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WSIB - Ontario Nurses' Association

WSIB - Ontario Nurses' Association

dent. ONA will represent

dent. ONA will represent if the claimant: has likely PI; likely recurrences/flare up; sensitivity, i.e., latex allergy; likely future lost time, i.e., expectedsurgery; future symptoms/breathing problems.10. Claims for less than two weeks entitlement, where there is no PI evident.ONA will represent if the claimant: has likely PI; likely recurrences/flare up;sensitivity, i.e., latex allergy; likely future lost time, i.e., expected surgery;future symptoms/breathing problems.Appeals to WSIB (Operations and Appeals Branch)Please note: the WSIB appeals procedures are in the process of being restructured.The points below describe the process in general and the basic stepsinvolved.• There is no guarantee of the time frame for ONA to do your appeal.• If at any time during the appeals process you decide to represent yourself orobtain an external representative, your ONA WSIB appeal file will be closedand your WSIB file will be returned to you.• To meet legislative time limits to appeal and to obtain a copy of your claimfile, ONA sends a letter to WSIB that you intend to appeal the adverse decisionand reasons for the appeal/objection.• ONA requests the Objection Form (which must be completed and submittedwith the final appeal documents) and the WSIB claim file.• If the WSIB sends the file directly to you, leave the file in the order in whichyou received it. Forward the file to the ONA WSIB team member handlingyour appeal.• ONA will obtain any necessary evidence and use it to try to convince yourWSIB Case Manager (CM) (formerly Claims Adjudicator) OperationsBranch to change the decision. If unsuccessful, ONA will complete and sendWSIB the formal appeal with written submission and any supporting newevidence we have gathered in our investigation of your case. You will receivea copy of our submissions and any correspondence with WSIB.• After reading the submission, the CM has another opportunity to change thedecision. If the CM maintains her/his decision, the matter is referred to WS-IB’s Appeals Branch, where it is assigned to an Appeals Resolution Officer(ARO).• In authorizing ONA to act as your representative, you are giving ONA theauthority to have carriage of the appeal in the most appropriate forum, suchas a telephone conference, written submission, or in-person hearing. Current-29

ly, there is a “60-Day Decision Option” which, if chosen, involves a paperreview of your file only with no opportunity for a hearing at the AppealsBranch level.• If the decision is not reversed or changed by the ARO, after we have exhaustedall appropriate options at the Appeals Branch, ONA will determine ifan appeal to the Workplace Safety and Insurance Appeals Tribunal (WSIAT)is appropriate.Appealing to WSIAT and ONA WSIAT CriteriaThe ONA WSIAT representation criteria establishes a process whereby pre- andpost-Bill 99 appeals to WSIAT will be reviewed in the same way arbitration decisionsare reviewed before a judicial review proceeds. The following criteriawould apply:1. Review file for merit on medical and WSIB policy.2. Impact on membership – future and existing.3. Unusual circumstances and exceptional cases.BenchmarksA claim must meet the first point and at least one of the other criteria for ONAto consider WSIAT representation. The ONA CEO/Strategy Team will make thefinal decision on whether ONA will proceed to WSIAT. Should the CEO/StrategyTeam decide not to proceed to WSIAT, the ONA appeal file will be closed, theclaim file will be returned to the worker and the worker will be notified that she/he is entitled to proceed to WSIAT on her/his own.Help ONA Help youTo facilitate the handling of your claim, you will be asked to actively participatewith the ONA WSIB Labour Relations Officer. This will help move your claimthrough the WSIB system as quickly as possible, and minimize any delays withinour control. To help the process move forward:• Sign and return all requested authorization forms within two weeks of beingmailed to you. Do not send the WSIB Direction of Authorization form directlyto WSIB but return it with all the forms to the ONA WSIB LRO.• You can pick up ONA requested medical reports and encourage your healthcare professional(s) to have the report ready in a timely manner.• Obtain witness statements and any documentation requested by the ONAWSIB LRO.30

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