3 years ago

WSIB - Ontario Nurses' Association

WSIB - Ontario Nurses' Association


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: 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

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