Workers’ Compensation

The size and strength of UFCW Locals 175 & 633 means that our Union can offer Members more services and benefits than some other Unions. One of those important services our Union offers free of charge to members is a Workers’ Compensation Department staffed by experts.

We know that having a work-related injury or illness is incredibly stressful. We also know that the Workplace Safety & Insurance Board (WSIB) and Workplace Safety and Insurance Appeals Tribunal (WSIAT) processes can be frustrating, unfair, and even demeaning at times.

Our Workers’ Comp Reps are here to support and represent members who have been injured at work with their denied Workplace Safety & Insurance Board (WSIB) and Workplace Safety and Insurance Appeals Tribunal (WSIAT) claims. That includes:

• Reconsideration Letters;
• Communication with the WSIB, and;
• Hearing representation where it is necessary and where we are able.

Your Union works tirelessly to make sure that the WSIB is held accountable to its purpose: to provide financial support, healthcare coverage, and more to injured workers in Ontario. Not only does the Union assist Members with their appeals, but our Workers Comp Reps also sit on committees related to workplace injuries and illnesses, and lobby the government to improve legislation and fix the broken WSIB system.

If you filed a WSIB 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 workerscomp@ufcw175.com.

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Injured Workers Day

Each year on June 1, we mark Injured Workers’ Day and pay respect to the hundreds of workers who have died or become injured while working on their job sites. Injured Workers Day is an opportunity to recognize the individuals who have suffered injuries and fatalities as a result of their workplace conditions.

We must stand together to acknowledge and support the workers who have lost their lives or been seriously injured as a result of hazardous workplaces. The day is an opportunity to collectively demand the provincial government ensure that workers’ safety is a priority and to pass legislation that ensures the well-being of every worker in the province. Together, we can save lives and prevent workplace injuries.

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 workerscomp@ufcw175.com or at 1-800-267-1977.

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Altered Lives Project

The Altered Lives Project tells the stories of our Members who have been affected by workplace injuries and violence. 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.

The UFCW Locals 175 & 633 Altered Lives Project aims to promote participation in the development of healthy, safe and supportive work environments and relationships. Injury and illness continue to occur in our workplaces and it has become more challenging to gain fair compensation.

The solution requires a concerted effort by everyone in our workplaces to prevent injury and illness. We must recognize and control all hazards that could cause harm to anyone in the workplace. We must ensure that proper training takes place for all employees. And we must report things that are unsafe so that those issues can be fixed.

Altered Lives featured several stories of workers who were injured on the job. The stories illustrate the devastating impact of a workplace injury, and how the lives of workers, family, friends and co-workers are forever changed.

• Debbie’s Story
• Donna & Len’s Story
• Don’s Story
• Jacqueline’s Story
• Kim’s Story
• Les’s Story
• Margaret’s Story
• Moon’s Story
• Paul’s Story
• Richard’s Story
• Steve’s Story
• Tamara’s Story

Please share these stories so we can prevent workplace illness and injury in the future.

Filing a WSIB Claim

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. If you file a claim, you have the right to get a copy of your file from the WSIB.

How to File a WSIB Claim

• Complete and sign the Workers’ Report of Injury/Disease (Form 6). This form is available on the WSIB website or you can call the WSIB at 1-800-387-3750.
• On the Form 6, you need to provide the WSIB with detailed information about your accident. You must provide your employer with a copy of the completed Form 6.
• Signing the Form 6 allows your doctor to complete a Functional Abilities Form (FAF) and provide a copy to you, your employer and the WSIB. Your functional abilities describe what you can and cannot do at work because of your work-related injury. Your functional abilities form (FAF) does not include information about your medical condition(s).
• Generally, the WSIB will pay no more than two weeks of benefits to a worker who has not signed a Form 6.

What is E-Filing?

• If your employer filed an Employer’s Report of Injury/Disease (Form 7) and the WSIB has assigned a Claim Number to the incident, the WSIB will send you a letter asking you to file a Form 6. You can complete this online on the WSIB website. Please print a copy of your form before filing it as you must give a copy to your employer. Similarly, your employer must also provide you with a copy of the Form 7 they sent to the WSIB.

What happens after I file a Form 6?

• You should receive a letter from the WSIB providing you with a claim number. A claim number does not mean that your claim has been approved. It only means that the WSIB knows about your claim and has started a file. You should refer to the claim number every time you contact the WSIB about your claim.
• If you do not receive a claim number, it may mean that the WSIB does not know about your claim. You should contact the WSIB right away to check. The WSIB will tell you how to establish a claim if you do not have a claim number.

