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Your Guide: Benefits, Services and Responsibilities – Worker Edition

 Your Guide: Benefits, Services and Responsibilities – Worker Edition banner image


The WSIB is here to serve you by providing benefits, compensation and return-to-work services as a result of a work-related injury or illness. Nobody should be hurt on the job but, if it happens to you, we will provide the care and support you need to recover and safely return to work.

This guide has information about the benefits and services we offer. These include health care, income replacement and return-to-work services. There is also information on the decision-making process and your responsibilities after you submit a claim.

This document does not list every benefit, service and responsibility you have. It is meant to be a summary of questions we know many people have about the WSIB. WSIB decisions are not based on this document. They are based on the Workplace Safety and Insurance Act (WSIA) and our policies. We always consider information that we get from you, your employer and your health care provider when making decisions about your claim.
 

 

Benefits and services

 

The following are benefits and services that you may receive after an eligible claim is filed and approved. You may have health care available to you even if you have not missed time at work.

 

Health care

We are here to help you recover after a work-related injury or illness. We pay for all approved health care costs related to your claim, even if you have insurance coverage. The type of benefits you may receive depends on the nature and severity of your condition.

Health care benefits

  • Health care benefits include:
    • treatment from your health care professional (e.g., doctor, dentist)
    • hospitalization, including emergency care and surgery
    • prescription drugs
    • prosthetics, or orthotics
    • reasonable travel and accommodation expenses
    • attendants, or other measures, to help severely- impaired workers live independently.
  • Most health care treatments, and related travel, require pre-approval from the WSIB.
  • The WSIB may pay your health care provider directly for services. A health care provider cannot require you to pay for any services because of your work-related injury or illness.
  • Even if your claim is not for a psychological condition, we may pay for psychological treatment to support your recovery and return to work.
  • If your claim has not been approved, you may need to pay for health care and then request reimbursement from the WSIB. Not all health care is covered and only approved claims are eligible for reimbursement.

Health care equipment and supplies

  • The WSIB pays for health care equipment that has been approved. This may include:
    • assistive devices (e.g., walkers)
    • braces and supports
    • other medical supplies (e.g., wound care supplies)
    • adjustable bed frames and mattresses.
  • You will be provided with choices for approved suppliers of health care equipment.

 

Return-to-work (RTW) services

We will help you and your employer find solutions to support your return to work. Examples of RTW services include:

Return-to-work services

  • RTW staff will meet with you and your employer to talk about returning to suitable and available work, including any accommodations you may need.
  • You may also be referred for a vocational assessment to help determine the type of work that may be suitable for you.
  • In some cases, we may recommend a re-training program to develop skills that will help you return to work with your current employer or a new employer (if applicable).

 

Income replacement

If your work-related injury or illness causes you to lose earnings for any period of time, the WSIB will provide income replacement benefits. 

Loss of Earnings (LOE)
  • If it is determined you cannot work due to a work-related injury or illness, or you can only safely return to work for less pay, we may pay up to 85 per cent of your pre-injury take-home pay.
  • There is a limit on the maximum amount of LOE benefits you can receive in a year. Your Case Manager can give you these details.

Loss of Retirement Income (LRI)

  • To be eligible for the LRI benefit you must:
    • be under 64 years of age at the time of the injury or illness; and
    • have received LOE benefits for at least 12 continuous months.
  • If eligible, the WSIB may compensate you for lost retirement income. You may also choose to allocate some funds from your LOE to your LRI.
  • When you turn 65, LRI benefits may be paid to you.

 

Other benefits

You and your dependents may also receive Non-Economic Loss (NEL) and Survivor Benefits.

Non-Economic Loss (NEL)
  • If your work-related injury or illness causes a permanent impairment, you may be compensated for the physical, functional or psychological loss.
  • Your compensation amount will be based on your level of impairment, and age.
  • You may be required to be examined by a WSIB-approved health care provider to determine level of impairment.
  • You may be reimbursed for any travel expenses or lost wages that you experience from attending your examination.

Survivor Benefits

  • Spouses or dependents of workers who die due to a work-related injury or illness may be entitled to:
    • survivor payments (lump sum and monthly)
    • funeral and transportation costs
    • bereavement counselling
    • support for spouses looking to re-enter the workforce.

 

Decision making

Throughout your claim, we will make decisions to support your recovery and safe return to work. The WSIB employee(s) assigned to your claim will involve you in the process. You also have the following options available to you as you recover and return to work.

