Article Series
Browse Workplace Claims Solutions Group’s articles.
WSIB Claims Management & Return to Work: Basics & Compliance for Employers
Effective claims management and a proactive return-to-work (RTW) process help reduce workplace disruption, support recovery, and ensure WSIB compliance....
5 Ways Employers Can Reduce WSIB Claims Costs
Make health and safety practices as equally important as any other aspect of your operations. Each day there are...
Celebrate Communication
The key to resolving disputes is, I believe, communication and understanding the other party’s perspective. Recently, my office, once...
WSIB Claim Entitlement due to COVID-19 Exposure
Employer reporting obligations remain unchanged should an employee report they have been diagnosed with COVID-19. The employer is responsible...
WSIB Surplus Rebates of Premiums
Eligible businesses will receive surplus rebates in April 2022, as our insurance fund now has a surplus greater than...
In The Rear View Mirror…
Is right where we want 2020 to remain. Someone once gave me a trinket that hangs from my rear-view...
FAQ
Frequently Asked Questions
Why did WSIB pay benefits even though modified work was offered?
WSIB will only approve Loss of Earnings (LOE) benefits if certain conditions are met. They carefully review:
- Whether the offer of modified work was in writing.
- If the duties were clearly and specifically described.
- Proof that the employee actually received the written offer.
- Whether the modified duties match the employee’s medical and functional capabilities.
REMEMBER—if it isn’t in writing, it’s as if it didn’t happen. Always document your offer clearly and keep a copy.
An employee had a pre-existing back issue but got hurt at work. How long will WSIB cover treatment? How does WSIB decide they've recovered?
For WSIB to accept the claim, it must be shown that a workplace accident caused or worsened the injury.
If medical records confirm that the employee’s back condition changed because of a workplace incident, WSIB will typically allow benefits.
Entitlement to benefits continues until the workplace injury has resolved. WSIB uses medical information to compare the employee’s function, treatment needs, and symptoms before and after the workplace injury to determine when recovery has occured.
How long do I have to object to a WSIB decision, and how do I do it? What happens next?
Most decisions can be disputed within 6 months of the decision date (not the date you received it).
For decisions about return-to-work matters, the objection period is 30 days.
You must submit your objection in writing. WSIB provides an “Intent to Object” (ITO) form on their website that can be uploaded through e-Services.
Important: Keep a copy of your completed ITO form and your upload confirmation for your records.
Can an employer get a copy of an employee’s WSIB claim file?
Yes. If you disagree with a WSIB decision, you must notify WSIB in writing using the “Intent to Object” (ITO) form.
After you submit the ITO, the WSIB decision-maker will reconsider the original decision. You don’t need to submit new evidence at this stage—just explain why you disagree.
If the decision is upheld, WSIB’s Access Department will process the release of the claim file. The employee’s consent is needed for releasing health records. If the employee doesn’t consent, WSIB will eventually provide all relevant medical information to the employer as part of the process.
What criteria does the WSIB use to accept a claim?
WSIB uses a 5-Point Check System:
- Is the employer is covered by WSIB? (Not all employers in Ontario are required to have coverage.)
- Was the person a “worker” of the employer?
- Did the worker suffer a personal injury arising out of and in the course of employment?
- Did a workplace accident cause the injury?
- Does the medical diagnosis match the reported workplace accident?
Tip:When completing a Form 7, carefully address each point–it’s your chance to tell the full story based on what you’ve learned about the incident.
When does an employer have to report a workplace injury to WSIB?
Employers must report to WSIB using Form 7 when they learn a worker requires health care and/or any of the following applies:
- The worker is absent from regular work.
- The worker earns less than their usual pay for regular work (e.g. working reduced hours).
- The worker is doing modified work at less than regular pay.
- The worker is performing modified work at regular pay for more than seven calendar days after the accident.
In other words, if a worker tells you they are:
- Absent because of work-related injury or illness.
- Seeking health care for a work-related injury or illness.
- Unable to do their regular job and working modified duties at lower pay or reduced hours.
- On modified duties for over 7 days.
Then you must file a Form 7 with WSIB within 3 business days of learning about it.
Note: “Employer” includes anyone in your reporting structure–a supervisor, team lead, manager, HR, or safety specialist. The 3-day clock starts when any of them learn of the situation.
What if the employee didn't report the injury right away?
This has two parts:
Internally: Follow your own company’s reporting policies. If the employee was aware of the procedure but didn’t follow it, you should address that through your internal processes.
For WSIB: Workers generally have 6 months from the date of injury or the date of diagnosis of an occupational disease to file their claim. WSIB requires the worker to complete a Form 6 (Worker’s Report of Injury) to start the claim.
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