If you sustained a workplace injury and are in receipt of Workplace Safety and Insurance Board (WSIB) benefits for the first time, there are essential pieces of information that you should be familiar with.
The first is that workers are required to be cooperative with respect to:
- Healthcare treatment
- Early and safe return-to-work plans
- Work transition assessments/plans.
The WSIB requires injured workers to provide medical reports as requested and to attend recommended treatment. Injured workers are also responsible for keeping their employers up to date regarding their recovery, and also sharing information with respect to limitations, to assist in the return-to-work process. This does not mean that employers are entitled to all medical information; however, they are entitled to functional limitations to guide the return-to-work process.
Workers also have a shared responsibility to assist their employer in locating suitable work within their limitations. Should an employer not be able to accommodate an injured worker and the injury becomes permanent, the worker may be required to attend a work transition program that may include, but is not limited to, retraining and job searching.
Failure to participate in any of the above activities could potentially result in the reduction, suspension, or termination of loss-of-earnings benefits.
It is also imperative to report any material changes to the WSIB while you are in receipt of loss-of-earnings or any other benefits. Material change is defined under WSIB Policy 22-01-02 as any change that affects a person’s entitlement to benefits and services under the Workplace Safety and Insurance Act. Types of changes may include, but are not limited to:
- Improvement or deterioration of the work-related condition
- A need for more or different treatment
- Stopping treatment
- A need for an assistive or prosthetic device, or to make changes to an existing device
- Receiving a wage increase or decrease
- Receiving CPP or QPP disability benefits
- Changes in CPP disability benefits
- Change of address.
Injured workers are required by law to report a material change to the WSIB within ten days of the change occurring. Failure to do so could result in penalties, such as a fine or jail time. If you are not sure whether a change is material, it should be reported to the WSIB and you will be advised whether there is an effect on your benefits. It is better to be safe rather than sorry and learn that you may have been overpaid and have to repay a debt, or have committed an offence under the Act.
It is also an offence under the Workplace Safety and Insurance Act to make false or misleading statements to obtain benefits or services about any claim. This could also result in charges under the Act.
The above blog was published by Nelligan O’Brien Payne LLP on June 30, 2016. Peggy King is a Workers’ Compensation Consultant for Nelligan O’Brien Payne LLP, with extensive experience in adjudicating the claims of injured workers. She was employed for more than a decade with the WSIB, and has significant insight into determining an employee’s entitlement to benefits and services.
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