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LOE Reviews: After 72-Month Lock-In

August 15, 2017 at 12:20pm

Workers Comp Claims & Appeals: LOE Reviews After 72-Month Lock-InInformation adopted from the Ontario Worker Adviser (OWA) website. Used with permission.

When will WSIB conduct a final review of my LOE benefits?

The WSIB is required to a final LOE review of your benefits 72 months (six years) after the date of your injury. Usually, the WSIB cannot review your benefits again after your final review. However, there are some important exceptions to this general rule.

When can WSIB review my LOE benefits after the 72-month final review?

WSIB may review your LOE benefits after 72 months from the date of your injury in several specific circumstances. These exceptions deal with situations where your condition changes or where a proper review of your LOE benefits cannot be done at the 72-month date.

Can WSIB conduct an LOE review if I fail to report a material change in circumstances or commit fraud or misrepresentation?

Yes. WSIB can review your LOE benefits if you:

In these circumstances, WSIB can review your LOE benefits at any time.

Can WSIB review my LOE benefits if I have a permanent worsening of my condition?

Yes. If you have a permanent deterioration in your condition, WSIB can do an LOE review benefits after the 72-month date in the following situations:

  • You receive a non-economic loss (NEL) award: The WSIB can review your LOE benefits within 24 months of the date it is granted. If you are in a work transition (WT) plan at the end of the 24 months, WSIB can wait and review your LOE benefits up to 30 days from the date you complete the plan.
  • You receive an increase in a NEL award you are already receiving: The WSIB can review your LOE benefits within 24 months of the date of the increase. If you are in a work transition (WT) plan at the end of the 24 months, WSIB can wait and review your LOE benefits up to 30 days from the date you complete the plan.
  • You suffer a significant deterioration in your condition and WSIB decides you are likely to receive a NEL award or an increase in your existing NEL award: The WSIB can conduct an LOE review at any time from that point until you receive a NEL award or an increase in your existing NEL award or WSIB decides that you are not entitled to a NEL award or an increase in your existing NEL award.

Some of these exceptions may not apply to you if you suffered a permanent deterioration before July 1, 2007. Speak to the Workers’ Compensation Department for advice on your specific circumstances.

Can WSIB review my LOE benefits if I have a temporary worsening of my condition?

Yes. If you have a temporary deterioration in your condition, WSIB can review your benefits. WSIB can also review your benefits when it determines you have recovered.

WSIB cannot review your LOE benefits if you recovered from your temporary deterioration before July 1, 2007. If your deterioration began before July 1, 2007, WSIB can only review your LOE benefits from July 1, 2007.

What if I have not finished my Work Transition plan 72 months after my injury?

If the WSIB granted you a work transition plan and you do not complete it within 72 months after your injury, WSIB can review your LOE benefits within 30 days of the date you complete the plan.

This exception does not apply to plans completed before November 26, 2002.

What if I am participating in early and safe return to work activities 72 months after my injury?

If you and your employer are co-operating in your early and safe return to work 72 months after your injury, WSIB has an additional 24 months during which it can review your LOE benefits. If you perform modified work for the employer where you suffered the workplace injury then the WSIB may consider you to be co-operating in early and safe return to work.

What if I am participating in health care measures 72 months after my injury?

If you are co-operating 72 months after your injury, then the WSIB has an additional 24 months to review your LOE benefits. It is likely that WSIB will require you to be receiving or waiting for treatment to improve your condition. The exception will likely not apply to health care that helps keep you at your current condition. This includes medications, physiotherapy or chiropractic treatment.

Can I appeal a WSIB final review of LOE benefits?

Yes. You can object to any decision that affects your LOE benefits. Generally, you must object within six months of the date of the decision. If a decision about your early and safe return to work or work transition affects your LOE benefits then you must object within 30 days of the decision date.

If you wish to appeal a decision contact the Workers’ Compensation Department (1-800-267-1977).