The following paper is for academic use only and is not intended to be used or interpreted as legal advice.

Paralegals Can Help Injured Workers at the Workplace Safety and Insurance Board 

Written by: Katherine Sperti, Partner at Marmac Legal and Immigration LLP

Edited by: Jonathan Thibert LL.B.

If you are injured in the course of your employment, you may be entitled to compensation benefits from the Workplace Safety and Insurance Board.  You must file a claim with WSIB who will then decide to grant entitlement to benefits.  Once you have filed your claim, WSIB will assign you a nine digit claim number, and a claims manager who will adjudicate your claim.  Your claim manager will send you a letter either granting or denying you entitlement to benefits.  If you received a letter denying you entitlement to benefits, that is when a paralegal can help you.

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A paralegal can help you understand and manage your WSIB claim.  They will be able to communicate with your claim manager, your treating physicians, and healthcare professionals to establish the base for entitlement to benefits.  There are many benefits available to injured workers which include but are not limited to: lost wages, healthcare costs, transportation, and retraining.  Hiring a paralegal to navigate you through the many policies and procedures of WSIB will alleviate the stress of dealing with the Board and get you benefits of which you may not have been aware.

 

Time is of the essence when you receive a letter from WSIB, as there are rules and deadlines to appealing a negative decision. The denial letter will state that the claim or request has been denied, the reasons for the denial, and a date by which to appeal.  If a denied claimant has received only a verbal response, it is imperative to ask for the decision in writing because important rights may be lost otherwise.  A decision to hire a licensed paralegal to navigate the complicated WSIB system may mean the difference between living on minimal disability benefits barely able to financially support oneself, and obtaining benefits that are deserved in the case of a workplace injury.

 

Once the paralegal has been retained, the paralegal will communicate with WSIB, request a copy of your claim file and review the file to research entitlement to benefits that the injured worker may not be aware of, such as a psycho-traumatic disability or entitlement to retraining to return to the workforce.

If new information is submitted this will allow for the decision to be reconsidered by an Operations Intake Team Manager before a formal appeal is heard by the Board.  It is important to note that with an increase in the number of appeals being filed, it takes considerable time to receive a claimant’s file and communication from the Board. The average turn-around time on a decision is approximately 18 months.

 

The first appeal is an internal appeal to the Appeals Branch.  Your paralegal will complete the documentation to proceed with your appeal.  An Appeals Resolution Officer will either review written submission or schedule an oral hearing. Typically, the hearings are conducted by written submissions.  For the layperson, attempting to navigate this complicated system and assemble written submissions that will meet the burden and standard on appeal can be a difficult task.  Researching previous cases and supporting the theory of the claimant’s case is of the utmost importance in an appeal.  Having a paralegal represent you will ensure that all issues in your claim have been addressed.  After a review of the claim file, an examination of the law, and an analysis of the Operation Policy Manual, your paralegal will be able to present a well-researched submission or oral hearing to prove that you should be granted the appeal.   It may take approximately six months to get a decision.

If you are granted the appeal, your claim will be sent back to WSIB for implementation. However, if you have been denied, your appeal is not over; you have the opportunity to proceed to the Workplace Safety and Insurance Appeals Tribunal, which is separate from WSIB.

 

The Workplace Safety and Insurance Appeals Tribunal is an independent government tribunal which reviews decisions of the Board and makes decisions on benefit entitlement with a review of the claim file, legislation, and the Operational Policy Manual.  Once you have appealed your claim at the Workplace Safety and Insurance Appeals Tribunal, you will be assigned a hearing date.  A paralegal as your representative will have the opportunity to present your case, and apply the law and policies to show that you, as an injured worker, should be entitled to benefits.

 

Paralegals in Ontario are educated, trained, licensed, insured and regulated by the Law Society of Upper Canada.   Paralegals have been practicing in the area of Workplace Safety Insurance Board for many years and have experience directly representing clients including filing forms, conducting legal research, and communicating with and preparing submissions for the Board.  These are skills that make a trained legal professional a wise choice. Licensed paralegals and lawyers who specialize in WSIB hearings and WSIAT appeals know how to prepare a claimant’s case. This is an area of law where many vulnerable people may not know where to turn, and cases are often lost due to a lack of experience. A legal representative with compassion and excellent communication skills is always a wise choice for most injured workers.

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