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      SETTLEMENT DOCS FOR CLAIMS AFTER JANUARY 1, 1998

      FULL LOSS OF EARNINGS (LOE) BENEFITS

      Use this Settlement Doc to gain entitlement to Full Loss Of Earnings benefits. This applies to claims after January 1, 1998.

      PARTIAL LOSS OF EARNINGS (PLOE) BENEFITS - ACTUAL EARNINGS

      Use this Settlement Doc 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 Settlement Doc 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. 

      PARTIAL LOSS OF EARNINGS (PLOE) BENEFITS - DETERMINED EARNINGS

      Use this Settlement Doc to make the case that that your Partial Loss of Earnings benefits should be based on actual earnings from employment and not determined earnings as 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),or are voluntarily underemployed in the identified SO. This applies to claims after January 1, 1998.

      SETTLEMENT DOCS FOR ALL CLAIMS AFTER JANUARY 1, 1990

      NON-ECONOMIC LOSS ENTITLEMENT

      Use this Settlement Doc 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 Settlement Doc can help you in requesting a reconsideration of that decision.

      NON-ECONOMIC LOSS REDETERMINATION

      Use this Settlement Doc 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 Settlement Doc to have that decision reconsidered. This only applies to claims after January 1, 1990. 

      NON-ECONOMIC LOSS PRE-EXISTING CONDITION REVIEW SETTLEMENT DOC

      This Settlement Doc is used to request the WSIB to review your Non-Economic Loss award concerning the amount that was reduced from your NEL award due to your pre-existing non-work related condition.

      SETTLEMENT DOCS FOR CLAIMS FROM JANUARY 1, 1990 - DECEMBER 31, 1997

      FUTURE ECONOMIC LOSS PRESUMPTION SETTLEMENT DOC

      Use the Future Economic Loss Presumption Settlement Doc 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 from January 1, 1990 to December 31, 1997.

      DOCS FOR CLAIMS BEFORE JANUARY 1, 1990

      PRE-1990 PENSION ENTITLEMENT

      Use this Settlement Doc 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. 

      PRE 1990 PENSION REASSESSMENT

      Use this Settlement Doc 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. 

      PRE-1990 WAGE LOSS SUPPLEMENT

      Use this Settlement Doc 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. 

      SETTLEMENT DOCS THAT APPLY TO ALL CLAIMS REGARDLESS OF DATE OF INJURY OR DISEASE

      CHRONIC PAIN DISABILITY ENTITLEMENT

      Use this Settlement Doc 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.

      PSYCHOTRAUMATIC DISABILITY

      Use this Kit Settlement Doc 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.

      INDEPENDENT LIVING ALLOWANCE

      Use this Settlement Doc 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.

      SECONDARY CONDITION ENTITLEMENT

      Use this Settlement Doc to gain entitlement to a Secondary Condition resulting from your work injury or illness. This applies to all claims.

      COMPENSATION RATE RECALCULATION - CLAIMS BEFORE JANUARY 1, 1998

      THE PROCESS

      THIS IS A FOUR-STEP PROCESS AS DESCRIBED BELOW:

      About the Compensation Rate Recalculation Process

      We have carefully laid out a process to determine if your case meets eligibility for a Compensation Rate Recalculation.

      This is only applicable to claims between April 1985 and December 31, 1997.

      These are the types of benefits that can be impacted for eligible claims. Temporary Disability Benefits (TTD), Permanent Disability Benefits (PD) and any Section 147 Supplements that you were paid during that period, Future Economic Loss benefits (FEL), and Section 43(9) Supplements..

      STEP 1:

      Preliminary review by WSIB Settlements of eligibility for a Compensation Rate Recalculation

      STEP 2:

      Complete and submit the WSIB Settlements Payment Agreement

      STEP 3:

      Submit request to the WSIB for payment information and calculation of the initial Compensation Rate

      STEP 4:

      Preparation and submission of the Compensation Rate Recalculation Settlement Doc

      • PROCEED TO STEP 1

      STEP 1 - PRELIMINARY REVIEW OF ELIGIBILITY

      By completing this form, you will provide us with information to determine if there is a likelihood that you may qualify for a Compensation Rate Recalculation.

      STEP 2 - WSIB SETTLEMENTS PAYMENT AGREEMENT

      To proceed with the preliminary recalculation of your compensation rate, please complete the following and sub

      STEP 3 - REQUEST FOR EARNINGS INFORMATION FROM THE WSIB

      This Settlement Doc is used to request very specific information from the WSIB pertaining to their calculations of your Compensation Rate. This information is generally not provided with the file when requested under the Freedom of Information and Privacy Protection Act (FIPPA). It is being requested directly from their Payment Department.

      STEP 4 - COMPENSATION RATE RECALCULATION SETTLEMENT DOC

      Based on our calculations, it would appear that you are eligible to have your Compensation Rate Recalculated and can proceed with the completion and submission of the Compensation Rate Recalculation Settlement Doc

      THREE-LEVEL RECONSIDERATION PROCESS

      DECISION RECONSIDERATION SETTLEMENT DOC - STEP 1 - CASE MANAGER

      This Settlement Doc is the first of three steps within the Due Diligence Strategy. It is addressed to the original decision-maker. The Settlement Doc is a request for a reconsideration of a decision as authorized in Section 121 of the Workplace Safety & Insurance Act (WSIA) and outlined in WSIB Policy 11-01-14. It compels the WSIB, upon written request, to reconsider any decision previously made in a claim. The next two Docs are the second and third steps in the process. Those Settlement Docs are also available for use.

