How to File a WSIB Claim

How to Report Properly and Avoid Problems

Statistics show there is a strong likelihood you will sustain a work-related injury at some point during your working career.

This document contains tips on utilizing the Workplace Safety Insurance Board (WSIB). It is vitally important that all ONA members understand how to navigate through the WSIB process in the event that you do become injured on the job.

These tips will help ease you through the process and may help prevent complications with your WSIB file.

Copies of this document are available in the Mailroom at ONA’s Toronto head office.

If you have any concerns or questions about what to do if you feel your condition or injury is related to work, or if you have any questions about the tips contained in this document, contact your local union representative for further guidance.

By following some of these basic steps, you may be able to avoid the hardships experienced by ONA members when their claims for workplace injuries are denied by the WSIB.

These tips are listed in priority order. However, if each and every tip is understood and followed as necessary, it is very likely your claim will be allowed.

Please note that the word “injury” as used in this document also means any easily or not so easily identifiable strain, sprain, pull, illness, exposure, aggravation of a pre-existing condition, etc. that may be related to the work that your perform.

1. Try to understand how the WSIB defines an accident.

  1. A work-related injury is not just an identifiable accident, like when a patient grabs your elbow unexpectedly for support and you suddenly develop excruciating pain in your elbow (these are easy claims to deal with).
  2. An injury can also be something that happens gradually over time (this is what the WSIB calls a disablement). A disablement can also be something the WSIB views as an unexpected result of working duties.
  3. Illnesses, including conditions that develop as a result of exposures to blood-borne pathogens, ie. mould etc., can also be considered a work related injury.

2. Report all injuries/illness/disablement/exposure immediately to your employer when first sustained.

  1. This includes any aches, pains, strains or a pull you felt in your body after doing any task related to your job.
  2. Report any changes in your work, no matter how insignificant you may think it is, ie. increase in workload, staff shortage, heavier or more acute patients etc.
  3. Report any witnesses to your injury/illness/disablement/exposure, or witnesses to any of your complaints.
  4. The longer you wait to report the incident, the more likely you are to have problems with your WSIB claim.
  5. Some members have reported they thought they only had 24 to 48 hours to report a work injury. This is not correct. The WSIB time limit to report any accident/illness that occurred as of Jan. 1, 1998 is six months, but if you wait that long, it will be difficult to win your case if denied by the WSIB. For accidents that occurred prior to Jan. 1, 1998, there is no time limit to report.

3. Your employer’s incident form is not the correct form you need to sign in order to officially report an injury/illness/exposure to the WSIB.

  1. The official form you must sign to report an injury/illness/disablement/exposure to the WSIB is called a Form 7. Your employer must fill out and submit this particular form to properly initiate the process for filing a claim.

4. You should also complete your employer’s incident form as well.

  1. Make sure you identify all body parts that were injured and/or even bruised or affected in any way by the injury or work you performed. Rushing to fill out this form is not advised. Be very specific about each and every detail. Incomplete forms can cause discrepancies and bring about issues of credibility.

5. You should always notify your employer of any injury immediately and ask your employer to complete a WSIB Form 7.

6. You should sign the section on the Form 7 claiming benefits.

  1. This authorizes your treating health professional to provide information about your functional abilities to you, your employer and the WSIB on the WSIB’s “Functional Abilities for Timely Return to Work” form.

7. You should write the WSIB a separate letter about any errors or omissions on Form 7.

8. If your employer refuses to complete a Form 7 and/or does not allow you to sign the claim and consent section, ask your employer for Form 1492, and make sure you sign this form.

9. You should see your treating health professional immediately and ask her/him to complete and send the appropriate form to the WSIB (Form 8, Physician’s First Report).

10. Make sure your doctor has physically examined you, and that she/he has documented all your physical findings in her/his clinical records. (ie. range of motion – very important, spasm, etc.) Make sure your doctor provides this information on the Form 8 to the WSIB.

11. Despite what your collective agreement says, if you are planning to claim the WSIB and you require time off from work, you will need authorization from your doctor.

12. Initially, you may need to attend a hospital emergency department or a walk-in clinic. The first physician to treat you must complete Form 8.

  1. There is also a Chiropractor’s First Report. According to WSIB policies, you make your choice of doctor when you accept treatment after the initial or emergency treatment.

13. If you see your employer’s occupational health doctor (OHD) for treatment after the initial or emergency treatment, the OHD will be your choice of doctor for the purpose of WSIB.

