WSIB GUIDE BENEFITS, SERVICES, AND RESPONSIBILITY

The Workplace Safety and Insurance Board is the provincially governed workplace compensation board in Ontario. The WSIB is supported entirely by employer premiums, administration fees, and investment proceeds and functions "at arm's distance" from the Ministry of Labour, Training, and Skills Development. The WSIB is one of North America's largest compensation boards, with primary responsibility for implementing the Ontario Workplace Safety and Insurance Act (WSIA).

As a result of work-related trauma or sickness, the WSIB is available to help you by providing benefits, compensation, and return-to-work services. Nobody should get any injury on the job, but we will offer the care and assistance you need to heal and return to work safely if you are. We can also provide professional interpretation and translation services if necessary.

This handbook contains details on the perks and services we provide. Health care, income replacement, and return-to-work assistance are among them. There's also information on the decision-making process and your obligations once you file a claim.

Remember that this guide does not include a complete list of your benefits, services, and responsibilities. It's supposed to offer a quick overview of the WSIB's most frequently asked questions. The WSIB does not make decisions based on this paper. All of these decisions are on the basis of our policies and the Workplace Safety and Insurance Act (WSIA). When making choices concerning your claim, we always take into account information from you, your employer, and your health care provider.

BENEFITS AND SERVICES: HOW CAN WE ASSIST YOU?

After an appropriate claim is made and granted, you may be entitled to the following benefits and services. Even if you haven't missed any work, you may be eligible for health care.

HEALTHCARE SERVICES

We're here to assist you in recovering from a workplace injury or sickness. Even if you have insurance, we will cover all approved healthcare expenditures linked to your claim. The type of benefits you may be eligible for is resolute by the nature and severity of your illness.

Health care benefits

Treatment from a healthcare expert (e.g., a doctor or a dentist) hospitalization, including emergency care and surgery prescription medications prosthetics or orthotics fair travel and lodging fees attendants, or other measures to assist severely impaired workers in living independently

The WSIB requires pre-approval for most healthcare procedures and related travel.

The WSIB (Workplace Safety and Insurance Board) will pay your healthcare provider directly for services. Because of your work-related injury or illness, a health care practitioner cannot make you pay for any treatments.

We may pay for psychological treatment to help you heal and return to work, even if your claim isn't for a psychological condition.

If they contradict your claim, you may have to pay for medical treatment and seek reimbursement from the WSIB. Only authorized claims are eligible for payment, and not all medical services are covered.

Health care equipment and supplies

The Workplace Safety and Insurance Board (WSIB) funds for certified healthcare equipment. This could include things like assistive technology (e.g., walkers)

• Supports and braces
• Additional medical supplies (e.g., wound care supplies)
• Mattresses and bed frame adjustments.

They will provide you a list of certified healthcare equipment providers to choose from.

RETURN-TO-WORK (RTW) SERVICES

We'll serve you and your employer to discover solutions that will help you get back to work. RTW services include the following:

Return-to-work services

• Staff from RTW will meet with you and your employer to discuss your options for returning to suitable and available work, as well as any adjustments you might require.
• We recommend a vocational assessment to assist you in figuring out what kind of job would be best for you.
• In some situations, we may suggest a retraining program to help you gain skills that will enable you to return to work with your existing or new company (if applicable).

INCOME REPLACEMENT

The WSIB will pay income replacement benefits if your work-related accident or sickness causes you to lose earnings for any amount of time.

Loss of Earnings (LOE)

• We may pay up to 85% of your pre-injury take-home pay if you cannot work due to a work-related accident or sickness or can only safely return to work for less income.
• The maximum amount of LOE advantages you can obtain in a year is limited. You can obtain all these facts simply from your Case Manager.

Loss of Retirement Income (LRI)

To be qualified for the LRI benefit, you must meet the following requirements:

• Be under the age of 64 at the time of the injury or sickness,
• And have been receiving LOE payments for at least 12 months.

The WSIB may be able to reimburse you for lost retirement income if you are eligible. You could also transfer some monies from your LOE to your LRI.

LRI benefits may be awarded to you when you reach the age of 65.

OTHER BENEFITS

Non-Economic Loss (NEL) and Survivor Benefits may be available to you and your dependents.

Non-Economic Loss (NEL)

• If you are enduringly disabled as a result of a work-related injury or disease, you may be entitled to compensation for your physical, functional, or psychological losses.
• The amount of payment you receive will be determined by your level of impairment and age.
• To evaluate the level of impairment, you may need to be assessed by a WSIB-approved health care professional.
• They might refund any travel expenses or lost pay incurred as a result of attending your examination.

Survivor Benefits

Workers' spouses or dependents who die as a result of a work-related injury or sickness may be entitled to the following benefits:

• Survivor benefits (lump sum and monthly)
• Costs of the funeral and transportation
• Counseling for bereavement
• Support for spouses who want to return to work.

DECISION MAKING

We'll make decisions to help you recuperate and return to work safely throughout your claim. You will be included in the process by the WSIB employee(s) assigned to your lawsuit. You can also choose from the following alternatives while you recover and return to work.

