Workplace Safety & Insurance Board
The social services department helps members with claims, appeals and return-to-work issues with the Workplace Safety and Insurance Board (WSIB).
This assistance is available right from the start of a claim by contacting the department.
If a Local 793 member is denied WSIB benefits, the department works with the member to discuss possible options.
If it’s determined that there is merit for an appeal, the department will work with the member to fill out the necessary paperwork to get the claim reviewed by the WSIB.
The department can also assist with return-to-work issues and represent members at meetings with the WSIB and the employer, and also ensure that any work being offered is suitable.
A member who has been injured while in the course of employment should immediately report the accident to the foreman or supervisor on site and if necessary seek first-aid, even if the individual feels well enough to continue working.
If a member requires medical help beyond first-aid, the member should inform a doctor about the accident. The doctor will complete a Form 8 and send it directly to the WSIB. If the doctor recommends time off work or work restrictions, the member should get it in writing and provide it to the employer.
If the injury is to be reported to the WSIB, the agency will require a member to complete Form 6. It is important to provide a full description of the accident and note any witnesses. For convenience, the Form 6 can now be completed online here.
A WSIB claimant is obligated under the Workplace Safety & Insurance Act (WSIA) to provide a copy to their employer.
The employer is required to complete a Form 7, which provides earnings history. The information will be used by the WSIB to determine benefits.
The Workplace Safety and Insurance Act states that a worker has up to 30 days to object to a WSIB decision about return-to-work and work transition issues, and 6 months for all other appealable decisions. The member must submit an intent-to-object form to the WSIB.
To find out how the social services department can help, call Local 793’s head office at 905-469-9299, or toll-free 1-877-793-4863, or contact the department via email at firstname.lastname@example.org.
Drug coverage from the WSIB is a reimbursement. All work-related healthcare expenses should be expensed through the WSIB and not via Global Benefits.
This website contains general information only. It is not legal advice about a particular situation and is not intended to replace advice from a qualified representative.
About the WSIB & WSIA
The Workplace Safety and Insurance Board (WSIB) was created in 1915. It was originally called the Workmen’s Compensation Board.
The WSIB is legislated by the Ontario government and is responsible for administering the Workplace Safety and Insurance Act (WSIA), 1997 that provides no-fault workplace insurance for employers and their workers.
The WSIB also provides benefits and/or services to workers who have suffered work-related injuries or contracted an occupational disease. The WSIB is funded entirely by the employers of Ontario and receives no government funding.
Click here to learn more about WSIB benefits.
The WSIA was formerly the Worker’s Compensation Act. It came into effect Jan. 1, 1998. The purpose of the WSIA is to:
- Promote health and safety in the workplace and prevent and reduce the occurrence of workplace injuries and occupational diseases.
- To facilitate return to work and recovery of workers who sustain personal injury in the course of employment or who suffer from an occupational disease.
- To facilitate re-entry into the labour market of workers and spouses of deceased workers.
- To provide compensation and other benefits to workers and survivors of deceased workers.
Steps to a claim
When should I file a claim?
How do I start a claim?
Returning to work
When Should I File a Claim?
Workers should submit a claim if you have:
- Received medical attention and/or;
- Lost time or earnings from work beyond the day you were injured;
- Had to perform different work for more than seven days due to an injury, at regular or reduced wages. (Reminder: Employers must report immediately if the worker still needs different work after seven days.);
- Continued to work, but on a reduced work load/schedule at regular or reduced wages.
Note: Under the Workplace Safety and Insurance Act there is a six-month time limit to apply for benefits. Delays on reporting may complicate a worker’s ability to collect WSIB benefits. For disablement injuries, workers have six months from the date the worker would have been reasonably aware that the condition was related to job duties.
Workers should not submit a claim if the following four statements are true:
- I only required first aid;
- I did not take any time off work;
- My pay was unaffected;
- My job duties did not change as a result of the injury.
Workers can file a claim for WSIB benefits for a number of different types of occupational injuries and illnesses:
- Willful and intentional act, but not an act of the worker;
- Occupational disease;
- Noise induced hearing loss;
Following are types of compensable claims:
- Disablement injury: This is a condition that gradually emerges over time and can not be attributed to a clearly defined time or place. Eg. carpal tunnel syndrome and tendonitis.
- Chance event Injury: This is an identifiable, unplanned event that precedes the injury. Eg. slip, trip and fall.
- Willful and intentional act, but not an act of the worker: If another worker assaults a worker as a result of work-related disagreement.
