Toronto WSIB Claim Denials and Appeals Lawyers
WSIB benefits are an important resource for those in Ontario who develop injuries or illnesses while on the job. The Workplace Safety and Insurance Board (WSIB) is a government-run insurance program for workers injured in the workplace in Ontario. It is funded through employer contributions and is meant to provide employees with financial compensation, healthcare benefits, and return-to-work support when they get injured. For example, you may be entitled to receive:
- Loss of earnings benefits (LOE)
- Loss of retirement income benefits (LRI)
- Non-economic loss benefits (NEL)
- And more
The WSIB operates under strict rules and policies. This means that even legitimate claims are sometimes denied due to technical problems or insufficient evidence. When your WSIB benefits are denied or rescinded, you may be left dealing with significant physical, mental, and financial challenges. It’s important to remember that it’s your right to appeal a WSIB decision when your claim is denied. Understanding why denials happen and how the appeal process works is an integral first step in receiving the benefits you deserve.
At Goodman Elbassiouni LLP, our Toronto WSIB lawyers are ready to help you object to negative decisions from the WSIB. Whether you have questions about why your initial claim was denied or you need help crafting an appeal, our legal team can assist. To schedule a free case assessment with our Toronto WSIB denial and appeal lawyers, you can call our Toronto office at 905-265-1005 or fill out our online contact form today.
What To Do if Your WSIB Claim Is Denied
When your WSIB claim is denied, you may be left without the benefits you need for the injury or illness you incurred while on the job. According to regulations outlined in the WSIB’s Operational Policy Manual (OPM) and Employer Classification Manual (ECM), there are many reasons a denial might happen. For example, the WSIB often argues:
- Lack of sufficient medical evidence of the injury or illness
- The injury is not severe enough or does not meet the permanent impairment threshold
- The injury was not reported on time
- Failure to comply with WSIB requirements, such as failure to follow medical treatment or return to work
- The injury is disputed by WSIB medical consultants
- And more
When this happens, you are entitled to respond to the negative decision. These are the steps you should follow after receiving a WSIB denial:
- Review the Denial Letter: When the WSIB denies your benefits, they will send you a letter that details the reason why your claim was not approved. You should thoroughly review the reasons they give for your rejection with your WSIB lawyer. This is a vital first step in getting your response started.
- Gather Additional Evidence: Before you get started with the actual objection, it is important to get your affairs in order. If the WSIB cited insufficient evidence as a reason for denial, you may be able to strengthen your case with extra:
- Medical reports
- Workplace incident reports
- Witness statements
- Independent medical assessments
- And more
- Contact a WSIB Lawyer: An experienced WSIB appeal lawyer can provide legal guidance when it comes to your denial and how to address it. Having fought against similar denials before, they will understand what supplementary documentation you may be missing to set you up for a successful appeal.
- File an Objection: Using an Intent to Object form, you must notify the WSIB that you intend to object to the negative decision they issued. For return-to-work decisions, your form must be submitted within 30 days. For other WSIB decisions, you may have up to 6 months. You will need to clearly outline the errors you believe exist in the WSIB’s decision. A legal professional can help you lay these out and respond to the initial rejection.
- Request Reconsideration from WSIB: During a request for reconsideration, you may need to speak with the original WSIB adjudicator who made the decision on your claim. If your initial objection fails, you may need to take your case to the next level.
The WSIB Appeals Process in Ontario
A WSIB appeal allows you to dispute your rejected WSIB claim. If you are successful, you will receive WSIB benefits or coverage for your workplace injury or illness. The appeals process can be complicated, depending on the reason your initial application was denied and the level to which you must escalate your case.
If you are appealing a WSIB claim denial, the steps include:
1. Filing an Objection
As previously mentioned, you must file an Intent to Object form if you intend to appeal your denial at any point in the future. It must be filed within 30 days or 6 months, depending on the type of decision you have received. You can submit your objection via fax, registered mail, or the WSIB online portal.
It is recommended that you work with a WSIB denial and appeal lawyer when crafting your objection, as you must thoroughly and clearly outline why you are disputing the denial. Once you have objected, the WSIB may reconsider and reverse its decision. In this case, you will receive benefits, or they will be reinstated. If the WSIB maintains its decision, you will need to escalate to a formal appeal.
2. Appeals Services Division (ASD) Review
If the WSIB does not change its decision upon receiving your Intent to Object, your case will move to the Appeals Services Division (ASD) of the WSIB as a formal appeal. As the injured worker, you will need to submit an Appeal Readiness Form with all necessary supporting documentation. There is no time limit on submitting an appeal readiness form (as long as you have already submitted an objection).
