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Ontario|Workers CompensationEmployees 636 Appealing a decision If your claim for Workplace Safety and Insurance benefits is denied, or you do not agree with other aspects of the decision, you can appeal the decision. Employers have the right to appeal also. Most appeals are handled by a lawyer or other representative, especially if they involve a hearing. Employees can get good advice from the Office of the Worker Adviser, legal clinics and other specialized service providers. The phone number of the Office of the Worker Adviser can be obtained from the Workplace Safety and Insurance Board.
- Time Lines
There are two different appeal deadlines depending on the type of decision being appealed. If you want to appeal a decision about your reemployment rights and return to work issues, the deadline to start an appeal is 30 days from the date of the decision. All other decisions regarding eligibility or benefit amounts must be appealed within 6 months of the decision. The employer and worker will each be notified of the appeal deadline from the Workplace Safety and Insurance Board when an entitlement decision is made.
- Four steps to appeal
There are four possible steps in the appeal process: they are writing a letter to an adjudicator, attending mediation if the adjudicator rejects the letter, attending a hearing held by the Workplace Safety and Insurance Board, and last, attending a hearing held by the Workplace Safety and Insurance Appeals Tribunal.
The first step for you or your representative is to write a letter to the adjudicator that made the decision, stating your name, file number, and why you disagree with the decision. The adjudicator will review the matter and may change the decision if you have provided new information or if a mistake has been made.
If the adjudicator does not change the original decision, you will be sent an objection form to fill out and return to the Appeals Branch of the Workplace Safety and Insurance Board. Once they receive your objection form, they will consider if there are issues in your case that can be settled through mediation. Mediation is an informal meeting between an employer and worker with a mediator assigned by the Workplace Safety and Insurance Board to help both sides find a solution. Mediation will occur automatically if the issue concerns return to work.
If mediation is inappropriate or does not work, the Workplace Safety and Insurance Board will hold a hearing at the request of either the employee or the employer. A hearing is more formal and is conducted by an Appeals Resolution Officer who will hear all sides of an issue and make a decision. Hearings before the Board may be conducted orally or in writing.
- Appeal to Workplace Safety and Appeals Tribunal
If the Workplace Safety and Insurance Board does not change the original decision, as an employer or and employee, you have a right to appeal to the Workplace Safety and Appeals Tribunal. A hearing before the Appeals Tribunal may be conducted orally or in writing. The Appeals Tribunal acts like a court. The issues they consider can be complicated, and people are advised to hire a lawyer or a compensation expert when going before the Tribunal. The Tribunal's decision is final and binding. There are lawyers who specialize in Workplace Safety and Insurance Board Issues. You can find a lawyer on the Legal Line Guide or website.
If you are unsure about your rights to appeal, you can call the Workplace Safety and Insurance Board for more information. This office is listed in the Blue pages of your telephone book.
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