For some of us it's hard to imagine being injured at work and being unable to do your job or live your life the way you used to. Unfortunately, workplace injuries, illnesses and diseases are very common.
The WSIB claims and appeals process exists to give injured workers the ability to gain financial compensation if they are injured at work or suffer from a workplace illness or disease.
If you filed a claim or would like to appeal a decision and you are having trouble with your employer or the WSIB, contact your Union Rep or the UFCW Locals 175 & 633 Workers’ Compensation Department at 1-800-267-1977 or at firstname.lastname@example.org.
The Altered Lives Project tells the stories of our Members who have been affected by workplace injuries and violence.
Please read the stories. If you have a story to share, or know someone else who might want to share their story, please contact the Workers' Compensation Department by email or call them at 1-800-267-1977.
Each story and experience is different, but the common theme found in the #alteredlivesproject is that injury prevention is a responsibility shared by workers, employers, co-workers, unions and the community.
Workers and activists commemorate the National Day of Mourning on April 28 each year.
We remember our co-workers, family & friends who have lost their lives due to a work-related injury or illness. Please report any hazards or unsafe working conditions at work to your workplace Steward, Health & Safety Rep, or Union Rep.
Check back near the beginning of next April for a link to events.
You can also download a poster for your workplace.
Each year on June 1, we mark Injured Workers' Day.
Across the country, Unions, injured workers and other activists rally to help bring awareness to injured workers and the struggles they face in getting fair compensation for their injuries and illnesses.
Annual events include overnight vigils, rallies, marches, guest speakers, and panel discussions.
Join us and help us stand up for the rights of Injured Workers!
For more information contact the UFCW Locals 175 & 633 Workers’ Compensation Department at email@example.com or at 1-800-267-1977.
Filing a WSIB Claim
The workplace insurance system provides benefits and services to workers who have been injured at work or who have illnesses related to work. Workplace insurance is also called workers’ compensation.
To qualify for workplace insurance benefits, you must meet the requirements set out in the Ontario law that governs workplace insurance. This law is called the Workplace Safety and Insurance Act, 1997.
How to apply for benefits:
To apply for workplace insurance benefits, you must file a claim with the Workplace Safety and Insurance Board (WSIB) within the time limit. The WSIB is an agency of the Ontario government that administers the workplace safety and insurance system. If you file a claim, you have the right to get a copy of your file from the WSIB.
Types of Claims
What types of injuries and illnesses can I file a WSIB claim for?
You can file a claim with the WSIB for many different kinds of injuries and illnesses. The types of conditions you can file a claim for include:
- disablements (injuries that happen gradually over time)
- psychological conditions
- occupational diseases
- hearing loss
You can also file a claim for survivors’ benefits if you are the spouse, child or other dependent of a worker who has died as a result of a workplace injury or illness.
Duties of Workers & Employers
Once you file a WSIB claim, the law requires you to cooperate with the WSIB and your employer. You are also required to report to the WSIB any changes in your health or financial situation that could affect your right to benefits.
Your compensation benefits can be reduced or cut if you are deemed non-cooperative. Knowing your rights and responsibilities is important. Both you and your employer have specific responsibilities under WSIB cooperation policies and procedures.
The WSIB provides a wide range of benefits and services to injured workers. The benefits can include payments to cover part of your wage loss, as well as coverage for health care costs related to a workplace injury. The WSIB also provides services to assist with returning to work.
What benefits and services can I receive after my injury?
The benefits and services you can receive from the WSIB will depend on the date you were injured. This section reviews the benefits and services available for workers injured in 1998 or later. If you were injured before 1998, a different version of the law applies to you. For more information, contact the Workers’ Compensation Department.
If you were injured on or after January 1, 1998, you may be eligible for the benefits and services described below.
Wages on day of injury
- Your employer must pay your usual wages and benefits for the day you were injured.
Loss of earnings benefits (LOE)
- The WSIB can pay you 85% of your net earnings loss from the day after your injury until you are no longer impaired, you no longer suffer a wage loss, or the WSIB believes you should no longer be suffering a wage loss.
- You can receive LOE benefits until the age of 65, unless you were 63 or older at the time of your injury. If you were age 63 or older, you can receive LOE benefits for up to two years after your accident.