What if my claim is denied?

• You should receive a letter from the WSIB explaining why they are denying your claim. If you disagree with the reasons provided, you have six months from the date of the WSIB decision to file an appeal. For more information on appealing a WSIB decision.
• 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.

Time Limit Extensions: Filing a Claim

What Time Limits Apply?

• Under the Workplace Safety and Insurance Act there is a six-month time limit to apply for benefits.
• If you have missed a time limit, you should seek help from a qualified representative as soon as possible. Contact the Union’s Workers Compensation department.
• Both the Workplace Safety and Insurance Board(WSIB) and the Workplace Safety and Insurance Appeals Tribunal(WSIAT) have the authority to extend time limit

What If You Did Not File Your Claim on Time?

• If you did not file your claim on time, you should complete a WSIB Form 6 (Worker’s Report of Injury/Disease) and submit it to WSIB. You can also obtain the Form 6 by visiting the WSIB website, or by calling WSIB at 1-800-387-0750. If your employer reported your accident, you should receive a letter from WSIB that includes a claim file number. If so, you can also file your Form 6 online through the WSIB website.
• You should provide WSIB with as much information as possible when explaining the reason for the delay in filing your claim.

What If WSIB Does Not Extend the Time Limit to File Your Claim?

• If WSIB refuses to extend the time limit and decides you are not eligible for benefits because you did not file your claim on time, you can appeal the decision to an Appeals Resolution Officer (ARO). See Appeals at the WSIB. If your appeal to the ARO is not successful, you can further appeal to the Workplace Safety and Insurance Appeals Tribunal (WSIAT). See Appeals at the WSIAT. If your appeal to WSIAT is successful, you should contact WSIB. WSIB will then decide your benefits. Contact the Local Union’s Workers’ Compensation for assistance and information on the appeals process.

Getting your WSIB File

What is a Workplace Safety and Insurance Board (WSIB) claim file?

A claim file is created by the WSIB whenever a work-related injury or disease is reported to them. Your WSIB claim file will include all the documents related to your injury or disease claim. It can include documents submitted to the WSIB by you, your doctor, and your employer, as well as documents created by WSIB employees. Every claim file has a unique number. WSIB employees will request your claim number every time you talk to them. A claim file is divided into sections separated by blue title pages. Each section of the file starts with the most recent document and then goes back in time.

A claim file usually includes these sections:

• Memorandums (memos) – This section contains memos created by WSIB employees. These memos may include explanations of decisions made in your claim, WSIB doctors’ opinions, as well as notes of telephone calls and meetings with you, your employer, your doctor, and others connected to your claim. The memos are all numbered. You should refer to these numbers when you contact WSIB employees about specific memos in your claim file.
• Forms – This section contains the accident report forms from you, your doctor and your employer. If your file does not contain this section, the forms can probably be found at the front of the Medical Reports section.
• Medical Reports – This section contains the medical reports that your doctors sent to the WSIB.
• Correspondence – This section contains all the letters the WSIB has sent and received about your claim including decision letters. It does not contain medical reports.
• Work Transition, Labour Market Re-entry or Vocational Rehabilitation- If you received work transition, labour market re-entry or vocation rehabilitation services, your file will contain this section.

Some files also include other sections, like NEL, Payments and Health Care Benefits.

When can I get a copy of my claim file?

• You can get a copy of your claim file at any time by writing to the WSIB.
• If you file an Intent to Object Form with the WSIB, you will automatically receive a copy of your claim file and an Appeal Readiness Form. This is the preferable way of getting your claim file if you intend to proceed with an appeal.

How can I get a copy of my claim file?

• You can get a copy of your claim file by writing to the WSIB. In your letter, you should provide them with your claim number and request a copy of your file. Make sure your letter is dated and includes your signature.
• If you object to a WSIB decision and file an Intent to Object Form, the WSIB will send you a copy of your file. For more information on appeals, see Appeals at the WSIB.

How long does it take to get a copy of my claim file?

• Usually, you will get a copy of your claim file about two months after you request it. Shortly after you submit your request, the WSIB should send you a letter confirming that they are preparing your copy of your file. If you do not receive any reply from the WSIB within three weeks of your request for your claim file, call the WSIB and follow-up.

Will I get everything in my claim file?

