task, or function, that a worker who is temporarily disabled can perform safely without risk of re-injury or exacerbation of their condition, and will pose no risk to others during their recovery. The work must however be productive and result of the work must have value.

Usually, modified work is a temporary vehicle designed to help workers be re-integrated into the workplace, to their pre-injury/illness jobs. Such modifications may include reduced hours, rotation of job duties, more frequent or shorter rest periods, the use of such equipment as ladders, step stools, chairs or many other types of modifications especially designed to suit the medical needs of each individual.