Area of Law: Workers' Compensation
Answer # 635
How to apply for workplace safety and insurance benefitsRegion: Ontario Answer # 635
If an injury or disease results from an accident at work, it is the employee’s responsibility to report it to the employer. The employer must notify the Workplace Safety and Insurance Board (WSIB) of all accidents which may result in benefit entitlement under the Workplace Safety and Insurance Act. The employer will normally fill out the appropriate reporting form, ask the employee to sign it, and submit it to the WSIB. If the employer does not submit the report to the Board, the employee can do so by completing a special employee reporting form. In most cases, in reporting workplace accidents, the employer effectively begins the claim process. In every case, however, the employee must sign a claim form, otherwise benefits will not be paid.
Apart from the claim process, employers must take the necessary steps to ensure that the employee receives immediate medical attention and pay the employee for the day the accident occurred.
Time for reporting injury or disease
Under the law, the initial accident reporting form should be filed by the employer within three days of when the injury or disease becomes known, and it should be received by the WSIB within seven business days. A workplace injury or illness can be reported by submitting an Employer’s Report of Injury/Illness Form 7 available online at the WSIB website. After completing and submitting the forms, the employer must give the employee a copy.
Once the initial reporting form is received by the WSIB, they will send the worker a package with information and a Worker’s Report of Injury/Disease Form 6 to be filled out and signed. The form includes a release of medical information to the employer and to the WSIB. Usually the doctor, nurse, chiropractor, or physiotherapist who is treating the injury or disease will have to fill out a form explaining the worker’s functional abilities. This information assists the employee and the employer in returning the injured worker to work in suitable employment.
An employee is responsible for getting the appropriate forms filled out and giving appropriate copies to the employer. It is a good idea for the worker to keep an organized file with copies of all the documents, and ask the employer for copies of any forms that the employer submitted. Employees must be diligent in ensuring their claim for benefits is made within six months of the date of the accident or the date that knowledge of an occupational disease became available.
Once all the forms are completed and submitted, the WSIB will review the application. This process is called the Adjudication Process. The WSIB attempts to start payments within the first two weeks of the accident. Depending on whether all the appropriate information has been provided, however, the adjudication process may take up-to six weeks from the date of injury or disease before the worker receives the first benefit payment. If a worker has already returned to work before receiving any benefits, then the payment will normally include the entire amount of benefits that the worker is entitled to based on the time they were off work.
For additional information on applying for benefits, you can contact a lawyer with workers’ compensation experience, or the Workplace Safety and Insurance Board.
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