News

Why is My Employer Disputing My WSIB Claim

March 14, 2019 at 12:59pm

Injured workers deserve fair compensation.

The way that the Workplace Safety & Insurance Board (WSIB) is administered, however, makes it clear that the WSIB’s only goal is cost efficiency. And, every one of the Board’s policies and procedures work to achieve that goal.

Far too often, achieving that goal comes at the financial, emotional, and physical expense of injured workers. It’s not surprising that injured workers are upset and frustrated by the WSIB system.

Employer disputing WSIB ClaimSo, when an injured worker learns that their employer is disputing their WSIB injury claim, the frustration rises more.

But, why does the employer want to fight against just compensation for the employee? After all, workers lost the right to sue their employers in exchange for the WSIB, which is an employer-funded program.

 

Why is your employer disputing WSIB claims?

There are several reasons. It could be that the employer:

  • Doesn’t believe the injury happened at work or that the employee’s duties caused the injury;
  • Believes that the injury or illness was more likely due to a non-work-related issue or condition; or,
  • Has a return to work program and, therefore, has the expectation the worker should return to work sooner.

But, the reality is that many employers dispute WSIB claims as a method of cost management or claim suppression. After all, compensation costs eat into profit margins.

The WSIB administers several compensation programs. Many UFCW Locals 175 & 633 members work for employers covered under the New Experimental Experience Rating (NEER) program.

Employers pay premiums and the system rewards good performance, such as low injury/illness rates, with rebates and future premium reductions. Poor performances, however, can cause increased costs.

This creates a significant financial incentive for employers to aggressively manage WSIB claim costs by, among other means, disputing the claims of individual injured workers. The relationship between the  Board and the employer is similar to a customer/client relationship. Often, the WSIB will consult employers to determine a worker’s entitlement to benefits. And, typically, that type of communication is with the employer representative who is responsible for managing WSIB claim costs.

All of this can put injured workers in a vulnerable position. Depending on who the employer contact is  for the WSIB, injured workers could encounter barriers including personal conflicts, translation issues, timeliness of reporting and responding, miscommunication, and errors and omissions.

Ultimately, many injured workers end up knowing that the only best interests the employer wants to protect are its own.

What can you do?

Make sure that any information you receive is accurate and truthful. This includes (but is not limited to):

  • Phone conversations with WSIB staff,
  • Your Form 7,
  • Letters;, and,
  • Work offers.

Most importantly, if you find inconsistencies, contact your WSIB case manager and discuss the problem. Members can call the UFCW Locals 175 & 633 Workers’ Compensation Department for help with any questions on your WSIB appeals.

This article appeared in the December 2018 issue of Checkout magazine.

Read more articles on workplace injuries, WSIB, and more or visit our Workers’ Compensation section to learn more about the process of filing and appealing claims for workplace injuries and illnesses.