  • Receive decisions in writing – We will explain our decisions in writing and give reasons for why we made the decision(s). Examples include eligibility and health care decisions.
  • Access to your claim file - You are entitled to a copy of your claim file at no charge. You must make the request to us in writing, through mail or fax. Under the Freedom of Information and Protection of Privacy Act (FIPPA), you have the right to your personal information collected by the WSIB.
  • Select a representative – You may choose to have someone represent you during your claim. This may include an informal representative or an authorized representative. Informal representatives may be a friend or family member who supports you and receives verbal updates about your claim. Authorized representatives are licensed under the Law Society Act or are exempted from the requirements of that act. Authorized representatives may receive verbal or written information (e.g., copies of your claim file) and represent you during the appeals process.
  • Appeal decisions – We carefully consider all available information when making decisions about your claim. We also understand that sometimes new or missing information becomes available or you might feel that a piece of information should be looked at again. If this is the case for you, you may ask us to reconsider a previous decision. If you continue to be dissatisfied after receiving an answer, you can file a formal appeal. You must indicate in writing your intent to appeal within 30 days for return-to-work, work transition and re-employment decisions and six months for all other decisions. If you are dissatisfied with the decision made by the WSIB about your appeal, you can ask the Workplace Safety and Insurance Appeals Tribunal (WSIAT) to review the decision. WSIAT is a separate and independent adjudicative body.

 

Responsibilities

 

We want to get you the health care and financial support you need as soon as possible. To do this, we need your help. You have some responsibilities when making a claim or receiving benefits.

Share information

  • Report your injury or illness to the WSIB - You must complete a Form 6 and send it to the WSIB. You must file your claim within six months of the date of injury or six months after being diagnosed with a work-related illness. You can only receive income replacement for up to two weeks after your injury without a completed Form 6. When you sign and complete your Form 6 you are also authorizing any health professional who treats you to provide information about your functional abilities to the WSIB and your employer.
  • Tell your employer about your injury or illness – Your employer plays an important role in helping you recover and return to work. You must tell your employer when you experience a workplace injury. Generally, employers may receive basic information about your injury or illness and related health care.  Employers may also receive information that is included in decision letters that we provide to you.
  • When requested by your employer, have a Functional Abilities Form completed – Treating health care professionals use this form to tell your employer about your functional abilities and limitations. This is important when planning for your safe return to work.
  • Provide all necessary information to adjudicate your claim – We may ask you for information such as how your injury or illness happened, your health care information and information about your return to work. You are required to share any information the WSIB needs to make decisions about your claim and to support your recovery and return to work.
  • Report any relevant changes in circumstance - You must report to the WSIB any changes that may affect your entitlement to benefits and services. This may include changes in your injury or illness, if you are receiving other income (e.g., disability benefits), or if your employment has ended. You must report the change no later than 10 calendar days after the change happens.

Participate in the process

  • Co-operate in health care appointments – To support your recovery, you must attend all scheduled health care appointments and examinations. You are entitled to select your treating health care professional(s). You may also be required to be examined by health care professionals selected and paid for by the WSIB or your employer.
  • Co-operate with return-to-work planning and activities – You are required to work with the WSIB and your employer to develop a plan to help you return to safe and suitable work. This means regularly providing updates to your employer about your recovery and functional abilities.
It’s better for everyone when we treat each other with respect and courtesy. That’s why we have a code of behaviour for our employees and the people that we serve. Find out more at wsib.on.ca/codeofbehaviour about the behaviours we expect from our employees and from you.
 
This also means participating in meetings requested by the WSIB that will help with other aspects of return-to-work planning. If you need to consider a new occupation because of the severity of your injury, you will be asked to participate in an assessment with a Return-to-Work Specialist who will help you develop a plan to prepare for your new job.

 

Additional resources

 

Your main contact for your claim is your Eligibility Adjudicator or Case Manager. If you are unsure who to contact, you can call us at 1-800-387-0750, Monday to Friday (7:30 a.m. to 5:00 p.m.), and speak to a Customer Service Representative who will be familiar with your claim. When possible, please have your claim number available to help us serve you better.

The Fair Practices Commission is the organizational ombudsman for the WSIB. The commission provides an independent, neutral and confidential service for injured workers, employers and service providers who have concerns about the fairness of the service, or treatment, they receive from the WSIB. You can find more information at www.fairpractices.on.ca or by calling 416-603-3010, or toll-free 1-866-258-4383.

The Office of the Worker Adviser (OWA) is an independent agency of the Ontario Ministry of Labour that provides workplace insurance services to non-unionized injured workers and their survivors. You can find more information at www.owa.gov.on.ca or by calling 1-800-435-8980 (English) or 1-800-661-6365 (French).

The following resources may help to answer your questions after reading this document.

Claims process

Benefits and services

Decisions

See Your Guide: Services and Responsibilities – Business Edition.

Other languages

Compass: Guiding you to a healthy and safe workplace
WSIB@work seasonal newsletter