- The WSIB may review the amount of your LOE benefits every year, or if there is a material change in circumstances. Usually, the WSIB cannot review your benefits more than 72 months (six years) after your final review, but there are some important exceptions to this general rule.
- If you are receiving Canada Pension Plan disability benefits for your work-related injury, the WSIB may reduce your LOE benefits.
- The WSIB will pay for health care that is necessary and appropriate as a result of your injury. This includes treatment by medical professionals, prescription medication and assistive devices.
- For serious injuries, this may also include the services of an attendant to assist with your daily living activities, changes to your home to enable you to live independently, or other measures to improve your quality of life.
- If you continue with contributions to your regular employment benefits, such as a dental or pension plan, your employer also must continue to make contributions to these benefits for the first year that you are off work because of your injury.
- If you are under the age of 64 at the time of your injury and receive LOE benefits for more than 12 consecutive months, you will receive a retirement benefit at age 65.
- The WSIB pays this benefit from amounts set aside as a percentage of your LOE benefits.
If you disagree with a decision in your workplace insurance claim, you can ask a different decision-maker to review the decision and decide whether it is correct. This review process is called an appeal.
There are two separate organizations that make decisions and decide appeals in workplace insurance claims. They are:
- the Workplace Safety and Insurance Board (WSIB)
- the Workplace Safety and Insurance Appeals Tribunal (WSIAT)
If you disagree with a decision in your claim, you must first appeal it within the WSIB to an internal branch called the Appeals Services Division (ASD). If you disagree with the decision made by the WSIB Appeals Services Division, you can appeal that decision to the WSIAT.
The Workers’ Compensation Department helps our unionized workers and their survivors with the appeals process and provides representation services at both the WSIB and the WSIAT. The Workers’ Compensation Department can also help identify appropriate appeal forms and provide advice about meeting time limits.
Overview of the Appeals Process
The chart below is a basic overview of the workplace insurance appeals process:
WSIB Operating Level
The Operating Level includes the front-line decision-makers at the WSIB. The initial decisions in a claim are usually made by WSIB staff at this level, including Eligibility Adjudicators, Case Managers, Return to Work Specialists and Work Transition Specialists. If you disagree with a decision of the Operating Level, you can appeal it to the WSIB’s Appeals Services Division.
WSIB Appeals Services Division
Decisions of the Appeals Services Division are usually made by Appeals Resolution Officers (ARO). The appeal process includes either a written or an oral hearing. After the ARO has reviewed the file material and considered any submissions, he or she will prepare a written decision explaining the result of the appeal. An ARO decision is generally considered the final decision of the WSIB.
Many forms are required to proceed on a WSIB claim. Your Workers’ Compensation Representative will complete most of these forms on your behalf however here are some of the forms that you may need to submit on your own:
- Form 6 (Worker's Report of Injury/Illness)
- ITO (Intent to Object Form)
- Also available are instructions on how to fill out this form.
- General Expenses
WSIB Appeal Forms: Intent to Object vs Appeal Readiness Form
These two charts explain the important differences between the Intent to Object Form and Appeals Readiness Form (as prepared by the Office of the Worker Adviser).
Intent to Object Form (ITO)
Appeal Readiness Form (ARF)
Why should I use an ITO?
Why should I use an ARF?
What does it do? The ITO:
What does it do? The ARF:
When do I send an ITO?
Immediately! Send an ITO for each WSIB decision you receive.
Keep a copy of the fax confirmation for your records.
When do I send an ARF?
Only when you are ready to appeal. There is no time limit to send an ARF. Have you:
Where do I get an ITO?
From the WSIB:
From the Office of the Worker Adviser:
Where do I get it?
The WSIB will send you an ARF:
If the WSIB does not send you an ARF, you can ask for one.
Is there a risk?
No. An ITO simply protects your right to appeal later on.
Is there a risk?
Maybe. The WSIB appeal procedure says you must be ready when you send in an ARF. If you are not ready to go ahead with your appeal, the WSIB may delay or stop your appeal.
There is no time limit to send an ARF. If you can, it is best to wait until you have consulted your representative and gathered your evidence.
What if I’m not sure if I should appeal?
Send in the ITO anyway.
What if I’m not sure if I should appeal or if I am ready to appeal?
Don’t send in the ARF. Consider talking with a Workers Comp Representative at the Union. Call 1-800-267-1977 or send us an email.