Who Can Obtain Optional Insurance?

Policy

Independent operators (IO), sole proprietors (SP), partners and executive officers (EO) are not covered under the Workplace Safety and Insurance Act, 1997, (WSIA) unless they apply for optional insurance or they are in the construction industry and are compulsorily covered.

Under the WSIA, compulsory coverage extends to IOs, SPs, partners and EOs in the construction industry, with certain exceptions. An individual in the construction industry who is exempt under policy 12-01-06, Expanded Compulsory Coverage in Construction, may make an application for optional insurance.

The WSIB reserves the right to determine whether an individual is a worker, an employer, an IO, or an EO.

Purpose

The purpose of this policy is to outline who is eligible to apply for optional insurance.

Guidelines

General

An individual who is not automatically covered under the Act, but who the WSIB deems upon application to be a worker, to whom the insurance plan applies, is said to have optional insurance.

Individuals requesting optional insurance must indicate their consent by completing and signing the Optional Insurance Request/Change form. For information on how to apply for optional insurance, or to change the amount of optional insurance for those who currently have it, see 12-03-02, Optional Insurance.

Right of action

Individuals with optional insurance lose certain rights of action, see15-01-05, Third Party Rights of Action. Those considering optional insurance may wish to consult a lawyer to evaluate whether optional insurance will benefit them.

Independent operators

Except in the construction industry, if an individual applies for optional insurance and his or her status as either a worker or an IO is unclear, the WSIB uses the organizational test to determine the applicant's status, see 12-02-01, Workers and Independent Operators.

Individuals in the construction industry are IOs if they meet the criteria set out in policy 12-01-06, Expanded Compulsory Coverage in Construction.

Executive officers

To determine whether an individual is an EO of a corporation, the WSIB considers if,

  • the name of the individual is recorded in the employer’s minute book as an officer/director, and/or
  • the status of the individual can be verified in other documents that the WSIB may review including resolutions by the board of directors, corporate by-laws, or public records filed with other government authorities.

The WSIB may also determine who is an EO by examining the substance of the relationship between the individual and the employer. In such cases, the documentation listed above will be considered, but the substance of the relationship determines whether an individual is considered an EO.

The WSIB will consider a variety of factors when examining the substance of the relationship between the individual and employer, including whether the individual

  • has been delegated the authority to act independently on behalf of the organization
  • is wholly or partially responsible for the overall direction and control of the organization’s operations or financial affairs
  • exercises a broad scope of authority to make decisions or formulate policies for the organization as a whole, rather than authority that is strictly limited to a specific branch or division
  • has the ability to bind the organization.

Unincorporated organizations may have individuals who are determined to be EOs under this policy based on the WSIB's examination of the substance of the relationship, as noted above. This includes organizations such as non-profits, municipalities, boards, commissions and the provincial government; but does not include SPs.

Spouse and family members

For a spouse or family member to be eligible for optional insurance, he or she must be

  • a partner or an executive officer, and
  • active in the business, and in receipt of earnings.

Part-time domestic workers

The WSIB considers domestic workers to be IOs eligible for optional insurance if they work

  • 24 hours a week or less for a single employer, or
  • more than 24 hours a week in total for more than one employer, but not more than 24 hours a week for any single employer.

For more information, see 12-04-14, Domestic Workers.

Occupants of a private residence employing domestics for the purpose of operating and maintaining their household may not obtain optional insurance for themselves or the operations pertaining to their household.

Average earnings

For information on determining average earnings, see 12-03-02, Optional Insurance.

Application date

This policy applies to all decisions made on or after April 1, 2016.

Document History

This document replaces 12-03-03 dated January 2, 2013.

This document was previously published as:
12-03-03 dated October 12, 2004.

References

Legislative Authority

Workplace Safety and Insurance Act, 1997, as amended
Sections 2(1), 11(2), 12, 12.2, 26, 28

Minute

Administrative
#2, March 22, 2016, Page 532