- Occupational disease: This is a disease or illness that was caused by some part of the worker’s job. Typically, occupational diseases are caused by exposure to a chemical or substance at work. Eg. asbestos, dust, fumes, gas and noise. A worker should file a claim for an occupational disease if the worker has been diagnosed with a disease that the worker and/or the worker’s health professional think is work-related, or the worker has been removed from exposure to a substance to prevent the worker from developing a disease.
- Noise induced hearing loss (NIHL): This is permanent hearing loss resulting from being exposed to high levels of noise over a long period of time, or a single exposure to a very loud noise, such as an explosion. The WSIB will accept entitlement for NIHL if:
- You have a hearing test showing an average hearing loss of 22.5 decibels (DBs) in both ears.
- For asymmetrical hearing loss, when the average hearing loss is 35 DBs in at least one ear but less than 25 DBs in the other, and when the pattern of hearing loss is clearly consistent with occupational noise exposure.
Workers should contact the social services department to request assistance with the creation of a work history report to help them with an NIHL claim.
Note: Age-related hearing loss is not compensable.
- Psycho-traumatic disorder: Click here for more information.
How Does a Worker Start a Claim for WSIB Benefits?
To file a claim for benefits the worker must report the injury or illness to the WSIB.
The process to file a claim for benefits involves completing Form 6. This form is available by calling toll-free 1-800-387-0750 or electronically here.
Note: The E-form 6 is a streamlined and paperless process that we encourage our members to take advantage of when initializing claim.
Workers should complete, sign and return Form 6 as soon as possible following a work-related injury or when they become aware of illness. Workers must provide a copy to the employer.
After the worker files a claim, the worker should receive a letter from the WSIB, confirming receipt of Form 6. This letter will also provide the worker with a claim number, which is unique to the claim. Please note, this does not mean the worker is approved for benefits. This is just a confirmation that the worker has a registered WSIB claim. Workers should have the claim number handy every time they contact the WSIB regarding the claim. Note: If a worker does not receive this letter, please contact the WSIB as soon as possible to determine why.
If a worker does not receive benefits it could mean that the WSIB does not have all the necessary information to make a decision. Eg. medical information may be missing.
A delay in decision-making could also mean the WSIB is still reviewing the claim. Workers who do not receive a response from the WSIB should call and enquire about the delay.
Once a claim is created, all relevant material in regards to an injury or disease will be categorized into a series of sections, under the worker’s unique claim number. Ensure the claim number is noted on all items sent to the WSIB.
Workers can acquire a copy of their claim file by sending out a written request to the WSIB.
If a compensable injury flares up, recurs, or turns out to be a condition more serious than the worker initially thought, the worker should ask the WSIB to re-activate his or her claim. To successfully re-open a claim, the worker will need to demonstrate what the WSIB calls medical continuity. Medical continuity refers to continuity of a complaint, or evidence of ongoing/persistence of difficulties related to the original work-related injury.
To show medical continuity, a worker will have to provide the WSIB with:
- A list of co-workers (contact information) with whom they’ve discussed their injury;
- A historical account of doctor visits regarding the injury;
- Documentation of complaints to an employer regarding the work-related injury.
Workers can find the form to file a claim for Noise Induced Hearing Loss (NIHL) by clicking HERE 0032A. Please contact the Social Services Department if you would like assistance with the form. We can also provide you with a work history to help support your NIHL claim.
Note: To complete your application for NIHL benefits, your completed ‘Worker’s Report Occupational Noise Induced Hearing Loss’ form, needs to be accompanied by an audiologist report, and a work history to verify your exposure.
Returning to Work
Coming back from a work-related injury or illness can be a difficult and stressful time.
The most obvious question that comes to mind is: How do I know if the work I am going to perform will not do further damage to my injury or illness?
To tackle this challenge, the WSIB created a tool called the Functional Abilities Form (FAF) for Early and Safe Return to Work. An FAF provides information about a worker’s abilities.
The worker and employer will use this information as a tool for planning the worker’s return to suitable work. A request for the form should only be initiated by the employer or the worker and, ideally, should only be completed when the worker is functionally able to return to work. Only regulated health care practitioners can complete the FAF. A worker is required under the WSIA to provide the WSIB with any information it needs regarding a worker’s healthcare.
The FAF is a great guide to understand what the worker’s limitations are to avoid re-injury.
What is Suitable Work?
Suitable work is employment that the worker is able to do without the risk of harm of oneself and/or others.
The WSIB recognizes that when an injured or ill worker is returning to work, the worker may not be able to jump back into the same position as prior to the injury or illness.
