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How to Apply for Workplace Safety Insurance Board Benefits

The Workplace Safety and Insurance Board is the provincial government agency primarily responsible for administering and enforcing the Workplace Safety and Insurance Act.

 

The Workplace Safety and Insurance Board (WSIB) provide workplace insurance, also known as workers’ compensation, to people who have been injured at work or have employment-related illnesses. This is a mandatory alternative to private legal action (i.e. tort claims).The Workplace Safety and Insurance Act (WSIA) limits the ability of workers to sue their employers in exchange for entitlement to benefits. Providing over $2.5 billion in benefits per year, the Board is funded by employer premiums, administration fees, and investment revenue.

 

Origin and Principles of WSIB

Ontario’s Workers' Compensation System originated in 1910 with Sir William Meredith’s Royal Commission. Tasked with studying workers' compensation systems worldwide, Meredith came up with a set of 5 principles. When the WSIB was formed in 1915 through the Workmen's Compensation Act, the organization embodied these findings. The modern WSIB scheme uses the same principles today:

  1. No-Fault Compensation: Workers are paid benefits regardless of how the injury occurred, in return for waiving the right to sue the employer. Responsibility or liability for the injury is irrelevant, as an injured employee can get workers’ compensation without proving blame on behalf of your employer. Even if the injury is the worker’s fault, they will still receive compensation.
  2. Security of Benefits: WSIB fund is guaranteed to pay benefits.
  3. Collective Responsibility/Liability: Employers contribute to a common fund and therefore share liability for workplace injury insurance and the total cost of the compensation system.
  4. Independent Administration: WSIB administrators are separate from government.
  5. Exclusive Jurisdiction: Only WSIB may provide workers’ compensation insurance and all claims are directed solely to the board, who is the final authority.

 

WSIB Eligibility

In order to qualify for workers’ compensation, an Applicant must meet the statutory requirements set out in WSIA. Workers and their dependents may claim benefits if:

  1. The worker suffers an injury, disease or death that arose out of and in the course of employment;
  2. The worker’s employer is subject to compulsory coverage under the WSIA, as defined by Schedule A (private organizations who pay premiums) or Schedule B (public organizations who reimburse WSIB directly) of the Act;
  3. The individual is a worker under the WSIA, which includes anyone employed under a contract of service or apprenticeship with an employer carrying on a business listed in Schedule 1 or Schedule 2; and
  4. The injury happened in Ontario, or if the injury happened outside of Ontario, 2 of 3 conditions must be satisfied: The injured worker was (A) is not employed outside of Ontario for more than 6 months, (B) usually resides in/employed in Ontario, (C) and the employer’s place of business is in Ontario. The injured party must elect whether they are claiming WSIB, rather than the workers’ compensation of the other jurisdiction, within 3 months of the accident. [Note that there are special specifications for boats and other vehicles.]

 

If any of these preconditions are not satisfied (i.e. the employer is not subject to compulsory coverage), then the injured party may be allowed to pursue a claim in tort.

 

WSIB Application Procedure

To apply for workplace insurance, an injured worker must file a claim through the WSIB. Injured workers should notify their employer immediately, so that employer can send a report of accident or disease (Form 7) to the WSIB and the employee within three days. They should also seek medical attention as fast as possible and the treating practitioner will file a Health Professional's Report (Form 8) to the WSIB. A key aspect of the WSIB application process is getting your doctor to release “functional abilities” information (i.e. what you can and cannot do at work) to your employer and the WSIB. A Worker's Report of Injury/Disease (Form 6) is then completed by the worker within six months from the date of your accident. After the Form 6 is filed, the WSIB will provide a claim number for reference.

 

Multiple types of benefits may be claimed, including (i) wages on day of injury, (ii) loss of earnings at 85% up to age 65 (subject to deductions from collateral sources such as CPPD), (iii) non-economic losses, (iv) health care/medical and rehabilitation, and (v) employment and retirement benefits. The WSIB also provides services to assist with returning to work, either through re-employment with the same company or another.

 

If the claim is accepted by the Board, you will begin to receive benefits with an administrative delay. As a recipient, you must notify the WSIB within 10 days of any change in circumstances that affects your entitlement. This includes changes in medical status, changes in incomes), changes in work status, or other occurrences (i.e. go to prison). A decision-maker will review the information provided and decide its effects. If you are denied and disagree with the decision, you have 6 months to file an appeal.

 

Call the Personal Injury Lawyers in Barrie at Littlejohn Barristers

If you have any questions regarding the WSIB procedure, entitlement, or other claims and benefits that may be potentially available, please contact Littlejohn Barristers at 705-725-7355. We’re a dedicated team of personal injury lawyers serve Barrie and across the region, and we specialize in personal injury law to serve your case better. Take a look at some of our case results, here.

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