Your Guide: Benefits, services and responsibilities – Claimant edition
Your Guide for people with claims
We’re here to help. When an injury or illness happens on the job, we move quickly to provide wage-loss benefits, medical coverage and support to help people get back to work. We also make it easy for you to quickly access your basic claim information any time through our online services . Additionally, we can provide you with free professional interpretation for phone calls and meetings, and we can arrange for letters to be translated into your language if you need them.
This guide has information about the benefits and services we offer. These include health care, income replacement and return-to-work services. There is also information about our online services, how we communicate decisions and your responsibilities after you submit a claim.
This document does not list every benefit, service and responsibility you have. It is meant to be a summary of answers to questions we know many people have about the WSIB. WSIB decisions are not based on this document. They are based on the Workplace Safety and Insurance Act (WSIA) and our policies. We always consider information that we get from you, your employer and your health care provider when making decisions about your claim.
Benefits and services: How can we help you?
The following are benefits and services that you may receive after you have filed a claim and it is approved. Health care benefits may be available to you even if you have not missed time at work. If you sign up for online services, you can see what benefits and services are applicable to you.
We are here to help you recover after a work-related injury or illness. We pay for all approved health care costs related to your claim, even if you have insurance coverage. The type of benefits you may receive depends on the nature and severity of your injury or illness.
Health care benefits
- Health care benefits include:
- treatment from your health care professional (e.g., doctor, dentist)
- hospitalization, including emergency care and surgery
- prescription drugs
- prosthetics, or orthotics
- reasonable travel and accommodation expenses
- attendants, or other measures, to help severely- impaired workers live independently.
- Most health care treatments, and related travel need pre-approval from the WSIB.
- We may pay your health care provider directly for services. A health care provider cannot require you to pay for any services because of your work-related injury or illness.
- Even if your claim is not for a psychological condition, we may pay for psychological treatment to support your recovery and return to work.
- If your claim has not been approved, you may need to pay for health care and then ask us to reimburse you. Not all health care is covered and you will only be eligible for reimbursement if your claim is approved.
Health care equipment and supplies
- If your health care provider prescribes health care equipment or supplies and we approve them, we will pay for the equipment. This may include:
- assistive devices (e.g., walkers)
- braces and supports
- other medical supplies (e.g., wound care supplies)
- adjustable bed frames and mattresses.
- You will be provided with choices for approved suppliers of health care equipment.
We have a team of specialized return-to-work experts to help you and your employer find solutions to support your return to work. Our role is to:
- Meet with you and your employer to talk about returning to work safely and at the right time, including any accommodations you may need.
- Provide information to help you understand:
- what to expect throughout the return-to-work process
- what is expected of you and your employer
- your rights and responsibilities
- who to ask for help
- If needed, connect you or your employer with specialized services, including workplace visits to evaluate your workspace, arranging for an assessment to determine what type of work might be suitable for you, and/or working with you and your employer so you can work safely.
- In some cases, we may recommend a re-training program to develop skills that will help you return to work with your current employer or a new employer (if applicable).
If your work-related injury or illness causes you to lose earnings, we will provide income replacement benefits.
- If we determine that you can’t work because of your work-related injury or illness, or you can only safely return to work for less pay, we may pay you up to 85 per cent of your pre-injury take-home pay.
- There is a limit on the maximum amount of loss-of-earnings benefits you can receive in a year. A Case Manager can give you these details.
- To be eligible for the loss-of-retirement benefit you must:
- be under 64 years of age at the time of your work-related injury or illness; and
- have received loss-of-earnings benefits for at least 12 continuous months.
- If you are eligible, we may compensate you for lost retirement income with loss-of-retirement benefits when you turn 65. Before you turn 65, you may also choose to allocate some funds from your loss-of-earnings benefit to your loss-of-retirement income benefit.
You and your dependents may also receive benefits for non-economic loss and survivor benefits.
Benefits for non-economic loss
- If your work-related injury or illness causes a permanent impairment, we may compensate you for the physical, functional or psychological loss.
- Your compensation amount will be based on your level of impairment and age.
- You may need to be examined by a WSIB-approved health care provider to determine your level of impairment.
- We may reimburse you for any travel expenses or lost wages that you experience from attending your examination.
- Spouses or dependents of people who die due to a work-related injury or illness may be entitled to:
- survivor payments (lump sum and monthly)
- funeral and transportation costs
- bereavement counselling
- support for spouses looking to re-enter the workforce.
Throughout your claim, we will make decisions to support your recovery and safe return to work. The WSIB employee(s) assigned to your claim will involve you at every stage. You also have the following options available to you:
- View your claim information online – You can sign up for our secure online services at wsib.ca to see your claim status, latest payments, approved benefits and appeal status, if applicable.
- Receive decisions in writing – We will explain our decisions in writing and give reasons for why we made the decision(s). Examples include decisions about eligibility and health care.
Access to your claim file – You are entitled to a digital copy of your claim file at no charge. You must make the request to us in writing. For quicker service, complete aand log in to our online services to submit this form straight to your file. You can also request your file by mail or fax. Under the Freedom of Information and Protection of Privacy Act (FIPPA), you have the right to your personal information collected by the WSIB.
