Who is wsib

The Act contains lists of types of industries and these lists are called Schedule 1 and Schedule 2. A worker employed in an industry or business listed in Schedule 1 or Schedule 2 of the Act is automatically covered. Schedule 1 Industries include but are not limited to : mining and related industries; manufacturing; transportation and storage; retail and wholesale trades; and construction. A variety of service industries are covered by the Act, including temporary agencies, hospitality and full-time domestic workers.

Schedule 2 Industries include but are not limited to : provincial governments; railways; and telephone companies licensed by the federal government. Although municipal governments are listed in Schedule 2, some have opted to become Schedule 1 employers. Some employers can make an application to the WSIB to be treated like a covered industry.

You can also call the WSIB and ask if your employer is covered. Important : If your employer should be paying coverage for its workers, but does not have an account with the WSIB or has not been paying premiums, you still have rights to benefits and services.

Breaching these duties can result in penalties. The specific facts of your case need to be considered. My worker twisted his ankle a week ago and is still off work. He will not return my calls. What can I do to get him back to work? Workers have a duty to co-operate in their early and safe return to work, including the duty to communicate with their employer. In this case, call and advise the adjudicator assigned to the claim that the worker is not co-operating in his return to work.

The WSIB granted him benefits. How do I object? The unfunded liability was the difference between the cost of paying future benefits to workers and the money available in the insurance fund. We appointed two experts to conduct an operational review of the WSIB.

The review will:. The reviewers will not be looking at how the WSIB makes decisions about claims adjudication or benefit levels, and will not be looking at individual claims. Sean Speer has expertise in public policy and governance. Speer is a member of the Board of Governors for Lakehead University.

In other words, you will only receive WSIB benefits that are a direct result of the areas of injury and diagnoses for which the WSIB has granted you initial entitlement. The WSIB will only provide treatment until it determines that your workplace injury or illness has resolved. You may choose your initial treating professional for your workplace injury, such as a physiotherapist.

The WSIB will not cover treatment for multiple practitioners such as a physiotherapist and a chiropractor. If you choose to see a treating professional in your occupational health department for the treatment of your workplace injury, you may encounter problems with your WSIB claim because this treating professional also works for your employer. Where possible, ONA strongly encourages you to seek treatment outside of your occupational health department.

It is, however, perfectly fine and absolutely necessary to discuss the specifics of your functional abilities, restrictions and ability to return to work with your occupational health department. ONA does not recommend that you discuss any specific diagnosis or broadly consent to your occupational health department discussing matters with your treating professional.

The WSIB may also refer you to its specialty clinics for additional treatment to assist with your recovery. Failure to attend treatment requested by the WSIB whether its own specialty clinics or other types of treatment it deems necessary may negatively impact your benefits, such as suspension of your loss of earnings benefits.

The WSIB will make this decision based on the objective medical evidence provided by your treating practitioners, along with any offers of modified work from your employer, whether verbal or written. The WSIB relies on the objective medical evidence provided by your treating professionals in order to make decisions concerning your entitlement to WSIB benefits.

Lack of objective medical information is one of the most common reasons that the WSIB will deny benefits or deny a claim altogether. It is your responsibility to provide updated medical information to the WSIB. Keep the WSIB informed of any referrals to specialists or diagnostic tests.

More objective information ROM, spasms, etc is necessary than complaints of pain to support entitlement. The WSIB will review objective medical evidence to support any entitlement decision. This includes physical findings such as range of motion , along with X-rays, MRIs, and other medical tests. This information is used to confirm the connection between your injury and the workplace accident, and also the level of disablement that may have resulted from it.

If your workplace injury is complex, it is ideal to have your family physician make a referral to a specialist as soon as possible. The WSIB may also consult its own internal medical consultants if it is unsure whether your condition or ongoing symptoms are a result of your workplace injury.

In these situations, a medical consultant will review the information on your WSIB claim file that was provided by your treating professional s and provide their opinion to the WSIB who will then make an entitlement decision. The WSIB takes the position that injured workers are better off at work unless they are totally disabled and incapable of returning to any kind of work including modified. When you are injured at work, your employer is required to provide you with an offer of modified work as soon as possible that is safe, productive, and within your functional abilities.

It is very common for employers to offer you modified work as soon as you report a workplace injury. Injured workers are expected to cooperate and return to work that is within their functional limitations. Remember that pain alone is not considered to be a reason that would totally prevent an injured worker from returning to modified work.

You must see your treating professional as soon as possible. If there is any delay in getting an appointment, you should go to a walk-in clinic or an emergency department to have the offer of modified work reviewed and the FAF completed. The WSIB provides assistance with return to work with your employer.

This usually happens if the injured worker and the employer are having difficulty identifying suitable modified work during the recovery period. You have the right to representation in these meetings and we strongly encourage you to include your ONA Bargaining Unit representative in these meetings. At these meetings, a RTW plan will be created that generally increases the duties and hours that you are performing with the ultimate goal of resuming your pre-injury job.