      This applies to all claims regardless of the date of injury or illness.

      DECISION RECONSIDERATION SETTLEMENT DOC - STEP 2 - MANAGER OF THE CASE MANAGER

      This is step two of the Due Diligence Strategy. This Settlement Doc is used in the event that the reconsideration request made in the first step to the Case Manager was denied.

      DECISION RECONSIDERATION SETTLEMENT DOC - STEP 3 - MANAGER'S MANAGER

      This is the third and final step of the Due Diligence Strategy. This Settlement Doc is used in the event that the reconsideration request made in the second step was denied.

      THREE-LEVEL FOLLOW-UP LETTERS

      FIRST FOLLOW-UP LETTER

      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 one week from the date of this letter by using the MANAGER FAILURE TO RESPOND FOLLOW -UP LETTER.

      MANAGER FAILURE TO RESPOND FOLLOW-UP LETTER

      This letter is titled MANAGER FAILURE TO RESPOND FOLOW-UP LETTER. 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 Letter when prompted.

      DIRECTOR FAILURE TO RESPOND FOLLOW-UP LETTER

      This letter should be sent to the Director who oversees the Manager and the individual to who you sent the Follow-up Letter.

      APPEAL - WSIB APPEAL SERVICE DIVISION

      APPEAL SETTLEMENT DOC

      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 Settlement Doc, 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.

      HEALTH CARE FOLLOW-UP

      REIMBURSEMENT OF HEALTH CARE EXPENSES LETTER

      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 READY REVIEW PROCESS

      APPEAL READY REVIEW QUESTIONNAIRE

      This questionnaire is required in order to give us the necessary details pertaining to your case that we require in order to provide you with our opinion as to whether your case is ready to proceed to the WSIB's Appeal's Division Services or the Workplace Safety & Insurance Appeals Tribunal.

      SERIOUS INJURY PROGRAM

      WHAT IT IS & WHO IT APPLIES TO

      What it is.

      The Serious Injury Program provides people who have been seriously injured at work with the specialized treatment, equipment and services they need to enable their functional recovery and enhance their quality of life.

      The program team includes dedicated case managers, nurse consultants, occupational therapists and home modification consultants with specialized training to provide comprehensive care and support to people injured at work and to their families.

      Once someone is referred to the program, they may also be entitled to support such as an independent living

      Who it is for.

      It's for people who have any of the types of work-related injuries or conditions listed below: 

      - A serious or permanent disability 

      - Any of the following injuries or conditions: 

      1. Hemiplegia, paraplegia, quadriplegia, or paraparesis

      2. Major amputations, such as those where the person's non-economic loss (NEL) assessment indicates bodily impairment of 60 per cent or more. Other than shoulder disarticulation, this would generally result from amputation beyond that of a single limb.

      3. Blindness

      4. Major burns:

      5. Brain injuries that require major cognitive interventions, prevent the injured person from living independently or handling their own affairs

      6. Serious crushing injuries to chest, abdomen, or pelvis such as those that require transferring the person to a major trauma hospital

      RESOURCES FOR SERIOULY INJURED WORKERS & THEIR FAMILIES

      There are many types of benefits and services available within the Serious Injury Program for those who qualify and their families. Please click on the link below to access a manual outlining the various types of benefits and services available.

      RETURN TO WORK

      Unable to Rturn to Work Due to Compensable Condition Doc

      Use this Doc to advise the WSIB that you are unable to return to work due to your compensable condition and on the advice of your doctor. This Doc should be submitted along with the Functional Abilities Form completed by your doctor, supporting your inability to return to work.

      CONTINGENCY FEE AGREEMENT

      Contingency Fee Agreement

      Please click below for the Contingency Fee Agreement. Fill in your information where indicated and sign the Agreement. At the bottom of the form click Preview (PDF) and you will be able to view the Agreement before submitting it. Click submit and the document will be produced for you. We are also notified of the document having been completed and signed.

      Next Step:

      Once you have submitted your signed Agreement, click on the WSIB File Request Form below and complete the Form. You can download the Form onto your desktop and upload it directly to the WSIB from the WSIB Document Upload Portal below.

      Once you have received the electronic copy of your WSIB Claim File, please email it to us so that we may proceed with Your WSIB Case Audit.

      WORK REINTEGRATION

      Objection Work Reintegration

      This letter can be used if you have any reservations about whether Work Reintegration Services will be successful and you want to preserve your right to appeal.

      OTHER WSIB GENERIC DOCS

      Request to Communicate in Writing

      This Doc is used to make a formal request for the WSIB to communicate with you in writing. This will ensure the accuracy of your communications with the WSIB and vise versa and that there is a written record of your communication should you need to use it in the future.

      WSIB Document Upload

      To expedite having your issues addressed by the WSIB you can upload your completed Settlement Doc 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