The WSIB explores a number of options to return workers to their pre-injury/illness work in the following order:
- Pre-injury job with the employer, the starting point and overall objective;
- Pre-injury job with the employer, with accommodation where necessary;
- Work comparable in nature and earnings to pre-injury job with the employer, with accommodation where necessary;
- Alternative suitable work with the employer, with accommodation where necessary;
- Work comparable in nature and earnings to pre-injury job in the labour market, with accommodation where necessary;
- Alternative suitable work in the labour market, with accommodation where necessary.
What happens if a worker chooses not to participate in an offer of modified work?
If the offer of modified work is meaningful, productive and determined to be suitable by the WSIB, given the worker’s compensable restrictions, the worker’s benefits will be reduced or stopped if he or she does not participate.
Click here for more information on workers obligations.
Is the worker’s employer required to take him or her back?
Construction employers are obligated to offer to re-employ injured or ill construction workers who have been unable to work due to a work-related injury or disease.
The start of this obligation begins when the employer is notified that an injured construction worker is medically able to perform:
- The essential duties of his or her pre-injury job;
- Suitable construction work; or
- Suitable non-construction work.
Following notification, the employer must offer to re-employ the injured worker in the first job that becomes available that is consistent with the worker’s medical ability to return to work. The employer’s offer of work must take into account its obligation to accommodate the work or the workplace to the needs of the worker to the extent that the accommodation does not cause the employer undue hardship. Click here for more information on re-employment obligations within the construction industry.
Is a worker required to co-operate?
Yes. If a worker is in receipt of WSIB benefits, the worker is required to co-operate by:
- Contacting the employer as soon as possible following injury and maintain communication;
- Assist the employer as requested to identify suitable work;
- Provide information to the WSIB in regards to the return-to-work process; and
- Report any changes in the worker’s employment, health, and earnings (often referred to as material changes);
Note: The WSIB should remind workers verbally and/or in writing of their duty to co-operate and of the possible consequences if they do not comply. The WSIB will not pay benefits for periods where benefits were reduced or suspended due to non-co-operation.
Click here for more information.
Will a general medical note suffice to obtain LOE benefits?
General medical notes advising time-off work for any length of time must be supported by limitations, indicating the tasks that a worker is temporarily incapable of doing.
A general medical note often does not suffice to allow for LOE benefits.
Objective medical evidence should accompany a health professional’s opinion that one can not return to work. Eg. FAF form.
What can workers do if they’re having difficulty returning to work?
Workers should notify their case manager and return-to-work specialist. Should issues persist, the worker can request a meeting with the WSIB and his or her employer. Given sufficient notice, and upon request from the worker, a representative from Local 793 may be available to accompany you to a return-to-work meeting.
The WSIB appeals process can be managed informally at the operations or case management level or, if necessary:
- Formally at the Appeals Services Division, or at
- The Workplace Safety and Insurance Appeals Tribunal (WSIAT), which is an independent organization from the WSIB.
WSIAT is the final level of appeal for WSIB disputes in Ontario.
When the WSIB makes a decision, the agency will notify a worker in writing. The letter will highlight that the WSIB has made its decision based on information currently available and provide time limits to object to the decision.
Under section 120 of the Workplace Safety & Insurance Act, a worker has up to 30 days to object to a WSIB decision about return to work or work transition issues, including re-employment decisions. A worker also has up to six months to object to any other WSIB decision.
If you disagree with the WSIB decision, the worker can then object to the decision by completing and sending to the WSIB an ‘Intent to Object’ (ITO) form, within the time limits given above. Intent to Object form
The form will allow workers to attach or refer to any information that they believe was overlooked, so that they may request a reconsideration of the decision. Workers can have a form mailed to them by calling 416-344-1000 or 1-800-387-0750.
Local 793’s social services department can help workers complete the form. WSIB staff can also assist workers in completing the form.
After a worker submits an ITO form, the WSIB will review it. The process generally takes two to four weeks. If the decision is overturned, the WSIB will notify the worker. If the adverse decision is upheld, the WSIB will refer the worker’s file to its access department. The worker will be provided a copy of the claim file and receive an appeals readiness form and instruction sheet.
Once a worker has submitted an ITO Form there is no time limit for submitting the appeal readiness form.
A worker can have Local 793 represent him or her with the appeal by contacting the social services department before submitting an appeal readiness form.
Workers should only submit the appeal readiness form when the WSIB has considered all the facts and has seen all the medical information and any other information the worker thinks is important to support the position.
The limit for appealing final decisions from the WSIB appeals services division is six months, which allows a worker to proceed to a hearing at the WSIAT. The specified time is counted in calendar days. Click here for the notice of appeal.
