KITS FOR CLAIMS AFTER JANUARY 1, 1998
Use this Kit to gain entitlement to Full Loss Of Earnings benefits. This applies to claims after January 1, 1998.
Use this Kit to gain entitlement to Partial Loss of Earnings, if you were left with a permanent impairment as a result of your work related injury or illness which allowed you to return to some type of employment following your injury or illness, but were unable to restore all your pre-injury average earnings in suitable and available employment. This Kit requests that the WSIB pay your partial LOE benefits based on your actual earnings obtained in suitable and available employment.
This applies to claims after January 1, 1998.
Use this Kit to makethe case that that your Partial Loss of Earnings benefits should be based on actual earnings from employment and notdetermined earningsas concluded by the WSIB. If you were not provided with Return To Work (RTW) services following your injury, are underemployed in a job not identified in the Suitable Occupation (SO),orare voluntarily underemployed in the identified SO. This applies to claims after January 1, 1998.
KITS FOR ALL CLAIMS AFTER JANUARY 1, 1990
Use this Kit to gain entitlement to a Non-Economic Loss Award, if you had a workplace injury or developed a workplace illness on or after January 1, 1990, which resulted in a permanent impairment. If you were assessed for a NEL award and were given a zero award, our Decision Reconsideration Kit can help you in requesting a reconsideration of that decision.
Use this Kit to request the WSIB to grant a redetermination of a previously awarded Non-Economic Loss (NEL) benefit. A NEL redetermination can only be done 12 months after the previous NEL assessment took place. If you were previously denied a NEL Redetermination, you can use our Decision Reconsideration Kit to have that decision reconsidered. This only applies to claims after January 1, 1990.
KITS FOR CLAIMS FROM JANUARY 1, 1990 - DECEMBER 31, 1997
Use the Future Economic Loss Presumption Kit to request the WSIB to grant entitlement to a full Future Economic Loss (FEL)benefit. If you had a workplace injury or developed a work-related illness after January 1, 1990, and said injury or illness prevented you from returning to work in any capacity, you may be entitled to a full FEL award to compensate you for your wage loss. This applies to claims on or after January 1, 1990.
KITS FOR CLAIMS BEFORE JANUARY 1, 1990
Use this Kit to gain entitlement to a pension. If you suffered a work-place injury or illness prior to January 1, 1990 and said injury or illness resulted in a permanent impairment which is supported by medical documentation, you are entitled to receive a Permanent Disability (PD) benefit (also referred to as a Pension) to compensate you for your permanent impairment.
Use this Kit to gain entitlement to a reassessment of your pension. If you currently receive a Permanent Disability (PD)benefit or pension for a work related injury or illness that took place before January 1, 1990, and if there has been a deterioration of said injury or illness supported by medical documentation, you are entitled to have a reassessment of your pension.
Use this Kit to gain entitlement to a Section 147(4) Supplement(also referred to as a Wage Loss Supplement and an Older Worker Supplement) if you are in receipt of a Permanent Disability (PD) benefit or pension and you were not able to restore your escalated pre-accident earnings following your injury or illness, due in part to your work illness or injury.
KITS THAT APPLY TO ALL CLAIMS REGARDLESS OF DATE OF INJURY OR DISEASE
Use this Kit to gain entitlement to Chronic Pain Disability (CPD)for a work related injury or illness when medical documentation demonstrates that you have not fully recovered from said injury or illness and your condition meets the WSIB's five point criteria governing Chronic Pain Disability. This applies to all claims regardless of injury date.
Use this Kit to gain entitlement to Psychotraumatic Disability for an injury or illness you suffered at work which has resulted in a psychotraumatic disability and is supported by medical documentation.
Use this Kit to gain entitlement to the Independent Living Allowance (ILA)if your work related injury or illness has been assessed at 100% Permanent Disability (PD) award or pension (for pre-1990 injury or illness), or a 60% Non-Economic Loss (NEL) award (for post January 1, 1990 injury or illness, or a combination of the two.
Use this Kit to gain entitlement to a Secondary Condition resulting from your work injury or illness. This applies to all claims.