  1. Unless your contract specifies otherwise, it is recommended you do not go to the OHD for treatment or to discuss your diagnosis, because the OHD works for your employer. You can discuss your functional abilities with the OHD and what type of work you might be able to return to, but be careful not to divulge too much information.
  2. Here’s an example of why you should not discuss your situation in great detail with the OHD. In one hospital, the doctor convinced ONA members they should be treated by him and give him full authorization to access all their medical records. He then used this information to get what is called “cost relief” from the WSIB, which gives the employer a break on the cost of the claim. In another case, he used his knowledge of an ONA member’s condition to get the WSIB to deny a claim for psychological impairment resulting from a work injury.

14. If you do go to occupational health, check the notes on file, including doctor and nursing notes.

  1. Make sure everything you said at the meeting is reflected in the notes. Often, important information about work-relatedness is left out.
  2. When documented accurately, information in the occupational health file has often helped ONA win a case, especially when we argued the worker had ongoing complaints of pain or reported the injury.

15. You should notify WSIB in writing about your injury.

  1. In your letter, ask for entitlement and benefits. Make sure you write about every ache and pain and body part affected by your work or by the injury, and what you think may have contributed to or actually caused the injury.
  2. You should say you asked your employer to complete Form 7, and signed or will sign the claim and consent section.
  3. You should also indicate if your employer refused to complete the Form 7, or refused to give you an opportunity to complete the claim and consent section or Form 1492.
  4. If you signed the Form 1492, state this in the letter and enclose a copy of this form. Although Form 1492 states a worker should not return the form to WSIB, we recommend you do send WSIB a copy if you didn’t sign a claim and consent section.
  5. If you are entitled, WSIB will pay up to two weeks loss-of-earnings benefits. No further benefits will be issued unless you meet requirements to claim and consent. There are time limits.

16. WSIB may send you a Form 6, which you should complete, as well as sign the claim and consent section.

  1. You should ensure the form is clear and complete, and contains no errors or omissions. Again, make sure to write about every ache and pain and body part that was affected by your work or by the injury, and what may have contributed to the injury or actually caused the injury.

17. WSIB policies state you have the right to request and receive a copy of your employer’s Form 7.

18. Your employer must report all injuries to the WSIB if you require health care and/or:

  1. are absent from regular work
  2. earn less than regular pay for regular work (e.g., part-time hours)
  3. require modified work at less than regular pay
  4. requires modified work at regular pay for more than seven calendar days following the date of your accident.
  5. WSIB policies state they must receive your employer’s complete accident report (Form 7) within seven business days of your employer learning of the reporting obligation. (Business days are Monday to Friday, and do not include statutory holidays).

19. Your employer must fill out a WSIB Form 7, even if they don’t think your work is the cause of your injury or illness.

  1. Your employer may try to convince you that your injury/illness is not a workers’ compensation claim, and that you should instead receive benefits under your sickness and accident plan, i.e. short-term disability. Explain to your employer it is the WSIB’s job, not theirs, to decide if your work is responsible for your injury.
  2. If your WSIB claim is denied, apply for full sickness and accident benefits under your collective agreement, if there is such a provision. Some collective agreements provide for these benefits during the time the WSIB is making a decision on whether to allow or deny your case.
  3. Even if the WSIB accepts your condition as work-related and pays you benefits, you may be eligible for an additional minimum $50 payout from your long-term disability plan (e.g. HOODIP) under the terms of your collective agreement. If you are injured or ill, immediately talk to your local union representative about this benefit, because there are time limits.

20. If you have a pre-existing condition that is either symptomatic or asymptomatic and your work in any way aggravates it, you should report this to your employer, the WSIB and your doctor as a work-related injury.

  1. WSIB policies allow you to be paid for the acute episode or phase during which your condition is aggravated. If this flare-up never returns to your pre-flare-up stage, WSIB benefits should continue and you may be entitled to what is called a non-economic loss (NEL) award.

21. The best way to avoid problems with the WSIB is to report every incident, no matter how minor.

  1. If your work has changed under any circumstances, i.e. nursing cut backs, etc., and you believe that change is now causing additional demands on your body to the point that you are starting to feel aches and pains, report this immediately to your employer. Identify what you think is causing the problem. Do this even if you have not yet lost any work time or sought medical attention.

22. Do not self-treat. See your physician so she/he can document your complaints and anything you believe may have contributed to your condition.