After the notice of appeal is sent to the WSIAT, the worker has two years to send a completed readiness form. Click here for the readiness form.
Can I sue my employer?
Workers gave up the right to sue for their work-related injuries, regardless of fault, in return for secured compensation for accepted claims. Employers receive protection from lawsuits in exchange for financing the program through premiums. The structure of collective liability provides fair compensation for injured workers and their families, while spreading individual costs among employers. Similar to other insurance agencies, the industries exposed to greater danger and higher claim costs pay higher premium rates. If a third party caused or contributed to the accident or illness, the right to legal action may be available. If an opportunity for legal action exists the WSIB will send a worker an election form to indicate if the worker would like to take legal action or collect benefits through the WSIB. Note: The social services department advises you to seek a legal opinion in regards to any decision between WSIB benefits and legal action.
Am I eligible for WSIB coverage?
Workers are eligible for WSIB insurance benefits if they are injured, as all construction employers and most employers in general must retain workplace insurance.
Who is covered in the construction industry?
The following four categories of workers in the construction industry are considered workers under the WSIA:
- Independent operators;
- Sole proprietors;
- Partners in partnerships;
- Executive officers in corporations.
What are Loss of Earnings (LOE) benefits?
Loss of Earnings (LOE) is a bi-weekly benefit that attempts to restore an injured worker’s pre-injury earnings. LOE benefits are disbursed at 85 per cent of the worker’s net average earnings.
When do LOE benefits end?
LOE benefits will continue until the worker is no longer impaired by the workplace injury or illness, or:
- Until the WSIB determines that the worker is no longer suffering a wage loss from a work-related condition; or
- Until the worker no longer has a loss of earnings; or
- Until the worker reaches age 65.
Note: Workers who are 63 or older at the time of injury may receive LOE benefits up to two years from the date of injury.
What is the difference between full and partial LOE benefits?
Full benefits are provided to an injured or ill worker when:
- The worker can not return to modified work; or
- If the worker’s employer does not offer suitable work for one to perform.
- If the worker co-operates in work transition activities.
Partial LOE benefits are provided to an injured or ill worker when:
- The worker returns to work at a wage loss (as a result of a work-related condition); or
- If the WSIB determines the worker is able to return to work after an assessment or plan.
Why have my LOE benefits been recalculated?
If a worker has seasonal or irregular employment, the WSIB conducts a recalculation of LOE benefits after 12 weeks of the worker being in receipt of LOE benefits.
This allows for a more accurate reflection of the worker’s total earnings. Generally, this results in one’s LOE benefit being reduced if he or she works in construction.
How are short- and long-term earnings used to recalculate LOE benefits?
The first 12 weeks of a worker’s LOE benefits is based on the worker’s short-term average earnings. This includes all of the worker’s earnings, with all employers, 4 weeks prior to date of injury or illness.
If the worker is a seasonal worker, after the 12th week of receiving LOE benefits, the worker’s case manager will recalculate the worker’s LOE benefits based on the long-term average earnings. The long-term calculation will generally take into account all the worker’s earnings in the 24 months leading up to the work-related injury/illness. Note: The long-term recalculation includes any employment insurance (regular) benefits.
Why are my LOE benefits less than my pre-injury earnings?
The WSIB constructs benefit payments on an annual wage ceiling. Earnings you receive in excess of this ceiling are not covered. The annual wage ceiling is based each year on 175 per cent of the average industrial wage for Ontario.
What is a Loss of Retirement Income (LRI) Benefit?
If an injured worker has received a Loss of Earnings (LOE) benefit for 12 continuous months the WSIB will apportion five per cent of every subsequent payment into a retirement fund. An injured worker has an option to contribute an extra five per cent from their LOE benefit payment.
When can I receive my retirement benefit?
The retirement benefit is paid to the injured worker at age 65, or if the worker dies before turning 65 payment is paid to his or her survivors.
What is a Non-economic Loss (NEL) award benefit?
If a worker has suffered a permanent impairment due to a workplace injury or disease the worker is eligible for a Non-economic Loss (NEL) benefit from the WSIB. This benefit or award is paid out to recognize that the worker has sustained a physical, functional, or psychological loss due to a permanent impairment. This benefit would be determined when the worker’s condition has reached a point where no further improvement can be expected. This date is referred to as maximum medical recovery by the WSIB. The amount paid is based on a legislated base amount times an impairment rating.
Can I get my NEL award increased if my condition deteriorates?
Yes. A worker is able to request a review 12 months from the date of the most recent decision if the worker possesses medical evidence that he or she has experienced a significant deterioration of injury or disease.