A Step Beyond Uncategorized About Ontario’s Workplace Safety and Insurance System

About Ontario’s Workplace Safety and Insurance System



The Workplace Safety and Insurance Board (WSIB) is part of
an Ontario-wide system. The system is designed to help protect
workers from injury or illness in the workplace, and to help
them if they do suffer an injury. Most Ontario employers must
have workplace insurance coverage by law. Employers pay the
premiums for their workers and are not allowed to deduct them
from workers’ wages.

The WSIB’s focus is on:
■ Promoting health and safety in workplaces, and preventing and
reducing the number of workplace injuries and occupational
diseases
■ Helping injured workers and workers with an occupational
disease recover and return to work
■ Helping the re-entry into the labour market of workers and
spouses of deceased workers
■ Providing compensation and other benefi ts to workers and to
survivors of deceased workers.

Our staff is here to help you. Your WSIB team includes:
Adjudicator
duties
■ Determines all questions of entitlement
■ Decides what benefi ts you get, how long they last and their
amount
■ Promotes prevention, disability management and assists with
return to work.
Nurse Case Manager
duties
■ Makes sure that you receive quality care at the right time
■ Gives you the support needed so that you can return to work
safely
■ Gets medical/health care information and provides guidance to
adjudicators
■ Promotes prevention, disability management and assists with
return to work.
Customer Service Representative/Account Manager
duties
■ Registers new employers
■ Assists employers with their accounts and helps them to
understand their premiums
■ Promotes the prevention of workplace injuries and the
importance of early and safe return to work of injured workers.

Health and Safety, Your Rights
and Responsibilities (Ontario)
Here is some workplace safety information you
should know.
You have the right to:
■ Know about dangers. Your employer must
provide information and education about the
hazards and dangerous chemicals or materials
used in your workplace.
■ Participate in making your workplace safe.
■ Refuse unsafe work. If you believe the work you do or
the equipment you use is not safe, you can refuse to do
that work until the situation is fi xed. No one can suspend
you, fi re you or dock your pay. But you must tell your
supervisor right away of your concerns. During the
investigation, you should remain in a safe place near your
workstation.

You have a responsibility to:
■ Work safely. Don’t take risks. You could injure yourself or
another worker.
■ Report unsafe conditions. If you see anything that looks
wrong, tell your supervisor immediately Don’t wait until
somebody gets hurt.
■ Wear the right safety equipment for the job.
■ Wear your protective equipment or clothing and get trained
to use and care for it properly

Your employer has a responsibility to:
■ Provide information and education about health and safety, and
take reasonable steps to protect you.
■ Advise you of any workplace hazards.
■ Prepare and post a written occupational health and safety
policy, and the Occupational Health and Safety Act.
■ Provide and keep your equipment in good condition, and
enforce its proper use.
■ Provide training on safe use of machinery, tools, dangerous
chemicals or materials.
■ Make sure that a joint health and safety committee (workplaces
with 20 or more workers) or a health and safety representative
(workplaces with six to 19 workers) is available and working

WSIB Benefi ts
Your adjudicator is your main contact at the Workplace Safety
and Insurance Board. Depending on the nature of your injury, you
may also be contacted by a nurse case manager.

Financial Benefi ts
Loss of Earnings Benefi t (LOE)
If you had a work-related injury (on or after January 1,
1998) and lose wages as a result, you are entitled to Loss
of Earnings Benefi ts. This benefi t is based on 85% of your
net average earnings (take-home pay), up to a pre-set annual
maximum. Your adjudicator will advise you of the maximum,
or you can check the “For Workers” section . When calculating your benefi t, the adjudicator
considers both your ability to work and the availability of
suitable work.
Here are some of the things you must do to be entitled to LOE
Benefi ts:
■ Give the WSIB the information necessary to manage your
claim.
■ Co-operate in health care treatment as recommended by your
treating health care professional.
■ Co-operate in all activities that will help you achieve an early
and safe return to work.
■ Co-operate in a Labour Market Re-entry Plan (if required).
Section 3 WSIB Benefi ts