KITS THAT APPLY TO CLAIMS BETWEEN JULY 26, 1985 & DECEMBER 31, 1997
THIS IS A TWO STEP PROCESS AS DESCRIBED BELOW:
This Kit provides the entire process we've setup to allow you to have the WSIB recalculate your compensation rate if your injury or illness happened between July 1985 and December 31, 1997. This will impact previously calculated Temporary Disability Benefits (TTD), Permanent Disability Benefits (PD) and any Section 147 Supplements that you were paid during that period. Should this result in an increase to your compensation rate, this will result in arrears benefits being paid, and any monthly pension you currently receive will also be increased.
Before proceeding with preparing and submitting this Kit, it is recommended we first conduct a preliminary recalculation of your Compensation Rate in order to confirm that it will result in an increase to your previously established rate. Click the following link to proceed with the Compensation Rate Preliminary Recalculation process.
Once we have completed the preliminary recalculation and have determined that your rate will be increased, you may proceed with submitting the Compensation Rate Recalculation Kit to the WSIB for an official recalculation.
DUE DILIGENCE STRATEGY
The Kit is the first of three steps within the Reconsideration Process as authorized in the WSIB Act and outlined in WSIB Policy. It compels the WSIB, upon written request, to reconsider any decision previously made in a claim. The next two Kits are the second and third steps in the process. Those Kits are also available for use.
This applies to all claims regardless of the date of injury or illness.
This is step two of the reconsideration process. This Kit is used in the event that the Reconsideration request made in the first step was denied.
This is the third and final step of the reconsideration process. This Kit is used in the event that the Reconsideration request made in the second step was denied.
GENERIC FOLLOW UP LETTERS
This letter is used to follow up to a previous letter you sent to someone at the WSIB handling your claim. For example your Case Manager, Nurse Case Manager, Return To Work Specialist etc. Experience tells us that things tend to get lost and people forget to respond in a timely manner. We suggest you make note to follow up within two weeks from the date of this letter by using the MANAGER FOLLOW UP LETTER.
This letter is titled FOLLOW UP REGARDING FAILURE TO RESPOND. It is used to follow up with the Manager of the individual to whom you sent your original letter and your follow up letter. In order to ensure that you are sending this letter to the appropriate manager, contact the WSIB client services and find out who the manager is. Give them the name of the person to whom you sent your original letter and they will be able to tell you who that person's manager is. You will be able to insert that person's name in this Kit when prompted.
This letter is used to request reimbursement from the WSIB for health care expenses you incurred for treatment of medical problems resulting from your workplace injury or illness, as recommended and provided by your treating physicians.
It is recommended that you provide receipts for expenses being claimed for treatment that you paid for, even if it was paid for by a private insurance company. It is also recommended that you provide a note from your family doctor or the health care professional who provided the treatment, confirming that the treatment provided was necessary to treat the affects of your injury or illness. For your convenience, we are providing a Form that you can take to your health care professional to fill out confirming the nature of the treatment provided.
APPEAL - WSIB APPEAL SERVICE DIVISION
In almost 30 years of practice, we were able to achieve great success in resolving issues before a case ended up at the WSIB's Appeal Service Division ASD). We did this by making a determination of whether the case had any reasonable chance of success by identifying if these 3 basic principles were present.
The issue must be clearly defined, the evidence must support it; and It must be supported by legislation. An additional factor we relied upon was if there was Tribunal jurisprudence on the issue at hand and if that could have a significant impact on the case. Although the WSIB does not consider precedent in their decision making process, they cannot ignore it when a higher level of appeal such as the Workplace Safety & Insurance Appeals Tribunal (WSIAT) has established significant jurisprudence on the matter, in favour of the claimant.
This also proved to be a positive strategy we employed particularly in cases where a Board decision or position was significantly at odds with that of the Tribunal. In creating our Appeal Kit, we applied extensive knowledge and experience in both the WSIB' ASD and the WSIAT, and is within the scope set out by the WSIB's Appeal Services Division's Practice & Procedures of January 1, 2018.
WSIB Document Upload
To expedite having your issues addressed by the WSIB you can upload your completed Kit and any other documents directly to the WSIB. This will also provide you with time-stamped confirmation of your documents having been received by the WISB.
Click the following link to submit your Documents