  1. If you are diagnosed with any condition you believe is related to your work, make sure to report this to the WSIB.

23. See your doctor on a regular basis (every two weeks is recommended).

  1. Documenting the problem and any ongoing concerns are key to having a problem-free WSIB claim. Again, make sure your physical findings are documented in your clinical records at each visit. To ensure that sufficient time is allotted for your assessment and that your doctor has time to document all of your findings, you may need to book a half-hour appointment.

24. If you have been injured from your work in any way, even if you think it is just a strain or pull, make sure your colleagues know you believe your aches or pains are from the accident or from the nature of your work.

  1. Even if your colleagues did not witness an incident, make sure they are aware of your injury.
  2. Keep notes in a journal documenting who you reported to, who you told about the incident or even just your aches and pains. Document all treatment you received, who you saw and when you were seen, etc.

25. Even if you feel it is only a strain or a pull, make sure you report it to your employer.

  1. If your problems surface a few hours or a few days later, it is easier to relate it back to the strain, pull or awkward lift, etc., if you reported it at the time of the incident.

26. Tell your employer, doctor and the WSIB if you are continuing to work in pain, but are getting assistance from your colleagues in order to manage your job.

27. If you have filed a claim and not heard from the WSIB within a few weeks, call the WSIB adjudicator and ask if your claim has been reviewed for entitlement.

  1. If there is any indication of a delay or problem, call your local ONA representative immediately. Sometimes all it takes to get your claim allowed is for you to send in a witness statement verifying that you told your colleagues about the incident.

28. If you require modified work, speak to your local union representative and your employer.

29. If you return to work in any capacity but have any problems performing the job, speak to your local union representative and your employer about a job accommodation.

  1. Accommodation can mean anything up to that which causes undue hardship for the employer. For example, if you can do all tasks except manual lifting, the employer might have to purchase a mechanical lift suitable for your condition and for the patients. This is to accommodate your lifting restrictions, particular if they cannot find another job for you that does not require manual lifting.

30. Advise your employer of any health and safety hazards in your workplace.

  1. Ask your supervisor to correct the problem. If no action is taken, ask a member of your Joint Health and Safety Committee (JHSC) to make a recommendation in writing to your employer to correct the hazard and make your work environment safer.

31. If you are asked to attend a return-to-work meeting that only offers a gradual return to work, when you believe aspects of the job exceed your restrictions, you should tell your employer this is a health and safety hazard or concern.

  1. Speak up. Tell your employer you need them to accommodate those tasks that do not fall within your limitations.
  2. Many claims have been accepted initially and then denied because the employer told the WSIB they had accommodated an ONA member. In reality, they provided graduated hours and expected the ONA member to continue to do the heavy aspects of nursing work, i.e. lifting.
  3. Make sure your concerns about your job are put in writing to the employer and to the WSIB.
  4. Discuss with your doctor any concerns you have about certain aspects of your job exceeding your restrictions. Ask your doctor to document all concerns she/he may have with the job.

Claiming for a Recurrence of an Injury (Flare up/change in status)

32. If there is a recurrence of an injury, you should call and write to the WSIB asking for entitlement and benefits.

  1. You must report a recurrence to the WSIB within 10 days, because the WSIB may classify a recurrence as a material change in circumstance. Material changes in circumstances are subject to a 10-day notice policy.
  2. You should indicate you asked your employer to complete the Employer’s Continuity Report.
  3. Let the WSIB know if your employer refused to complete the Employer’s Continuity Report or a new Form 7, and/or if your employer refused to give you the opportunity to complete the claim and consent section or Form 1492.
  4. If you signed a Form 1492, state this in your letter and enclose a copy of the form. Although Form 1492 says you should not return the form, send a copy to the WSIB if you have not had an opportunity to sign the claim and consent section. WSIB benefits are not paid until you have met the requirements to claim and consent within the time limits.
  5. The WSIB may send you a Form REO6, Worker’s Continuity Report, to complete. You should complete this form and sign the claim and consent section. You should ensure the form is clear, detailed and complete, and that there are no errors or omissions. Return the completed form immediately to the WSIB.
  6. If you miss the deadline to report the recurrence, you should still request entitlement to the WSIB as soon as possible.

