WSIB - Ontario Nurses' Association

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SECTION CCLAIMING FOR RECURRENCE OF AN INJURY1. A worker is entitled to benefits for a recurrence of a work-related injury ordisease under an established claim number.A recurrence may result from an insignificant new accident, or may arise(flare up) even when there is no new accident.To identify a recurrence, WSIB confirms there is clinical compatibility betweenyour original injury or disease and your current condition, and/or thatthere is a combination of clinical compatibility and continuity (i.e., an ongoingconnection between original condition[s] and most recent problem[s]).The WSIB Recurrence Coordinator can now allow entitlement based solelyon clinical compatibility.If a significant new work-related accident occurs, WSIB may establish a newclaim.2. If you suspect you have a recurrence, seek medical attention immediately.Advise your treating health professional to send the appropriate forms toWSIB.3. If you suspect you have a recurrence, notify your employer immediately.Complete in detail the Employer Incident Form(s) and all WSIB forms.4. With a recurrence of a workplace injury or disease, you re-instate and/or continueto cooperate with all WSIB requirements for your claim.5. To determine earnings (rate of pay) for Loss of Earnings (LOE) – Recurrences,where a worker has returned to work following a work-related injuryand then has a recurrence, the earnings will be the higher of:(a) Earnings at time of original injury; or,(b) Earnings at the time of the recurrence6. Your Case Manager may, under certain criteria, refer your claim to the RecurrenceSpecialty Team for a decision.19
SECTION DMISCELLANEOUSReporting an Exposure Where the Worker Does notBecome Ill or Lose Time from Work• Exposures where the worker does not become ill or lose time from workshould be reported to WSIB on their Program for Exposure Incident Reporting(PEIR) Form. You can download the form at the WSIB website at:http://www.wsib.on.ca/wsib/wsibsite.nsf/public/FormsWorkers.Click on the link to Form 3958A – Worker’s Exposure Incident Form.Other Important Points• If you resign or sever your employment relationship, you may adversely affectWSIB benefits and/or your WSIB appeal. This also applies if you changeyour employment status, i.e., transfer from full-time to regular part-time.Medical limitations may still include reduced hours of work.• You cannot be laid off by your employer while off work and in receipt of WSIBbenefits. You can be notified upon returning to work that you will be in a layoffsituation. You should discuss an employer layoff with your ONA BargainingUnit representative and the ONA staff person handling your WSIB case.• Once entitlement is granted, WSIB reimburses workers whose insurancepolicies paid for their health and welfare benefits, as if the benefits were paidfor by the workers themselves. Once workers receive this money from WSIB,they should notify the insurance company. Workers will have to reimbursethe insurance company.• If a member’s claim is allowed and they received STD, LTD, EmploymentInsurance (EI), welfare, etc., during the same period WSIB benefits are paid,these carriers will be reimbursed by WSIB for 85 per cent of the worker’s netaverage earnings. If one of these groups paid more to you than what WSIBpaid back to them, you may be asked to make up the difference.• The WSIA requires persons receiving WSIB benefits, or persons who maybe entitled to benefits, to notify WSIB of a material change in circumstanceswithin 10 days after the material change in circumstances occurs. A workerwho wilfully fails to inform WSIB of such a material change within 10 daysof when it happens, is guilty of an offence and may be prosecuted. A materialchange in circumstances is any change that affects a worker’s entitlement tobenefits and services under the WSIA. These changes include, but are notlimited to: changes in medical status; earnings/income; work status; avail-20
Page 1 and 2: Workplace Safety andInsurance Board
Page 3 and 4: CONTENTSIntroduction. .............
Page 5 and 6: SECTION AFILING A CLAIM FOR WSIBBy
Page 7 and 8: explaining the details of your acci
Page 9 and 10: cess an RN (EC) or physiotherapist
Page 11 and 12: has often helped ONA win a case, es
Page 13 and 14: • Subsection 131(4) of the WSIA s
Page 15 and 16: to provide a written job descriptio
Page 17 and 18: • Employers are required by the O
Page 19 and 20: The employer is entitled to functio
Page 21: • Many claims have been accepted
Page 25 and 26: Reimbursing the insurance carrierWS
Page 27 and 28: Workers should submit these stateme
Page 29 and 30: Time limits to notify ONA• Within
Page 31 and 32: claim was initiated, and who were n
Page 33 and 34: ly, there is a “60-Day Decision O
Page 35 and 36: and why. Review the file yourself a
Page 37 and 38: Suitable Occupation (SO)The Work Tr
Page 39 and 40: If a plan includes any work hardeni
Page 41 and 42: Other optionsEven though the worker
Page 43 and 44: When having your assessment, it is
Page 45 and 46: ONA OfficesProvincial Office - Toro
Page 47 and 48: North Western Ontario2114 Bordeau C
Page 49 and 50: TorontoWindsor970 Lawrence Ave. Wes
Page 51 and 52: Ontario Ministry of LabourEstablish
Page 53 and 54: CENTRAL REGIONCENTRAL REGION OFFICE
Page 55 and 56: St. CatharinesSarnia301 St. Paul St
Page 57 and 58: OttawaSarnia Liaison Office180 Kent
Page 59: ONAOH & SOHDOHSARN ECSEBSOSTDSWAWRW

WSIB - Ontario Nurses' Association

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