Receive decisions in writing

We will explain our settlements in writing and provide justifications for our choices (s). Eligibility and healthcare decisions are two examples.

Access to your claim file

You remain entitled to a free copy of your claim file. You must submit your request to us in writing, by mail, or by fax. You have the right to access your personal information collected by the WSIB following the Freedom of Information and Protection of Privacy Act (FIPPA).

Select a representative

You have the option of hiring a lawyer to represent you during your claim. This could be a non-authorized representation or a formal representation. Informal representation could be a friend or family member who backs you up and gets verbal updates on your claim.

Authorized representatives are either licensed or exempted from the Law Society Act's criteria. Authorized agents are allowed to obtain oral or written information (such as copies of your claim file) and steward you during the appeals process.

Appeal decisions

When making conclusions about your claim, we carefully analyze all available facts. We also appreciate that new or missing information may become available at any time or that you may believe they should review a piece of communication again. If this is the circumstance, you need to appeal that a previous decision needs to get revised. If you are still unhappy after obtaining a response, you can file a formal appeal.

For return-to-work, work transition, and re-employment decisions, you must submit a written notice of intent to appeal within 30 days. For all other choices, you must provide written notice of intent within six months. If you are unhappy with the WSIB's judgment on your appeal, you can request a review by the WSIAT (Workplace Safety and Insurance Appeals Tribunal). WSIAT is a distinct and autonomous adjudicating authority.

RESPONSIBILITIES: WHAT THE BOARD EXPECTS OF YOU?

We want to provide you the medical attention and financial assistance you require as quickly as possible. We'll need your help to accomplish this. When filing a claim or getting benefits, you have several duties.

SHARE INFORMATION

Notify the Workplace Safety and Insurance Board (WSIB) of any accident or illness.

Form 6 must be completed and sent to the WSIB. You have six months from the date of injury or six months from diagnosing a work-related illness to file a claim. Without a completed Form 6, you can only receive income replacement for up to two weeks following your accident. When you sign and proffer your Form 6, you're also giving the WSIB and your employer permission to share information about your functional abilities with any health practitioner who treats you.

Notify your boss of your accident or illness.

Your employer is crucial in assisting you in your recovery and return to work. When you have a working injury, you must notify your employer. Employers may obtain basic information about your injury or illness, as well as any linked medical treatment. Employers may also get the information contained in the decision letters we send you.

Complete a Functional Abilities Form when your employer requests it.

This form is made primarily to treat health care professionals to inform your employer of your functional abilities and limitations. When it comes to preparing for a safe return to work, this is critical.

Provide all relevant information for your claim to be adjudicated.

We may ask you for details about how your injury or sickness occurred, your medical history, and your plans for returning to work. You must provide any information necessary for the WSIB to decide your case and assist you in your recovery and retreat to work.

Report every relevant change in circumstances.

You must report any changes that may influence your eligibility for benefits and services to the WSIB. If you receive other income (e.g., disability compensation) or if your employment has ceased, changes in your ailment or disease are all examples of this. You have ten calendar days from the time the change occurs to report it.

PARTICIPATE IN THE PROCESS

PARTICIPATE IN MEDICAL APPOINTMENTS.

You must attend all planned health care appointments and examinations to aid your recovery. You have the right to accept your treating health care provider (s). Also, be compelled to be examined by health care professionals selected by the WSIB or your employer and paid for by them.

CO-OPERATE WITH RETURN-TO-WORK PLANNING AND ACTIVITIES 

You must collaborate with the WSIB and your employer to design a strategy to assist you in returning to safe and suitable employment. This entails giving your company regular information on your recuperation and functional capacities.

• When we treat each other with respect and civility, it benefits everyone. That is why we have a code of conduct in place for our staff and those we serve. Learn more about the behaviors we demand from our team and you at wsib.ca/codeofbehaviour.
• Participating in meetings requested by the WSIB to assist with other parts of return-to-work planning is also part of this. They will also invite you to participate in an evaluation with a Return-to-Work Specialist who will help you establish a plan to prepare for your new employment if you need to explore a different occupation due to the severity of your injury.

ADDITIONAL RESOURCES: WHERE TO FIND MORE INFO

The Workplace Safety and Compensation Board (WSIB) is a provincial organization that provides assistance and insurance to employees who get any injury at work. You can file a petition with the WSIB to receive the advantages of workplace insurance. The tribunal lays forth both workers' and employers' rights and obligations and a mechanism for enforcing those rights.

Workers who want to appeal to the Workplace Safety and Insurance Board and have their rights restored can seek legal help from us. When the worker is dissatisfied with the tribunal's judgment, we at Allied Paralegal provide professional paralegal services for appeals. We work with injured workers and companies to help them better integrate health care and return to work.

Suppose you are an injured worker who is having trouble getting the advantages of workplace insurance claims. In that case, our professional paralegal services will assist you in making a full recovery, reintegrating back into the workforce, and returning to work with work transition plans. Therefore, check our services and book an appointment with the best paralegals today.

Source: WSIB GUIDE BENEFITS, SERVICES, AND RESPONSIBILITY