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WSIB Appeals: Appealing your decision

August 15, 2017 at 12:22pm

Workers Comp Claims & Appeals: Appealing Your DecisionInformation adopted from the Ontario Worker Adviser (OWA) website. Used with permission.

The first Workplace Safety and Insurance Board (WSIB) decision is made at the WSIB Operating Level. If you disagree with that decision, then you can file an appeal to the WSIB Appeals Services Division within the time limit.

Members of Locals 175 & 633 who wish to make an appeal must contact the Workers’ Compensation Department as soon as possible to avoid delays or missed time limits.

Decisions made on or after January 1, 1998

  • Return to work, labour market re-entry, or work transition decisions:  You have 30 days from the date of the WSIB decision to appeal.
  • Access to worker’s file: You have 21 days to object to the release of medical information to your employer.
  • All other decisions: You have six months from the date of the decision to appeal.

Who can appeal a WSIB decision?

You can appeal a WSIB decision if you are:

  • An injured worker or an injured worker’s employer.
  • The spouse, dependant, or estate of a deceased injured worker.

How do I start appeal at the WSIB?

The Workers’ Compensation Department with submit an Intent to Object Form, within time limits to the WSIB. The Intent to Object Form contains such details as:

  • The date of the WSIB decision you disagree with, and
  • Lists the issues you want to appeal.

Even if you are not sure whether you agree with the decision, it is wise to complete an Intent to Object Form right away, so you don’t lose your right to appeal.

Once the WSIB receives your Intent to Object Form, they will send a letter confirming that the time limit has been met to appeal.   It is at this point that the WSIB processes an Appeal Readiness Form and a copy of your claim file for the Workers’ Compensation Department.

What should I do when I am ready to go ahead with my appeal?

If you wish to have the Worker’s Compensation Department to assist you with your appeal you do not need to submit any forms unless directed by your Representative.

If you will be representing yourself, be sure that you are ready to go ahead with your appeal before you send the Appeal Readiness Form to the WSIB. This means you should have already gathered and sent the WSIB any new information or documents about your case. This includes any additional evidence you have to support your claim, such as medical documents. If you disagree with your employer accessing your health care documents, that issue must be resolved before you send in your Appeal Readiness Form. It is also a good idea to read the WSIB’s Worker Instruction Sheet about the Appeal Readiness Form.

The following information should be on your Appeal Readiness Form:

  • The reasons why the decision is wrong.
  • A list of the additional WSIB benefits and services you expect.
  • The type of hearing you are requesting (hearing in writing or oral hearing).

If you want a hearing in writing, you must send your written submissions with your Appeal Readiness Form. A submission is an explanation of why you think the decision is wrong and how the appeal should be decided.

If you want an oral hearing then you must put the following information on the Appeal Readiness Form:

  • The reasons why an oral hearing is needed.
  • A list of your witnesses and an explanation of what they will say.
  • Whether you need an interpreter.
  • Your agreement that you are able to attend a hearing within 90 days.

What happens after I send in my Appeal Readiness Form?

The Objection Intake Team will review your Appeal Readiness Form to decide if your appeal is ready to move ahead. This review should be completed in about two weeks. If your appeal is ready, it will be forwarded to the Appeals Services Division. Here it will be decided by an Appeals Resolution Officer (ARO).

If your appeal is not ready because you included new issues or evidence, your file will be returned to the original decision-maker so he or she can consider the new information. Any new medical information that you provide may be sent to a WSIB doctor for review. This process can take some time. If the original decision-maker does not change the decision, your file will then be referred to the Appeals Services Division.

How does the appeal process work?

Once your appeal is sent to the Appeals Services Division, the WSIB will choose whether you will have a hearing in writing or an oral hearing.

Hearing in writing

In these cases, the Local Union will provide written submissions on your behalf. Your employer will provide the WSIB with written explanations of why the decision is wrong and how the appeal should be decided. After reviewing those submissions and the other documents in your WSIB file, the ARO will write a decision. You will receive a copy of the decision but you will not have an oral hearing or speak to the ARO.

Oral hearing

If the WSIB grants you an oral hearing then an Appeals Scheduler will schedule your oral hearing within 90 days. At a hearing, you and your employer will have a chance to explain why the decision is wrong and how the appeal should be decided. The ARO may also hear from witnesses necessary to the appeal. After the hearing, the ARO will issue a written decision. For information on presenting your case at an oral hearing.

How do I appeal a final WSIB decision?

You can appeal a Final WSIB decision (ARO decisions) to the Workplace Safety and Insurance Appeals Tribunal (WSIAT).