If an injury at work requires medical assistance, results in lost time from work or lost income, you may be entitled to file a claim for benefits with the Workplace Safety and Insurance Board (WSIB).
Fink & Bornstein has extensive experience in matters relating to the WSIB. Our legal counsel will:
- Provide a legal opinion on your claim
- Defend your interests, rights and responsibilities stemming from your injury
- Help you receive the medical and financial support you are entitled to
- Protect you from further injury at your workplace
- Ensure your return to work, with proper accommodation
What you should know:
Right to Sue
- A claim can be made after professional medical attention is given and your employer is notified of the injury
- Contact the WSIB immediately if you made a claim to WSIB and you do not understand or you disagree with a Decision arising from your injury in the workplace
- In any disagreement with a Decision made by your WSIB adjudicator, there are strict time limits that must be followed in order to file objections and appeals
- The workers' compensation system is a "no-fault" insurance plan that provides compensation to workers hurt or disabled from work. In most cases, injured workers cannot sue for work-related injuries or diseases. Their only option is to make a claim for compensation to the Workplace Safety and Insurance Board (the WSIB). The Workplace Safety and Insurance Act (the Act) is the government legislation that covers the compensation system.
- If your employer is covered under the Act and you are an eligible worker who was injured at work or out of the course of employment, you can make a claim for benefits. There is a 6 month time limit to make a claim.
- Compensation is available to survivors and dependants of injured workers whose death is related to a work injury or a work-related disability/disease.
- If your claim for benefits is rejected, you have six months to appeal that decision. The appeal process starts with the Objection Form and a review of your claim file by the Claims Adjudicator. After that review, you appeal is heard by the WSIB Appeals Branch.
- If your appeal is denied by the Appeals Branch, you can still appeal to a separate organization, the Workplace Safety and Insurance Appeals Tribunal. The Tribunal is the final level of appeals for workers' compensation matters in the province of Ontario.
- The Workplace Safety and Insurance Board (WSIB) was established by the Ontario government to provide health care and lost wages to those who were injured at work. The WSIB is a no fault system and will provide benefits even if the accident was the worker’s or employer’s fault.
Generally, if you have been injured at work you cannot sue your employer.
There is a six-month time limit to apply for benefits and thirty days for appealing return to work or retraining decisions. If you have missed a time limit, you should seek help from a lawyer as soon as possible. Obtain a legal representative who is competent and experienced.
Complete a Form 6 and send it along with a letter explaining why the time limit was missed. The WSIB may extend the time limit for specific reasons in limited circumstances.
Loss of Earnings Benefits
The benefits you are entitled to depend on the impact the injury has on you physically, mentally and financially. You are entitled to Loss of Earnings Benefits if you suffered a loss of income due to the work related injury. The level of benefits depends on the date of the accident.
|After January 1st, 1998:
|| 85% of your net average earnings
|From January 1st, 1990 - 1998
||90% of your net average earnings
|Before January 1st, 1990:
||75% of your gross average earnings plus cost of living
Non Economic Loss Award (NEL)
It is a benefit received from the WSIB when they recognize that your injury has a permanent impairment on your life. A permanent impairment means any permanent physical or functional abnormality or loss (including disfigurement) which results from an injury, and any psychological damage arising from the abnormality or loss. To determine if you have a permanent impairment, the WSIB looks at the relevant medical information in your file.
The amount of your award is expressed as a percentage of the whole body and based on an independent assessment.
The WSIB does pay for chiropractic and physiotherapy treatments as long they are recommended by your physician to treat your injury, and the treatment would improve your condition. You would usually receive 12 weeks of benefits for these treatments. An extension can be granted if your chiropractor or physiotherapist believes it is necessary and the Board agrees.
The WSIB will also pay for any medication that is needed for your injury, as long as entitlement is granted for that injury by the Board.
In most cases when you are injured, you will require some form of medication. In many cases the WSIB will reimburse the injured worker for these expenses; however they must be pre-approved by the board. As an injured worker you must provide the WSIB with the original prescriptions and receipts for all health care prescriptions and supplies
Many injured workers will need to travel for treatment and in some instances the WSIB will pay mileage or some travel expenses. However, approval must be obtained for out of town travel. If the treatment is outside of city limits but still local, the reimbursement is based on mileage. Treatment within the city limits is based on bus fare. In all cases it is important to ask for approval in advance.
Labour Market Re-Entry Program (LMR)
Often times an injured worker is unable to return to their original employment due to the severity of the injury. Injured workers are eligible for an LMR assessment if it is unlikely the worker will be re-employed by the accident employer due to the nature of the injury and or the injury employer is unable to arrange for suitable and available work. Based on the results of the LMR assessment, the WSIB decides whether a worker requires an LMR plan to return to the labour market. An LMR plan is tailored to each individual worker based on their existing transferable skills. A worker will receive benefits while co-operating with their LMR plan. If the worker does not agree with the suggested LMR plan they must appeal within 30 days in writing to the board.
Obtain Legal Representation
Far too often, disputes arise over what benefits are owed to you. Contact a lawyer who knows the worker’s compensation system. The Ontario law is complex. Employers are typically represented by competent experienced worker’s compensation lawyers who try to defeat the claim or minimize the benefits paid to you. You need a lawyer who will fight for you.
We may be able to help. To learn more,
contact us at 416-537-0108
|If you or your loved one has experienced a work related injury and want a Law Society of Upper Canada Certified Lawyer Specialist to evaluate the WSIB benefits you may be entitled to: Please Call 416-537-0108 for your FREE Case Evaluation.