Get Free Support with WSIB Claims and Appeals

Beverly Written by Beverly Leavitt June 28, 2024 Health and Safety

A person in a white coat holding another person's hand while putting on a white cast with black velcro attachments.

Have you heard of the Office of the Employer Advisor (OEA)? 

The “OEA provides Ontario employers with expert, free and confidential advice, representation and education on all workers' compensation issues under the Workplace Safety and Insurance Act, and on unjust reprisal issues under the Occupational Health and Safety Act,”

In other words, they are here to support you (the employer) with WSIB claims submitted by one of your employees, including in the event of an appeal. 

Setting the Scene 

Meet Joe. Joe hurts himself on the clock or becomes sick with a work-related illness. If he’s at work, his employer (you, the dealership) provides first aid and pays for his transportation so he can arrive safely at the hospital or doctor’s office. 

Joe gets assessed by a medical professional. He then reports the incident to his employer, fills in Form 6 and submits the worker’s report. You keep a record of the injury and submit Form 7 within three business days. 

WSIB works with you and Joe to help Joe recover and return to work safely and at the right time. 

Reporting-wise, that’s the best-case scenario. 

But sometimes, Joe’s story doesn’t match yours, or you may have heard through the grapevine that he had previously injured himself at home that weekend. Or maybe you’re uncertain if the injury even requires WSIB’s involvement. 

To check, fill out the self-evaluator for a list outlining your required actions. 

If you check “uncertain” at any point or question the legitimacy of the claim, contact OEA. 

Turn to OEA for Help 

“The OEA was set up in 1985 at the same time as the Office of the Worker Adviser and the Workplace Safety and Insurance Appeals Tribunal,” Bill Davis from the OEA explains.

Bill joined the ranks three years later and recalls, “At the time, MPP offices were overrun by workers trying to appeal WSIB claims. All three systems were set up at once.”

While the workers may have pushed the issue, it’s clear that both sides needed support. The Tribunal was put in place as the last stop, completely separate from WSIB, to hold the final say if a case couldn’t be resolved in previous appeals. 

Bill continues, “The OEA is in the Act itself to primarily assist employers with 100 employees or less.

“However, if you’re under 200 employees, we’ll generally assist you all the way through the appeal process, providing there is merit to an appeal. If you’re over 200, we’ll assist you over the phone, but we won’t provide formal representation without extenuating circumstances.

“We’re here to help smaller employers who get fewer claims.”

While the OEA will help throughout the claim process, its primary role is to support appeals. 

What Happens in an Appeal? 

An employee can appeal their case if they feel that their benefits were cut off too soon or denied altogether. 

When that happens, a letter is sent to you to inform you of the appeal. 

You have two choices: participate or decline participation. 

There may be a lot of emotions guiding your decision. One, you feel a personal attachment to the employee who’s filed the claim, and you don’t want to work against them. Two, you’re frustrated with the situation and want to wash your hands of it. 

Both are fair, but neither should prevent you from attending the appeal because WSIB will stop apprising you of the situation if you decline to participate. This means you won’t learn the outcome or how it affects your cost statement. 

Within that same letter, you’ll find OEA’s contact information. You’ll be connected with an agent representing your postal code who will guide you through the process. 

Alternatively, you may wish to appeal a decision made by WSIB, and OEA can help gauge whether you’ll be successful or not based on the documentation from all parties involved in the event. 

Old Cases Arising 

Sometimes, old cases come up for appeal, and employers wonder if it’s worth their time participating.  

Bill’s advice? “As a general rule, if the date of the accident is within the past 6 years, there is a greater likelihood of it affecting your WSIB cost statement.”

“It’s always best to stay in the loop,” he reiterates. 

Bill’s Closing Advice 

As we’ve established, Bill is a seasoned expert when it comes to WSIB. He does share that while most claims are smooth, he only sees the appeals. 

With that in mind, here’s some wisdom he leaves with you. 

  1. Document everything when an incident occurs
    • Interview staff and supervisors 
    • Keep detailed records 
  2. If you don’t agree with the employee’s claim, put it on the Form 7
    • You can always attach another page if there isn’t enough room on the form 
  3. Do your research to understand the outcomes of cases like yours
    • WSIAT posts all cases and their outcomes, free of identifying details, so you can review previous cases 

From our perspective, we know it’s cheesy, but the best offence is a good defence. Lead your team with a strong health and safety culture to avoid accidents and illnesses in the first place, and always encourage timely reporting should anything occur. 

To ensure compliance and reduce risks for your staff, join CEDA’s 5Plus program. This program is designed to help you develop and execute a compliant health and safety plan. 

If you have any WSIB questions, reach out to the Office of the Employer Adviser for free support.