For some
of us it is hard to imagine being injured at work. Even more
difficult, is to imagine being incapacitated to the point where
you are unable to perform your job as it was before your injury.
Unfortunately, workplace injuries, illnesses and diseases are
all too common. The WSIB claims and appeal process exists to
give workers the ability to gain financial compensation in the
event of a workplace injury, illness or disease.
If
you file a claim and are having difficulty with either your
employer or the WSIB, contact
your Union Rep or the Benefits Department at 1-800-565-8329
or at benefits@ufcw175.com.
If you think
an accident, injury, illness or onset of pain is work-related
you must follow these steps:
-
Report
it to your employer.
-
Complete
an Employer Incident Report.
-
Have
the employer complete a Form 7 (Employer’s Report
of Injury/Disease).
-
Seek
medical attention.
-
Report
your injury to your family doctor and have him/her complete
a Form 8 (Physician’s First Report).
-
Inform
a co-worker or witness.
KEEP
COPIES OF ALL DOCUMENTATION!
Maintain
your own file of all documents relating to your claim. This
includes doctor’s notes, copies of forms and any correspondence
from the WSIB, the employer or any other involved parties.
Remember:
-
WSIB
claims must be filed within six months of the initial incident.
Claims filed after six months may only be accepted in exceptional
cases.
-
You
have the legal right to report any workplace accident or
injury and cannot be told by anyone that you cannot file
a claim.
-
You
the right to be treated by your own health care professional.
This could be your family physician, chiropractor or dentist.
You choose your initial health care professional when you
accept treatment or emergency treatment.
-
You
are not permitted to change to another health care professional
without the WSIB’s approval.
Download
helpful brochures on the WSIB Claims and Appeals process. You
will require Adobe Acrobat - click
here for free download.
All timelines
are estimates on how long the average file takes to complete
the appeals process. Some may take longer than others at certain
stages. Once again, please keep a copy and
any relevant detailed notes of all documents relating to your
claim.
Denial
Letter
To appeal a WSIB decision you must have a denial letter from the
Board indicating that your claim, or part of your claim, has been
denied and the reasons for that denial. The last paragraph of
the denial letter will indicate a time limit of six months to
appeal the decision.
To have a Local 175 Benefits Representative represent you in your
appeal, please contact the
Benefits Department at 1-800-565-8329 as soon as you receive
your denial letter. The Benefits Department will send you authorization
forms to sign and return along with your letter of denial.
Objection
Your Benefits Representative will inform the WSIB that the Local
will represent you in your appeal and request a copy of your file
and an objection form.
Your claim file will be sent to the Access Section of the WSIB
where they will copy your claim file and forward it to your Benefits
Representative. It should take between two and four weeks to process
and another two to four weeks for the claim to reach your Benefits
Representative.
The Access Section will inform your employer of your appeal and
the employer will have the option of participating in the appeals
process.
Upon receipt of your WSIB claim file, your Benefits Representative
will review it and complete the objection form. The form is then
submitted to your Adjudicator who will review your claim and either
reverse their initial decision or send it on to the Appeals Branch.
This process can take up to three months.
Appeals Branch
Here your file is assigned to an Appeals Resolution Officer (ARO).
Once it has arrived here, you will receive a "60-day decision
option form." Should this form be completed, it allows the
WSIB to make a final decision in your claim within 60 days.
This decision would be the last step of the appeals process a
the WSIB level. This, however, is NOT the preferred
option for appealing decisions.
If this form is NOT submitted, the ARO will contact
you and your Benefits Representative to discuss your file and
how best to proceed with the appeal.
There are two options:
- The ARO will review the entire claim and
render a decision. This can include written submissions from
your Benefits Representative and from your employer (if they
are participating in the appeal.)
- The ARO will conduct an oral hearing that
you and your Benefits Representative must attend. Your employer,
if participating, may also have a representative heard.
Once a decision is made in writing by the ARO through
either of the above options, it is the final decision made regarding
your claim at the WSIB level.
If your appeal is denied, you may appeal to the WSIB Appeals Tribunal.
Please note, your Benefits Representative will try to have your
appeal processed in a timely fashion, however, due to the backlog
of claims at the WSIB, your appeal could take over one year to
complete.
Example
of your rights to worker's compensation
You work at a fast food restaurant for the summer. You earn $7
per hour and work about 20 hours per week. You have another part-time
job cutting grass with a landscape firm and earn $8 per hour for
an average of 20 hours per week.
While working in the restaurant one day you slip on a wet floor
and twist your back. You finish your shift but notice the pain
and discomfort increasing. You visit your doctor the next day
who advises you that you strained the muscles in your back and
should not go back to work for at least two weeks.
Are you
entitled to WSIB benefits?
Yes - Most employers in this province must have WSIB coverage
for all their employees. If an employee suffers an injury or disease
as a result of the workplace that employee is eligible for benefits
and services from the WSIB.
How do
you apply for these benefits?
After seeking medical attention for a work-related injury or disease,
the doctor must send a report to the WSIB, which will initiate
a claim and further investigation. You must also advise the employer
of your injury and your doctor's advice. You will be required
to complete a form with information regarding the accident.
For what
benefits might you be eligible?
Once the claim is allowed you may receive Loss of Earning (LOE
- click here for
PDF pamphlets) benefits - the equivalent of 85 per cent of
your net pay.
Your payments take into consideration all earnings with all employers
- not just the employer where the injury took place. In this case
your net pay from both jobs would be added together and you would
receive 85 per cent of this total.
You may also receive payment for any costs associated with medical
treatment including prescriptions or physiotherapy for example.
If the injury does not heal entirely, you may be entitled to other
benefits or services from the WSIB.
Is there
a time limit on filing for compensation?
Yes. The WSIB specifies that an application be made as soon as
possible following the initial incident. It can be no later than
6 months after the incident.
What
if the employer threatens you or tries to talk you out of filing
a compensation claim?
It is illegal for an employer not to file a report to the WSIB
for any accident involving medical attention of lost time from
work. If this happens contact
the Local's Benefits Department at 1-800-565-8329.
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Download
helpful brochures on the WSIB Claims and Appeals process.
