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WSIB - Ontario Nurses' Association

WSIB - Ontario Nurses' Association

SECTION EAPPEALSONA’s

SECTION EAPPEALSONA’s WSIB Appeal ProceduresIf you have an adverse decision from WSIB and you meet the ONA representationcriteria, ONA will represent you in your appeal to WSIB. We may provideyou with self-help kits if you do not meet ONA’s criteria. Decisions to proceedwith an appeal are based on the evidence available and chances of success. If youwant ONA to represent you, you should not, either verbally or in writing, objectto a WSIB decision. You should not set meeting or hearing dates. Contact ONA assoon as you receive the adverse decision.Time limits to notify WSIB of an appealDecisions made on or after January 1, 1998:Six-month time limit1. The six-month time limit on appeals applies to all WSIB decisions made onor after January 1, 1998.2. If the WSIB makes a decision you do not agree with, the decision letter willinform you about the time limit and procedures for appealing the decision. Ifyou want ONA to appeal a decision, you must notify us within the time limitsspecified below.30-day time limit1. The 30-day time limit applies to decisions on Work Reintegration or WorkTransition plans made on or after January 1, 1998.2. If the WSIB makes a decision you do not agree with, you will be advised inthe decision letter about the time limit and procedures for appealing the decision.If you want ONA to appeal a decision, you must notify us within thetime limits specified below.Criteria for extending the time limitsThe WSIB does have the authority to extend the time limit to appeal at any time ifit considers it advisable. To avoid any disappointments all appeals should be filedwithin the time limit.25

Time limits to notify ONA• Within one week of the date of the adverse decision if it is a 30-day appeal.• Within four weeks of the date of the adverse decision if it is a six-month appeal.• Within one week of receiving notice of an employer appeal.• It is the usual practice of WSIB Case Managers to call a worker to informhim/her of a decision on the same day the written decision is mailed. You donot have to wait for the written decision before contacting ONA.• If you want ONA to represent in an appeal, you do not send any letters toWSIB or advise them you will be appealing the decision. Contact ONAWSIB Intake first (1-800-387-5580, press 0 for Toronto office, ask for WSIBIntake or dial extension 7721).ONA WSIB Case Representation CriteriaUnlike grievances, there is no legal obligation for ONA – or any union – to providerepresentation in WSIB appeals to its members. The ONA Board of Directorsapproved the development of criteria to enable us to provide this representationto the most vulnerable of our injured members. The criteria is applied on a caseby-casebasis by the Labour Relations Officers on the ONA WSIB Team as towhether your case meets ONA’s Representation Criteria. There may be unusualor mitigating circumstances in your case that would permit us to waive criteria,therefore, even for the “Issue-Specific” criteria you must contact a WSIB LROvia the ONA WSIB Intake line – ext. 7721 – to determine if we can represent youin an appeal.When you contact ONA about an adverse WSIB decision you wish to appeal, andyou have contacted us within the above ONA time limits, an LRO with expertisein WSIB matters will determine if your case meets our criteria for representation.These criteria will be revised on an ongoing basis based on experience, newlegislation, regulations and WSIB policies. Each individual case will be assessedon an ongoing basis for meeting the criteria, including the merits. For example,if it is initially determined your case meets our criteria, and then a medical reportobtained later through our investigation contradicts or does not support your case,we may review the merits again and decide not to proceed further.In most cases where ONA decides there is no merit to continue with the appeal,self-help kits are provided to the worker to proceed on her/his own if s/he sochooses. The worker may utilize an outside representative, however, ONA doesnot pay this cost. ONA also does not pay the cost of obtaining medical assess-26

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