• You will usually get your whole claim file. In rare cases, the WSIB may send some medical reports to your family doctor rather than to you. To determine if any part of your file is missing, look at the Access Memo. It should be one of the first pages in the file

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Benefits

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.

Health care

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.

Employment benefits

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.

Retirement benefits

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.

Appeals

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)

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.

Appeals at the WSIB

The first Workplace Safety and Insurance Board (WSIB) decision is made at the WSIB Operating Level.If you disagree with that decision, you can file an appeal to the WSIB Appeals Services Division within the time limit.If you discover that you have missed an appeal time limit, you should obtain help from a qualified representative as soon as possible.

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.

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 an appeal at 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.

Within the time limit, fill out and send an Intent to Object Form to the WSIB. It is helpful to read the Worker Instruction Sheet provided by the WSIB before completing the form. Both the Intent to Object Form and the Worker Instruction Sheet are available from the WSIB’s website or by phoning the WSIB at 1-800-387-0750.

On the Intent to Object Form, you must write the date of the WSIB decision you disagree with and you must list the issues you want to appeal. If you are not sure how to list the issues, you may write that you want to appeal “All issues not decided in my favour.”The second page of the Intent to Object Form asks for the reasons for your objection. You are not required to complete the second page.

Once it is complete, send your Intent to Object Form by fax, courier or registered mail so you have proof that you sent it within the time limit. Keep the receipt or fax confirmation sheet in your records. Even if you are not sure whether you agree with the decision, it is wise to file an Intent to Object Form right away, so you don’t lose your right to appeal.

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

If you will be asking someone else to represent you, do not send the Appeal Readiness Form to the WSIB. Give the Appeal Readiness Form to your representative. There is no time limit for submitting the Appeal Readiness Form to the WSIB.

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. If your appeal is ready, it will be forwarded to the Appeals Services Division.

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 do I appeal a final WSIB decision?

Final WSIB Appeals Services Division decisions can be appealed to the Workplace Safety and Insurance Appeals Tribunal (WSIAT).

Appeals at the WSIAT

The Workplace Safety and Insurance Appeals Tribunal (WSIAT) is the final level of appeal to which workers and employers may take disputes. WSIAT is separate from and independent of the Workplace Safety and Insurance Board(WSIB). WSIAT, however, is required to apply WSIB policy when deciding appeals. WSIAT can only hear an appeal when there is a final decision from WSIB.

Who Can Appeal to WSIAT?

You can appeal to WSIAT 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 Appeal a Final WSIB Decision?

Appeals of final WSIB decisions are made to WSIAT. Final WSIB decisions are usually decisions made by an Appeals Resolution Officer (ARO).You must complete the WSIAT Notice of Appeal (NOA) form and return it to WSIAT within 6 months of the date of the final decision from WSIB. You may also obtain the NOA form from WSIAT by calling 1-888-618-8846. You should include a copy of the decision you are appealing along with the NOA form. Send these documents to WSIAT by fax or registered mail to ensure you have proof of having met the time limit by way of receipt. Please remember to keep the fax confirmation slip or registered mail receipt for your own records.

What Happens Next?

WSIAT will send you a Readiness Form acknowledging receipt of your NOA form. By signing the Readiness Form, you are confirming that you are prepared to tell WSIAT everything they need to know to schedule your case for a hearing. Once WSIAT receives your Readiness Form, they will prepare the Case Record.

What Is the Case Record?

The Case Record is the written evidence that WSIAT will review when hearing your appeal. The Case Record should contain all the relevant WSIB files. Once the Case Record is prepared, WSIAT will send it to you along with a Confirmation of Appeal (COA) form.

Your appeal will remain on a WSIAT Notice of Appeal List until such time as your completed Confirmation of Appeal​ (COA) form is received by WSIAT. A case can remain on the Notice of Appeal List for up to two years from the date you first contacted WSIAT, at which time WSIAT will decide whether to consider the appeal abandoned and close the file. After receiving the Case Record, carefully review the contents to make sure that all the necessary documents from your file(s) are included. Any missing or additional information should be sent to WSIAT along with the COA form. If you do not send this information along with the COA form, WSIAT may not accept it at a later date. If you obtain new information or evidence after completing the COA form, you must send it to WSIAT at least3 weeks before the scheduled hearing date.

Forms

• 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

Resources

More information can be found at:

• WSIB
• WSIAT
• Service Ontario
• Canada Pension Plan
• Workplace Safety and Insurance Act, 1997
• Office of the Worker’s Adviser
• Injured Workers Online