The WSIB claims and appeal process exists to give workers the ability to gain financial compensation in the event of a workplace injury, illness or disease. But what do you do if you are involved in a workplace accident, and WSIB denies your benefits: what happens next? It can be very frustrating to have your WSIB claim denied, but there are things that can be done.
There are two types of denials (1) initial denial of a benefit; and, (2) termination of an ongoing benefit. After you have submitted a claim, you may receive a denial letter from the Board indicating that your claim has been reviewed and denied, either all or in part, and the letter will set out the basis for that denial.
What To Do if WSIB Denies Your Claim
If you do receive a denial don’t lose heart. Any denial or termination may be disputed through the filing of a form called an “Objection”. This is a written document that sets out the reasons why the decision of the WSIB is incorrect. However, there are time limits that define when the Objection must be filed. In the majority of cases, the time limit to appeal a denial or termination of benefits is six months. Once an Appeal has been initiated, you are entitled to the complete reproduction of your WSIB file. It’s vital to consult with a WSIB lawyer to ensure that your rights are protected.
The Adjudicator assigned to your case will review the Objection form, and will either reverse the initial decision, or will refer the matter to the Appeals Branch. If the matter proceeds to an Appeal hearing, this can take place in writing or in person.
If the Appeal hearing is unsuccessful, then the next stage is an appeal to the Workplace Safety and Insurance Appeals Tribunal (WSIAT). The WSIAT is an independent board that has exclusive jurisdiction as the final appeal in the system.
Once the WSIAT has rendered its decision, there is no longer any right of appeal: only judicial review of the Tribunal’s decision. The courts have repeatedly stated that they will treat the decisions of the Tribunal with deference: the standard of review is “patently unreasonable”. This means that it is only in the most exceptional of cases that the decision of the WSIAT will be overturned.
The entire process of what to do if WSIB denies your claim, from start to finish, can take in excess of a year due to back-log and delay. This can be devastating for people who have suffered the double blow of being injured at work, and are now struggling to survive financially. Engaging a knowledgeable and experienced work injury lawyer can be critical in navigating through the WSIB maze, and ensuring that you build the elements of a winning case on appeal. A WSIB denied claim doesn’t have to be as ruinous as it initially appears, but it is important to contact an experienced WSIB claim lawyer as soon as possible.