Full LOE Benefi ts
If you are not able to work because of your injury and are cooperating
in a health care and/or return to work program, you are
eligible for full LOE Benefi ts. This amount equals 85% of your
take-home pay, up to a pre-set annual maximum. LOE payments
continue until:
■ You no longer have a loss of earnings related to your injury, or
■ You are no longer impaired by the injury, or
■ You reach 65 years of age.
Partial LOE Benefi ts

If you are able to return to work for less pay and the wage loss is
a result of your injury, you are entitled to partial LOE Benefi ts.
To be eligible, you must continue to co-operate with health care
and your return to work program. The value of the partial benefi t
equals 85% of the difference between your pre-accident and postaccident
take-home pay, again up to a pre-set annual maximum.

Calculating your LOE Benefit
Your Loss of Earnings Benefi t is based on average earnings. These
are your average earnings from all of your employers at the time
of your injury

Example
Earnings:
$20.00 per hour
40 hours per week
Monday to Friday
Calculation (short-term):
$20.00/hour x 40 hours/week = $800.00 per week
Less $16.88 (Employment Insurance)
Less $28.78 (CPP)
Less $154.63 (Taxes)
Take-home Pay (Net Average Earnings) = $599.71
85% = $509.75

If you are getting LOE Benefi ts for more than 12 weeks, we
will recalculate your average earnings if you are a seasonal or
temporary worker, or if it is not fair to keep paying LOE Benefi ts
based on your short-term average earnings. In other words, if your
short-term average earnings do not fairly refl ect your earnings
over the long term, we will recalculate your earnings.
If your job was permanent (for example, no set termination
date), we will recalculate your earnings based on the 12-month
period before your injury.

If your job was non-permanent (contract work or seasonal
work), we will recalculate your earnings based on the 24-month
period before your injury.

We also consider if there was a break in your employment
pattern or periods when you were not working when we calculate
your long-term earnings. Some examples of periods that we
consider include:

■ Maternity, paternity or parental leave
■ Full-time study
■ Illness, long-term disability or a period on WSIB benefi ts.

Section 3 WSIB Benefi ts
Health Care Benefi ts
We want to help you get quality health care at the right time – to
help you recover as much and as quickly as possible.

The WSIB pays for most treatments/services related to the
work-related injury. This can include:
■ Treatment by health care professionals such as doctors,
chiropractors, physiotherapists and dentists
■ Hospitalization, surgery and emergency care
■ Prescription drugs
■ Prosthetics, orthotics and other assistive devices such as glasses,
hearing aids, crutches and wheelchairs
■ Contracted services, such as an attendant and other measures
to help severely impaired workers live independently
■ Travel and accommodation costs related to the claim
(such as medical appointments).

You have the right to choose the initial heath care
professional who will treat you for your work-related
injury. You must notify and get approval from your
adjudicator to change who treats you (e.g., if your doctor
retires).

The WSIB pays health care professionals for most
treatments related to the work-related injury. This
includes a variety of diagnostic assessments, treatments,
surgery, and so on. In most cases, you should not have
to pay for prescription drugs required to treat the work-related
injury.

For some treatments, you need approval BEFORE you get the
treatment. You should get pre-approval to make sure that the
WSIB will pay for the health care received (e.g., hearing aids,
dental care).

We require that all health care professionals belong to a college
falling under the scope of the Regulated Health Professions Act.
We want to make sure that you are receiving the right treatment
by fully qualifi ed professionals. Sometimes the WSIB will purchase
services from non-regulated professionals. Check with your
adjudicator or nurse case manager before treatment/services start.

Payment for Health Care
Health care professionals bill the WSIB directly for any
treatments/services required for your work-related injury. The
health care professional should not bill you or another insurer
for any amount over and above the approved WSIB fee. If you
are billed by the health care professional for the balance of the
fee, contact your adjudicator or nurse case manager.

