Your guide: benefits, support and next steps for people with claims

Introduction

If you’ve been injured or become ill because of work, you can use this guide to learn what to do next, what support may be available for you and how we can help you recover and return to work safely.

Use this guide if you have submitted a claim or are thinking about submitting one. It explains common steps, benefits, services and responsibilities, but it does not include every benefit, service or requirement that may apply to your claim.

Our decisions 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.

We protect your privacy and the confidentiality of your personal information. You can read our privacy statement on our website.

Reporting your injury or illness

Sign up at wsib.ca to report your work-related injury or illness within six months of the date of injury or six months after being diagnosed with a work-related illness.

If you don’t report your injury, even if your employer or health care provider reports it for you, we can only provide you with wage-loss benefits for up to two weeks after your injury. When you report your injury online, you also give permission for your health care providers to share information about your functional abilities to us and your employer.

Tip: Report your injury or illness as soon as possible, even if you are not sure whether you will miss work.

Tell your employer

Let your employer know as soon as possible if you are injured or become ill because of work. After you report, we may share basic information with your employer, including:

• information about your related injury or illness
• information about your health care that supports your return to work
• copies of decision letters we send you

If your employer asks for a  Functional Abilities Form (PDF) , you need to ask your health care provider to complete it. This form describes what you can safely do at work.

What happens after you report an injury or illness

After you report an injury or illness, we register your claim and review information from you, your employer and your health care provider before deciding whether to approve your claim, which benefits and services you may receive and how we can support your recovery and safe return to work. We will explain our decisions in writing, tell you what they mean and let you know if we need more information.

A claim usually moves through these general steps:

1. Sign up at wsib.ca to report your injury or illness to start the claim.
2. We register the claim and then it will have one of the following statuses. (You can find the status by logging in at wsib.ca):
   • Allowed: the claim is approved
   • Pending: we need to review the claim further
   • On hold: we need more information and will contact you with what we need
3. We review and decide what benefits, services or next steps apply to you based on the information in your claim file.
4. If we approve your claim, we support your recovery through health care, income replacement (loss-of-earnings benefits), return-to-work services or other benefits.
   • If you disagree with one of our decisions, you can learn about our appeals process on our website.
5. Stay connected through our online services by logging on at wsib.ca to share updates and let us know if your health, work or income situation changes.

Manage your claim online

Log in at wsib.ca to use our secure online services to manage your claim when it is convenient for you. You can:

• see your claim status
• view payments
• see your approved benefits and services
• track the status of an appeal
• submit, view and download your claim documents whenever you need them
• send us secure messages
• update direct deposit information
• book approved transportation to and from appointments

Tip: Sign up at wsib.ca for online services to get claim updates faster, submit documents and send us secure messages.

Get the support you need

If your claim is approved, you may receive one or more benefits or services depending on your situation, the type and seriousness of your injury or illness and the information available in your claim file. These may include:

• health care
• health care equipment and supplies
• income replacement
• support returning to work
• retraining for a new job, if needed
• benefits for permanent injuries
• survivor benefits for eligible family members

Read more about the benefits and services we offer.

Health care and medical treatment

We pay for all approved health care costs related to your work-related injury or illness, even if you have insurance coverage. You may get health care benefits even if you have not missed time from work.

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 people with disabilities live independently

We also offer health care programs that provide early care after a workplace illness or injury. This includes programs of care, which are bundled services delivered by regulated health professionals and use the latest medical best practices to address some of the most common workplace injuries including musculoskeletal injuries, mild traumatic brain injuries, noise-induced or traumatic hearing loss, mental health and other specific illnesses.

We must pre-approve most health care treatment and related travel. Log in at wsib.ca to send us a message or call us before treatment if you need to change health care providers, plan to see a provider who is not registered with us or have treatment that cannot be billed directly to us.

Find a provider near you

Paying for treatment

If you get health care before your claim is approved, you may need to pay for it first and then ask us to reimburse you. We do not cover every type of health care, and we only reimburse costs that are approved and related to your workplace injury or illness.

When approved, we may pay your health care provider directly. We may also approve psychological treatment to support your recovery and return to work, even if your claim is not for a psychological condition. Health care providers cannot ask you to pay for approved services related to your claim.

Prescriptions

You may fill prescriptions for your work-related injury or illness at your local pharmacy. Most pharmacies in Canada can bill us directly. Read more about filling prescriptions at the pharmacy.

Sometimes you may have to pay for your prescription and then request reimbursement from us. This happens if we’re still reviewing your claim, the medication isn’t covered or the quantity of medication is more than what was approved. Complete the  Medication reimbursement form (PDF)  and log in at wsib.ca to submit it to us with a copy of your receipt(s).

Health care equipment and supplies

We will pay for health care equipment and supplies that your health care provider prescribes. This may include:

• assistive devices (e.g., walkers, hearing aids)
• braces and supports
• wound care supplies
• adjustable bed frames and mattresses

We need to pre-approve medical devices and equipment before you purchase it. Your supplier may need to send us a prescription from a regulated health care provider and details about the item and cost.