33. If you feel your condition has flared due to your work, seek immediate medical attention.

  1. Ask the treating health professional to complete and send the appropriate form to WSIB, i.e., Physicians Report of Re-opened Claim form.
  2. Initially, you may need to attend a hospital emergency department or a walk-in clinic. You should then see your treating health professional.
  3. Make sure your doctor documents your physical findings. If you can show the WSIB your findings are worse than when you first returned to work, it is likely then that you will be paid for the period of time during which your condition flared up

34. You should notify your employer of the recurrence and ask them to complete the WSIB Employer’s Continuity Report.

  1. If you did not meet the claim and consent requirements when the claim was initially accepted, you must meet them now.
  2. If your employer uses a Form 7 to notify the WSIB about the recurrence, you should sign the section claiming benefits. This authorizes your treating health professional to provide information about your functional abilities to you, your employer and the WSIB on the WSIB’s “Functional Abilities for Timely Return to Work” form.
  3. You should write a separate letter to the WSIB about any errors or omissions on these forms.
  4. You should complete an employer’s incident form. Be specific about each and every detail.
  5. You can also meet the claim and consent section requirements, by asking your employer for Form 1492; sign this form.

35. If you have a recurrence you must continue to see your doctor and/or specialist. Again, ensure that at each visit your physical findings are documented and submitted to the WSIB.

Early and Safe Return to Work (ESRTW)

36. It is your obligation under the Workplace Safety and Insurance Act (WSIA) to cooperate in your early and safe return to work. This can mean a return to work to your own job prior to your accident (accommodated or not), or to other work that is suitable and available.

  1. ESRTW means you must maintain communication with the employer even if you are not yet able to return to work.
  2. Work towards identifying a suitable and available job for you.
  3. Fulfil your reporting obligation to the WSIB.

37. If you are partially disabled, meaning your doctor feels you could return to some form of work with restrictions, then you will be expected to cooperate with your employer in identifying a job that meets your restrictions.

  1. Remember that while the WSIB may first look at your original job, WSIB policies do not require them to bring you back to nursing. Their only concern is that you restore your pre-injury earnings capacity.

38. If you believe you are unable to return to work but the WSIB insists you can, it is likely your doctor’s reports have been evasive and do not provide rationale for why you are unable to do any work in any capacity.

  1. Ensure your doctor is providing the WSIB with rationale and your physical findings.
  2. Keep in mind that when the WSIB feels you are partially disabled, it means they believe you can return to some type of job, but not necessarily in a health care setting.
  3. If your employer cannot accommodate you, the WSIB will likely refer you to a labour market re-entry (LMR) provider. The role of the LMR provider is to assess your skills and capabilities based on your restrictions for work, which may be suitable for you outside of your employer’s establishment.
  4. The LMR provider makes recommendations to the WSIB about the type of work they believe you are able to do, and that you may need training for in order to acquire the skills to do that job. If at any point in time you do not cooperate with the LMR provider, the WSIB will likely terminate your benefits. You should cooperate, and then appeal the WSIB decision.
  5. When cooperating in labour market re-entry, keep in mind that you may never return to the health care environment. For instance, if you could work as a receptionist and have the option to sit, stand and walk in that job, and that profession meets your restrictions, you may be required to pursue work as a receptionist. Failure to do so could result in a reduction or elimination of your benefits. If in doubt, contact your local ONA representative.
  6. If the WSIB believes you are partially disabled, you must begin to mitigate your losses by applying for jobs. You should keep records of all the jobs you researched and applied to.

WSIB Time Limit to Appeal Any Adverse Decision

  1. Under Bill 99, the WSIB changed the time limits to appeal any of its decisions, effective Jan. 1, 1998.

1. You now have only 30 days or six months to appeal a decision, depending on the issue. If you miss this time limit, you should appeal anyway, however it is likely that you will forego your rights to WSIB benefits in that issue.

ONA Time Limits for Representing Members With an Adverse WSIB Decision

40. Due to WSIB time limits imposed as of Jan. 1, 1998:

2. For 30-day appeals, you must notify your ONA Labour Relations Officer (LRO) within one week of the date of the WSIB decision.

3. For six-month appeals, you must notify your LRO within four weeks of the date of the WSIB decision.

4. You must notify ONA within one week of receiving notice or hearing of an employer appeal.

Although very detailed, these tips are only a guide and do not include every aspect of filing a WSIB claim. Keep these important points in mind at all times:

If it hurts – it may be related to your work – REPORT IT.

If you had a specific accident – REPORT IT. The complainer wins!!!

Self-treating does not establish continuity of complaint.

SEE A DOCTOR.

COOPERATE, COOPERATE, COOPERATE! If you don’t agree with a WSIB decision say so, but make sure they know you are cooperating. You can appeal a WSIB decision!

If in doubt call your Local ONA Representative.