It is always a good idea to provide updated functional abilities information from your treating professional prior to this meeting. If you disagree with a return-to-work decision, an Intent to Object Form must be filed within 30 days of the date of the decision letter.

If a RTWS determines that the offered work is suitable, but you decline to perform the modified work, you will not receive any LOE benefits for any lost time. You may be required to provide medical to the WSIB to support these accommodations. Both the WSIB and your employer are required to take into consideration any other accommodations under the Ontario Human Rights Code along with any restrictions from your workplace injury when creating a return-to-work or work transition plan.

However, the WSIB is only required to provide benefits that are related to your workplace injury. If the WSIB determines that the nature of your injury will prevent you from ever returning to your pre- injury job, it will conduct a RTW assessment to assist you in locating another position that will restore your pre-injury earnings as much as possible. Generally, the WSIB will look to your employer for suitable alternative positions first, and will assist with any required upgrading or retraining if necessary.

The WSIB may provide some retraining or skills upgrading for the identified suitable occupation. Generally, for ONA members this may mean job search training or computer skills upgrading.

Upon completion of the RTW Plan, the WSIB will determine what kind of wage it thinks you would be able to earn in the suitable occupation and may or may not provide ongoing benefits. The WSIB will use the information provided by you, your treating professionals, and your employer in order to monitor the claim and make any necessary entitlement decisions.

If you experience any new areas of injury or receive any new or additional diagnoses related to the workplace accident or injury ies , you must inform the WSIB of this new information.

The WSIB will then review your claim to determine whether you are entitled to this new area of injury or diagnosis. Similarly, if you experience any issues with your return to work, especially if you need to take time off work or are working less hours because of your workplace injury, you must advise the WSIB. The WSIB will review the information on your claim file and determine if you are entitled to loss of earnings benefits or if assistance is needed from a RTWS.

The WSIB will review your claim to determine if the medical evidence supports a deterioration and whether it is compatible with your original workplace injury. If you disagree with a decision regarding a recurrence, an Intent to Object Form must be filed within 6 months of the date of the decision letter. The WSIB will provide entitlement to benefits for chronic mental stress if the evidence supports that:.

The WSIB does not allow entitlement for chronic mental stress injuries caused by decisions or actions made by your employer concerning your employment such as changes to your schedule, the nature of the work performed, discipline and terminations. The WSIB will provide entitlement to benefits for traumatic mental stress if the evidence supports that:.

The WSIB does not allow entitlement for traumatic mental stress injuries caused by decisions or actions made by your employer concerning your employment such as changes to your schedule, the nature of the work performed, discipline and terminations. The WSIB will then make subsequent decisions concerning your entitlement to health-care benefits, loss of earnings, etc.

The WSIB does not allow entitlement for PTSD caused by decisions or actions made by your employer concerning your employment such as changes to your schedule, the nature of the work performed, discipline and terminations. The WSIB will continue to monitor the information provided by you, your employer, and your treating professionals to determine when you have:. The WSIB will review the information on the claim file and determine if you have recovered from your workplace injury. In some cases, the WSIB may close your claim file even if you are still experiencing ongoing symptoms, or do not feel that you have recovered.

The WSIB will often decide that any ongoing symptoms are not related to your workplace injury, but instead pre-existing or degenerative conditions. Based on the evidence on your claim file, the WSIB will determine whether you have reached a plateau in your recovery and if it is unlikely that you will recover further.

If so, then the WSIB will determine whether you have a permanent impairment as a result of your workplace injury. A permanent impairment is a physical or functional abnormality or loss, including disfigurement. This is established through the objective medical information on your claim file to support whether there is a permanent functional abnormality or loss, such as decreased range of motion or permanent workplace restrictions. A NEL award is a lump sum award that is calculated using a prescribed rating schedule.

It is not intended to compensate for pain and suffering, or loss of earnings. When you file a WSIB claim, you may be faced with a situation where you are unable to work due to your workplace injury or you are encountering difficulty with your return to work with your employer.

The WSIB may make the decision that you are capable of working, even if your doctors authorize you. You can appeal this decision, but the WSIB appeals process can be lengthy, so you may need to investigate whether there are other income sources available to you during this time.

We strongly recommend that you speak with your Bargaining Unit representative. They will be able to advise you of your options and whether there is any possibility of filing a grievance. You may be required to reimburse the employer the difference if you are successful on appeal.

As an ONA member, you may also be eligible for long-term disability coverage through Johnson Insurance. To apply, contact Johnson Insurance directly. For further information, please see the resources page. You may also need to file an income tax adjustment. When the WSIB makes a decision on your entitlement to benefits, they will provide a written letter that explains the criteria they used to make the decision and the rationale used to make its decision concerning your entitlement to benefits.

Within this letter, there will be an appeal deadline. If an ITO is not filed in time, then the issues contained in that decision letter cannot be appealed. The WSIB may extend the timeline to appeal, but extensions are granted for very limited reasons, such as serious illness. This is the first level of appeal at the WSIB.

The WSIB may:. The ARO will review the WSIB claim file along with any other information that was provided, but a hearing before an ARO is an opportunity for a fresh review of the issue s that are being appealed.