The adjudicator responding to your appeal will review all new evidence you have submitted and decide to either:
- Overturn the denial, OR
- Move the case to a formal hearing
Preparing your Appeal Readiness Form (mailed to you upon request) with appropriate evidence and documentation can be imperative to the success of your case. A Toronto WSIB appeal lawyer will be able to advise you on what documentation will be most helpful and how the adjudicator might respond to your appeal.
3. Workplace Safety and Insurance Appeals Tribunal (WSIAT)
The decision you receive from the ASD is the final decision of the WSIB. If you disagree with this final decision, it can be appealed to the Workplace Safety and Insurance Appeals Tribunal (WSIAT), the external and final level of appeal of workers’ compensation decisions.
The WSIAT process will include a hearing before an adjudicator (either written or oral, depending on your circumstances) and a final decision on your case.
The WSIB must comply with the final ruling delivered by the WSIAT. It is important to note that a court will only intervene through judicial review if the WSIAT/WSIB decision is deemed “patently unreasonable”. A WSIB denial and appeal lawyer in Toronto will be able to help you prepare for your WSIAT hearing and prepare evidence to support your case. If the decision you receive IS patently unreasonable, your lawyer can represent you in court.
The process of appealing a WSIB decision may range from a few months to several years. This will depend on the stage at which your appeal is taking place. In addition, delays due to backlogs can make the process lengthier and more frustrating for injured workers.
How To Strengthen a WSIB Appeal After a Claim Denial
A WSIB denial does not always mean your claim lacks merit. In many cases, the issue is that the file does not yet contain enough evidence to clearly support the worker’s position. This can happen when the medical records are incomplete, the accident was not described in enough detail, or the worker’s limitations are not fully documented. For many injured workers in Toronto, the appeal process becomes stronger once the record is better organized and supported.
Strengthening a WSIB appeal often starts with identifying exactly why the decision-maker denied the claim in the first place. If the denial was based on insufficient medical evidence, updated reports from treating doctors or specialists may help clarify the diagnosis, restrictions, prognosis, and connection to the workplace accident. If the WSIB questioned how the injury happened, workplace reporting records, witness accounts, and more detailed incident information may become especially important. In some cases, the issue is not whether the worker was hurt, but whether the available evidence clearly shows that the injury arose out of and in the course of employment.
It is also important to make sure the appeal materials are consistent. Small contradictions between medical notes, employer reporting, and the worker’s own account can create problems during an objection or appeal. A carefully prepared appeal should present the facts clearly, explain why the original decision was wrong, and include supporting documentation that addresses the specific reason for the denial. This is one reason many workers choose to speak with a Toronto WSIB appeals lawyer before moving forward.
Why Work With Our Toronto WSIB Appeal Lawyers When Your Claim is Denied?
Our Toronto WSIB denial and appeal lawyers have decades of combined experience dealing with the WSIB, ASD, and adjudicators. Many WSIB claims denials happen for completely resolvable reasons, and our legal team at Goodman Elbassiouni LLP knows the steps you must take to address such issues. Whether you have missed an appeal deadline, submitted an incomplete form, or have failed to provide sufficient evidence, we are ready to assist.
When you work with Goodman Elbassiouni LLP, we help you by:
- Evaluating Your Case Strength & Strategy: We will help you identify the best legal approach for appealing your WSIB denial. We can let you know how far we think you may have to escalate your case, and what documentation could help strengthen your claim.
- Gathering & Presenting Evidence: On top of recommending additional documentation to supplement your case, we can also help you gather and present it. We will collaborate with medical experts and other specialists to help you compile compelling evidence. In addition, we’ll make sure everything you collected is explained clearly and in full to the WSIB.
- Filing Legal Documents on Time: We have a thorough understanding of WSIB policies and deadlines. If you begin working with our Toronto WSIB claim denial and appeal lawyers right away, we’ll make sure you don’t surpass any important time limits.
- Representation at Hearings: Whether you need to meet with your original adjudicator at the WSIB or attend an oral WSIAT hearing, we’ll provide comprehensive legal representation.
Contact Our WSIB Appeal Lawyers Today for a Free Consultation
At Goodman Elbassiouni LLP, we are passionate about helping injured workers receive the benefits they deserve. While the WSIB is meant to provide coverage for those unable to work, denied claims can leave employees stressed about their physical and financial health. Our legal team has extensive experience appealing WSIB claim denials at all levels, depending on the unique situation our client is facing.
To discuss your denied claim and begin developing a legal strategy, contact our Toronto WSIB denial and appeal lawyers today. To schedule your free consultation, you can call our Toronto office at 905-265-1005 or fill out our online contact form.