PDF version of Workplace Safety and Insurance Appeals Assistance – WSIB Fact Sheet 3
How The Worker Safety Unit Can Help You
If you disagree with a WSIB decision denying entitlement to benefits, the first step is to complete and submit a WSIB Intent to Object Form (ITO). Please refer to WSIB Fact Sheet #2 Appealing a Workplace Safety and Insurance Decision. It is your responsibility to meet all time limits for each and every decision you wish to appeal.
- Failure to submit the Intent to Object Form (ITO) by the appeal deadline may result in the loss of your right to appeal.
It is imperative to meet the appeal deadline. Often, the reason for denial of a benefit is as a result of a lack of information or insufficient medical documentation. If you do have some additional medical or other supportive documentation, you can include it with your objection form when submitting it to the WSIB. If you are unsure of what is required, it would be helpful if you contact the WSIB decision maker to determine what is needed.
Do not jeopardize missing the time limit while you are pursuing additional medical information. Any additional information can be submitted at a later date if required. Meeting the time limit will preserve your right to appeal and will allow you the time to pursue additional information and/or schedule medical appointments if necessary.
Benefits Officers in the OPSEU/SEFPO Worker Safety Unit assist, and may represent members, in their WSIB and WSIAT appeals. If you would like OPSEU/SEFPO’s assistance, the Worker Safety Unit will require a complete and up-to-date copy of your claim file for review. The WSIB will send you a complete copy of your claim file if, after they have reviewed the Intent to Object form and any other information submitted, the decision to deny remains unchanged. If you do not receive a copy of your file, you can request one under the Freedom of Information and Protection of Privacy Act. You will find a WSIB Worker Request for Copy of Claim File form on WSIB’s website at the following: https://www.wsib.ca/en/forms#Request. WSIB will only send electronic versions of your claim file. If a paper copy is required due to some type of accommodation, you will need to formally request a paper file from the access department at WSIB.
Your Role and Responsibilities
Meeting the Appeal Deadline
It is each worker’s responsibility to meet all deadlines to appeal. This is done by submitting an ITO form to the WSIB within the time limits specified in the WSIB decision. On the ITO form, identify each and every issue you are objecting to and clearly indicate the date of the WSIB decision that addressed that issue(s). Additional ITO forms must be completed and submitted within the prescribed timelines for any subsequent decision letter that may deal with additional issues. If you have multiple claim files you must submit an objection form for each respective claim file for any decision you do not agree with.
When completing the ITO form, check “I will represent myself in the objection process, or I am currently seeking representation” in section 4 (Representation).
The WSIB decision maker will review your Intent to Object form, reasoning, any new information, and reconsider the original decision.
If the decision remains unchanged, the WSIB will send you a copy of your claim file along with an Appeal Readiness Form. Do not complete the Appeals Readiness Form at this time.
Once you receive your claim file, forward the complete original copy, in the order it was received, along with the blank Appeals Readiness Form to the Worker Safety Unit by:
- Emailing it to [email protected]. If you receive notice that the file is too large to email, please advise the Worker Safety Unit of this for further instructions on how to forward it.
- Dropping off a paper file, or an electronic file on a USB drive to your nearest OPSEU/SEFPO regional office and request it be sent to the OPSEU/SEFPO Worker Safety Unit via courier. You can locate the closest OPSEU/SEFPO office by visiting www.opseu.org and clicking on the Contact Us then OPSEU Regional Offices and Membership Centres.
- Send your file via regular mail (either paper or USB drive) directly to: OPSEU/SEFPO Worker Safety Unit, 5757 Coopers Avenue, Mississauga, Ontario L4Z 1R9.
You will receive written confirmation from the Worker Safety Unit that your file has been received and a brief outline of the process to follow. Your file will be assigned to a Benefits Officer for review to determine whether it meets our case representation criteria. The appeal must also have a reasonable chance of success based on the information in your WSIB claim file and any additional information you submit. If there is not a reasonable likelihood of success based on the current information, the Benefits Officer will outline the reasons in writing.
If a decision is made to represent you, you will be sent a Retainer and WSIB Direction of Authorization form that advises WSIB that you have given us authorization to represent you. We cannot begin to represent you until you have signed and returned the Retainer and the WSIB Direction of Authorization form to our office.
Return to Work (RTW)
While receiving or appealing WSIB benefits, the workplace parties have an obligation to co-operate throughout the RTW process. Please refer to WSIB Fact Sheet #4 Return to Work for more detailed information on the WSIB Return-to-Work principles.
Although not specifically addressed under WSIB policies, applying for WSIB benefits brings with it a duty on your part as the injured worker, to mitigate your circumstances while awaiting or appealing benefits. This means you are expected to try and take whatever measures you can to recover and get yourself back to work at the earliest opportunity.
You should work with your union, employer, and health professional(s) to return to work with proper accommodation(s), if possible. If you are having difficulties with return to work/accommodation issues, please contact your Local’s union representatives or an OPSEU/SEFPO staff representative for assistance.
If you are having difficulties with your working duties, contact your treating heath care professional to review your medical condition and modified work duties. Another Functional Abilities Form will need to be completed. Provide a copy of the updated Functional Abilities Form to your employer and the WSIB.
Reporting a Material Change in Circumstances
Remember to inform your WSIB Case Manager of any changes concerning your claim such as healthcare status, earnings/income, and return to work status. The Board refers to this as a “material change in circumstances.” You are required to inform the WSIB of any material changes within ten (10) calendar days.
Contact Us
To contact the OPSEU/SEFPO Worker Safety Unit:
Email: [email protected]
Call: 1-800-268-7376
THIS PUBLICATION CONTAINS GENERAL INFORMATION AND IS INTENDED AS REFERENCE ONLY. IT IS NOT INTENDED AS SUBSTITUTE FOR INDEPENDENT LEGAL ADVICE REGARDING YOUR PARTICULAR SITUATION.