Special Services for Severe and Complex Injuries
Regional Evaluation Centres
Regional Evaluation Centres (REC) are independent, hospitalbased
facilities approved by the WSIB. They provide independent
medical assessments for workers who have complex injuries or
whose recovery takes longer than expected. Your physician will
usually refer you to the Regional Evaluation Centre, but in some
cases your nurse case manager may make a referral. Your nurse
case manager will explain what you can expect and what your
examination will include.

Serious Injury Program
If you suffer a serious injury (e.g., paraplegia, quadriplegia,
industrial blindness), our Serious Injury Program will handle your
case. This program offers highly specialized health care services
based on your needs. This could include such things as changes to
your home and vehicle, attendant allowance or home care.

Transportation and Accommodation Costs
The WSIB pays all reasonable expenses incurred when, on the
direction or the approval of the WSIB, you must travel in relation
to a claim. Your adjudicator can provide more details.

Non Economic Loss Benefi t (NEL)
If your workplace injury or illness is severe enough to cause a
permanent impairment, you may be eligible for a Non Economic
Loss Benefi t. We pay this benefi t to recognize that, beyond your
wage loss, you may also have suffered a permanent physical,
functional or psychological loss.

If there is evidence of permanent impairment, your
adjudicator will refer you for a Non Economic Loss medical
assessment. You should note your right to the NEL Benefi t (if
applicable), is not affected by returning to work.

Loss of Retirement Income Benefi ts
The Loss of Retirement Income Benefi t replaces money
that you would have saved for your pension had you not
been injured at work. It is meant to add to your retirement
income. It does not affect other retirement pensions you
may receive from your employer, the Canada Pension Plan
or old-age security.

You may be eligible for this benefi t when you reach age
65 if you have received Loss of Earnings Benefi ts for 12
continuous months and you were less than 64 years of age
at the time of your injury.

The Loss of Retirement Income Benefi t is paid at age
65. We will send you information about the benefi t a few
months before your 65th birthday. If you die before age 65,
the benefi t is paid to your survivors.

Survivor Benefi ts
There are four types of benefi ts/services the WSIB may
provide to the survivors of a worker in the event of a
work-related death. They are:
■ Monetary benefi ts (monthly and lump-sum payments)
■ Burial expense payment
■ Bereavement counselling
■ Labour Market Re-entry assistance to the surviving
spouse.

Section 4
Managing your Claim
While receiving WSIB benefi ts, you have certain
responsibilities. Your job during this time is to
focus on returning to work that is safe, and within
your physical (functional) abilities. You share this
responsibility with your employer and must work
together to achieve it.

It is important that you co-operate in efforts to return you to
work in a safe and timely manner. We are looking to you for full
commitment by keeping in regular touch with your employer,
making suggestions about how you could return to work while
recovering and participating in whatever assessments/programs
are arranged.

Co-operation can include things like:
■ Regular attendance at programs arranged for you
■ Keeping in touch with us, your employer and any service
providers that may be involved
■ Completing and returning WSIB forms promptly
■ Keeping appointments and being on time for them
■ Taking every reasonable measure to ensure the success of your
recovery
■ Telling us about any important change in the status of your
claim, known as “material change in circumstances”, including
eligibility for WSIB loss of earnings benefi ts

What is a “material change in circumstances”?
You are also responsible for reporting any changes that affect
your injury, employment or earnings to us within 10 days of the
change. Here are some common examples of situations you must
tell us about:
■ Changes in your medical status or treatment – you become
capable of doing modifi ed work
■ Changes in earnings/income – your wages from employment
have increased or decreased or you begin to receive Canada
Pension Plan disability benefi ts
■ Changes in your work status – returning to work, fi nding a new
job or a temporary part-time job, being fi red or retiring
■ Changes in your employment conditions – hours of work,
wages, duties, etc.
■ Situations that affect your recovery or ability to work – for
example, moving out of the province, an unrelated health
condition or if your work visa expires

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