- Select a representative –You may choose to have someone represent you during your claim. This may include an informal representative or an authorized representative. Informal representatives may be a friend or family member who supports you and receives verbal updates about your claim. Authorized representatives are licensed under the Law Society Act or are exempted from the requirements of that act. Authorized representatives may receive verbal or written information (e.g., copies of your claim file) and represent you during the appeals process.
Reconsideration or appeal decisions – We carefully consider all available information when making decisions about your claim. We also understand that sometimes new or missing information becomes available, or you might feel that we should look at a piece of information again. If this is the case for you, you may ask us to reconsider a previous decision. If you are still dissatisfied after receiving an answer, you can file a formal appeal. If you plan to appeal a decision you must let us know in writing within 30 days for return-to-work decisions and six months for all other decisions. For quicker service, you can log in to our online services to submit anto your claim file, or you can notify us by mail or fax. If you are dissatisfied with our decision about your appeal, you can ask the Workplace Safety and Insurance Appeals Tribunal (WSIAT) to review the decision. WSIAT is a separate and independent adjudicative body.
Responsibilities: What is expected of you?
We want to get you the health care and financial support you need as soon as possible. To do this, we need your help. You have some responsibilities when making a claim or receiving benefits.
You may find it’s easier to meet these responsibilities if you use our online services. You can sign up for our secure online services account to see your claim status, add your direct deposit details and check your benefit and payment information. You can also book a WSIB pre-approved taxi to and from your appointments, track the status of your appeal, submit documents straight to your file and send us messages, all in one convenient place. You’ll need your claim number and personal identification number to get started, if you don’t have a personal identification number, call us and we can either securely email or mail it to you.
- Report your injury or illness to the WSIB –You must complete a Worker’s Report of Injury/Disease (Form 6). You can complete and submit it using our website. You must file your claim within six months of the date of your injury or six months after being diagnosed with a work-related illness. You can only receive income replacement for up to two weeks after your injury without completing this form. When you sign and complete your form, you are also authorizing any health professional who treats you to provide information about your functional abilities to the WSIB and your employer.
- Tell your employer about your injury or illness – Your employer plays an important role in helping you recover and return to work. You must tell your employer when you experience a workplace injury. Generally, we may share basic information about your injury or illness and related health care with your employer. We will also send your employer a copy of any decision letters that we provide to you.
When requested by your employer, have acompleted – Treating health care professionals use this form to tell your employer about your functional abilities and limitations. This is important when planning for your safe return to work.
- Provide all necessary information to make decisions about your claim – We may ask you for information such as how your injury or illness happened, your health care information and information about your return to work. You are required to share any information the WSIB needs to make decisions about your claim and to support your recovery and return to work. Once you have a claim number, you can sign up for our online services to share this information by submitting documents straight to your claim file.
- Report any relevant changes in circumstance –You must report us any changes that may affect your entitlement to benefits and services. This may include changes in your injury or illness, if you are receiving other income (e.g., disability benefits), or if your employment has ended. You must report the change no later than 10 calendar days after the change happens. You can use our online services to report these changes by submitting documents straight to your claim file.
Participate in the process
- Co-operate in health care appointments – To support your recovery, you must attend all scheduled health care appointments and examinations. You are entitled to select your treating health care professional(s). You may also need to be examined by health care professionals selected and paid for by the WSIB.
- Co-operate with return-to-work planning and activities – You are required to work with the WSIB and your employer to develop a plan to help you return to safe and suitable work. This means regularly providing updates to your employer about your recovery and functional abilities.
- It’s better for everyone when we treat each other with respect and courtesy. That’s why we have a code of behaviour for our employees and the people that we serve. Find out more about the behaviours we expect from our employees and from you.
- This also means participating in meetings requested by the WSIB about your return to work. If you need to consider a new occupation because of the severity of your injury or illness, we will ask you to participate in an assessment, so we can help you develop a plan to prepare for your new job.
Additional resources: Where to find more info
If you have questions or need information about your claim, please call us. If you are unsure who to contact, you can call us at 1-800-387-0750, Monday to Friday (7:30 a.m. to 5 p.m.), and speak to a Customer Service Representative who will be familiar with your claim. When possible, please have your claim number available to help us serve you better.
You can visit other parts of our website to find more details about the information in this guide and other updates. You can also follow us on Twitter.
Visit wsib.ca/myclaim to learn more about signing up for an online services account to access your claim information any time.
The Fair Practices Commission is the organizational ombudsman for the WSIB. The commission provides an independent, neutral and confidential service for injured people, employers and service providers who have concerns about the fairness of the service, or treatment, they receive from the WSIB. You can find more information at www.fairpractices.on.ca or by calling 416-603-3010, or toll-free 1-866-258-4383.
The Office of the Worker Adviser (OWA) is an independent agency of the Ontario Ministry of Labour that provides workplace insurance services to people with work-related injuries and illnesses who are non-unionized, and their survivors. You can find more information at www.owa.gov.on.ca or by calling 1-800-435-8980 (English) or 1-800-661-6365 (French).
There is also a version of this guide available for businesses. See Your Guide: Services and Responsibilities – Business Edition.