2 years ago

WSIB - Ontario Nurses' Association

WSIB - Ontario Nurses' Association

• If your

• If your WSIB claim is denied, the majority of full-time employees canapply for sickness and accident benefits under your collective agreement.Some collective agreements provide for an advance from STD benefitsduring the time WSIB is making a decision on whether to allow or denyyour case. If you request an advance, you may be required to sign an agreementto reimburse your employer once the WSIB decision is issued.• Even if WSIB accepts your condition as work-related and pays you benefits,where applicable, apply for Long Term Disability (LTD) benefitswithin the insurance carrier’s time limits. We advise this as in many casesa future dispute arises with WSIB and a worker’s WSIB benefits are discontinued.If the worker applied for LTD benefits within the insurance carrier’stime limits, the worker may then still be eligible for LTD benefits.Depending on the insurance carrier and the terms of your collective agreement,a member may also be entitled to an additional minimum $50 payoutfrom your LTD plan (e.g. HOODIP), while on WSIB benefits. If you areinjured or ill, immediately talk to your Bargaining Unit ONA representativeabout this benefit, because there are time limits to apply.13. See your treating health professional immediately and ask her/him tocomplete and send the appropriate first report form to WSIB (Form 8 –Health Professional’s Report).In early 2004, WSIB policy was amended whereby registered nurses (ExtendedClass) (RN [EC]) and physiotherapists may now treat an injuredworker and submit an accident report to WSIB on the newly revised Form 8.Doctors and chiropractors will also use this newly revised Form 8 to report anaccident.This is a key development for our members, but it is important injured membersnot use this policy as a means to forego visits to their family doctor. Itis still WSIB practice to always place more weight on the medical evidencereceived by a physician specialist, a family doctor and their own WSIB physicians.If an RN (EC) does the initial assessment and documentation and there is adiscrepancy, we believe WSIB will ask their own medical consultant to reviewthe file. Where the WSIB physician’s findings differ from the RN (EC),WSIB will likely deny the claim. Therefore we strongly recommend youdo everything in your power to be treated by a physician.In remote areas where a member does not have a family doctor and cannotaccess a hospital emergency room or clinic, our members should at least ac-5

cess an RN (EC) or physiotherapist to document the physical findings anddiagnosis when they are able to do so. Where there is no access to an RN (EC)or a physiotherapist, they should at least ask another RN to document the accidentand any physical findings observed within their scope of practice.When the injured worker does not have access to a doctor, chiropractor, RN(EC) or physiotherapist and they ask another RN to document their findings,the RN who does the assessment should simply send a letter to WSIB of theirfindings. Please ensure that, in these unique situations, the RN only sends inthe findings from a member’s assessment by way of written letter, and doesnot fill out any WSIB forms. (The WSIB will not pay an RN to write this letter,therefore, it would have to be done voluntarily.)The College of Nurses of Ontario (CNO) has indicated to us that an RN andRN (EC) can also authorize lost time. If you are injured and require time offwork due to your injury, and again are in an area where you have no accessto a doctor, you should at the very least have an RN (EC) authorize your losttime. Where you do not have access to an RN (EC), you should then ask anotherRN if they could authorize your lost time for you in writing and submitthis to WSIB.Understand that when using the RN (EC) and physiotherapist to fill outforms, or when using the RN to send a letter, we believe the injured memberwill likely be under close scrutiny by WSIB to ensure they first did everythingpossible to see a doctor.14. Make sure your health professional has physically examined you andthat s/he has documented all your physical findings in her/his clinical records(ie. range of motion – very important, spasm, etc.). Make sure yourdoctor/health professional provides this information on Form 8 to WSIB.15. If you are planning to make a claim with WSIB and you require time offfrom work, you will need authorization from your doctor/health professional.If your doctor/health professional believes you require time off work,s/he should not document any restrictions on Form 8 or Functional AbilitiesForm.16. If your doctor/health professional recommends time off, make sure s/hegives the reason for the time off on Form 8 or Functional Abilities Form.For example, if you have a back injury and are experiencing muscle spasm,usually you will require a period of rest to give the muscles a chance to relax.Rest is an appropriate treatment recommendation for WSIB claims, especiallyin the acute period after an injury, but WSIB claims adjudicators don’t6

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