You can choose your equipment from a list of our approved suppliers. We will provide you with the list.

We may also reimburse reasonable travel costs related to your claim, such as public transportation, mileage, parking, accommodation, meals or an approved escort. 

Read more about arranging travel for your claim.

Benefits to replace your missed income

If you miss work and do not get paid because of your work-related injury or illness, you can get benefits to replace your missed income.

Income replacement

If 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.

This income replacement is also known as loss-of-earnings benefits.

There is a limit on the maximum amount of income replacement we provide each year. You can use our net average earnings calculator or ask your case manager for more details.

Loss-of-retirement-income benefit

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 wage-loss benefits for at least 12 continuous months.

If you are eligible, we may pay you for lost retirement income when you turn 65. Before turning 65, you can also choose to move some of your wage-loss benefit toward your loss-of-retirement-income benefit.

Other benefits that may be available

You may also receive benefits for non-economic loss. And your dependents may be entitled to survivor benefits.

Permanent impairment (non-economic loss)

You may qualify for a non-economic loss benefit if your work-related injury or illness causes permanent physical, functional or psychological impairment.

The amount is based on your level of impairment and your age. A WSIB-approved health care provider may need to examine you to determine your level of impairment. We may reimburse you for any travel expenses or lost wages for going to this examination.

Survivor benefits

Spouses or dependents of people who die because of a work-related injury or illness may receive:

• lump sum or monthly survivor payments
• funeral and transportation costs
• bereavement counselling
• support for spouses looking to re-enter the workforce

Read more about the benefits and services we offer.

Return to work safely

Returning to work is an important part of recovery. Our goal is to help you return to safe and suitable work at the right time. You will have our support throughout the process.

Our team of return-to-work experts will:

• meet with you and your employer to talk about your return
• discuss accommodations that may help you return safely
• explain what to expect during the return-to-work process
• provide information on your rights and responsibilities
• answer your questions
• connect you and your employer with specialized services, if needed

Additional support

Depending on your situation, we may also:

• visit your workplace to evaluate your workspace
• arrange assessments to determine suitable work
• help identify safe work options
• recommend retraining if you’re unable to return to your previous job

Read more about returning to work safely.

Help us help you

Working together helps us make decisions, support your recovery and help you return to work safely. Here are your responsibilities while making a claim or receiving benefits.

Give us the information we need

We may ask for additional information to help us make decisions about your claim. For example, we may ask about:

• how your injury or illness happened
• your medical treatment
• your recovery
• your return-to-work plans

Tip: For faster service, log in at wsib.ca submit documents directly to your claim file.

Tell us if something changes

Let us know if anything changes that could affect your claim or your benefits. Examples include:

• your condition gets better or worse
• your wages or income increase or decrease
• your job duties or work hours change
• you start receiving, or there are changes to your Canada Pension Plan disability benefits
• your ability to participate in treatment or return-to-work activities changes

You must report any changes to us no later than 10 calendar days after it happens. 

Tip: If you are not sure whether a change affects your claim, tell us anyway so we can help you understand what it means.

Take part in the process

To support your recovery, attend all scheduled medical appointments, examinations and treatment sessions. You can choose your health care provider.

We also need you to work with us 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 and participating in meetings.

If you need to consider new work because of the severity of your injury or illness, we can help you develop a plan to prepare for a new job.

Treat each other with respect

Respectful communication helps us work together. Our code of behaviour explains what we expect from our employees and the people we serve. Learn more about the behaviours we expect.

Claim access, support and reconsideration

You have the right to understand what is in your claim file, get help from someone you trust and ask us to reconsider a decision if you disagree. This section explains how to access your claim file, choose a representative and what steps you can take if you want a decision reconsidered.

Access your claim

1. You can get a digital copy of your claim file at no cost. Complete a  request for copy of claim file (PDF)  and log in at wsib.ca to submit the completed form.

Under the Freedom of Information and Protection of Privacy Act (FIPPA), you have the right to your personal information collected by us.

Have someone represent you

You can choose someone to help you with your claim.

An informal representative can be someone you trust such as a family member, friend or caregiver. They can support you and receive verbal updates about your claim.

An authorized representative can receive both written and verbal information about your claim, access your claim file and represent you during the appeal process. This can include a lawyer or legal service/aid/clinic, the Office of the Worker Advisor, a friend, family, a union representative, an ombudsman, a Member of Provincial Parliament or a social worker.

If you disagree with a decision

We carefully review all information before making a decision. Sometimes new information becomes available, or you may feel that we should look at a piece of information again. If this is the case, here are the steps you can take:

1. Log in at wsib.ca to send a message or call your case manager to ask us to reconsider the previous decision
2. If you are still dissatisfied after reconsideration, you can file a formal appeal
3. If you are dissatisfied with the outcome of your appeal, you can ask the Workplace Safety and Insurance Appeals Tribunal (WSIAT) to review the decision. WSIAT is separate and independent from the WSIB.

Your employer also has the right to object to a decision allowing your claim. They have six months from the decision date to object.

Read more about what to do if you disagree with a decision.