My WSIB Claim was Denied. Now What? How to Win a WSIB Appeal.

Advice from a WSIB Appeals Lawyer with 40 Years of Experience and an 85%+ Success Rate over $100,000.

When a WSIB claim has been denied, many workers are left feeling defeated and perplexed, wondering why the report from their doctor wasn’t enough. Appealing a denied WSIB claim is complex, and to be successful you’ll need more than a doctor stating that you can’t go back to work.

If you’re feeling overwhelmed with your WSIB claim or that there is no hope in winning your appeal, we can guide you through the complicated, multilayered process. Our efforts in supporting workers with WSIB appeals are successful more than 85% of the time, winning $100,000+. We can help you, especially when your case feels unwinnable.

In this post, we reflect on our extensive experience and answer some of the most common questions surrounding WSIB appeals.

Reasons for WSIB Claim Denials 

There are various reasons as to why a WSIB claim would be denied. Identifying why a claim was denied and how you can effectively appeal it can be challenging. Here we answer common  questions relating to WSIB denials. 

Why Would WSIB Deny My Claim?

For many workers, understanding why their WSIB claim was denied and knowing how to move forward with their appeal feels overwhelming. Claims can be denied multiple times and at multiple levels of the process. Even when you have won one issue, you likely will still need to appeal a further denial for a related issue . Reports have confirmed that WSIB  loss of earnings awards have gone down 60-70% in the last 10 years. With an 85%+ success rate, our team can help you beat the odds.

Common reasons why a WSIB claim may be denied include:

• WSIB or the employer is questioning if the claim is related to work
• Insufficient information from your doctor
• Incomplete Functional Ability Forms
• Missed deadlines
• Strict WSIB requirements  not followed

In some instances, an employer may move past your presenting issue and pull outside concerns into your work-related claim. When disputes happen, it is possible that WSIB may be more inclined to believe your employer. A lawyer specializing in WSIB claim appeals can help bring the focus back to the issue at hand and realize success for your claim.

General law firms, large or small, who do not specialize in worker WSIB clientele, often lack a deep understanding of the WSIB system and may tell you that your case is unwinnable. In our experience, that is simply not true. We have helped employees gain WSIB benefits for claims that are years, if not decades old, and have the expertise needed to be successful with complex WSIB claims. 

Why Won’t WSIB Listen to My Doctor?

Many workers feel frustrated when what their doctor said wasn’t enough to win their claim. Though your doctor’s report plays a crucial role in the success of your case, it is important to remember that your doctor is not your lawyer or your advocate. Doctors don’t always know what needs to be explained in their report and may not provide enough detail to support your claim. WSIB may not  listen to the fact that you have an injury; you may be unaware that there is a timeline involved, or you need more  to be successful with an appeal.

Sometimes some healthcare professionals may provide information that is unhelpful to your case. For example, the inclusion of an injury in your teens is likely irrelevant to a work-related injury in your 40’s. With the help of an experienced WSIB claims lawyer, you can identify what information is needed to support your claim and what is not, and effectively navigate the maze of the WSIB appeal process.

What Is the Hardest Injury to Prove?

Emotional or psychological issues tend to be the hardest injury to prove. For many workers, a work-related injury can lead to lasting psychological issues that don’t show up on a test, MRI or CAT scan. It may not always be obvious that your injury is continuing. In fact many workers themselves don’t realize or accept the impact an emotional or psychological injury has had on their lives and their family’s lives.  

In some instances, WSIB may claim that your injury  is not permanent particularly if a worker ceases active treatment which often is because they could not afford the treatment. It is not uncommon even when WSIB has accepted your psychological illness and that it is permanent, they don’t allow the next logical step; how this interferes with your life and contributes to your inability to return to work. An experienced WSIB appeals lawyer can help you navigate and overcome these obstacles.

Potential Consequences of a WSIB Denial or RTW Decision

Being denied WSIB can put your job security and benefits at risk. It is important for workers to understand the significance of their WSIB appeal and how seemingly unimportant return-to-work decisions can affect their appeal process and end up a disaster. 

Can Return to Work Jeopardize My Benefits?

Yes, return to work (RTW) can put your WSIB appeal and benefits in jeopardy. If you are being pushed back to work too soon and are up against meeting with your employer, their HR head , work supervisor, and maybe even legal representation for the employer, facing them alone is challenging and frankly, not advisable. If you are forced back to work too soon this can also end up in disaster for you obtaining ongoing WSIB benefits or even in your workplace if you do continue to work, with or without modifications. Just because part of your appeal has been successful, it does not mean that your claim is over. A WSIB claims lawyer can help you navigate this process and protect hard-earned benefits.

Can You Be Fired if WSIB is Denied?

Yes, you could be fired after a denied WSIB claim. But even if you were fired, your WSIB appeal can be addressed. Retroactive appeals can be successful, and the age of your claim does not matter with our degree of expertise in your corner. If you were fired after a denied claim, don’t give up. 

The WSIB Appeal Process 

The WSIB appeal process is complex and can be lengthy. It is possible that you will need to navigate multiple appeal processes at various levels before final benefits are won. Here, we answer common questions about the WSIB appeals process, including the number of times you can be denied, appeal deadlines, and how the appeal process works. 

How to Appeal a WSIB Decision

To file an appeal for a WSIB decision, it is essential that you submit an Intent to Object (ITO) form promptly. You must file an ITO every time that you are issued a letter of denial, which means you may need to submit this multiple times through your claim. If you can, it is best to file immediately and then consult with a lawyer.

Many workers try to navigate WSIB appeals on their own. Without a deep understanding of the complex WSIB system, mistakes, oversights and missteps can happen. We can help you get ahead of common mistakes even with the proverbial  “unwinnable” cases. For our firm the glass is always half full, not half empty .

How Long Do I Have to File a WSIB Claim?

Deadlines matter for WSIB claims, and staying on top of them can be challenging. For WSIB appeals, every decision must be appealed within six months, and with some decisions within one month. As many appeals may happen at multiple levels of your claim process, keeping up with deadlines can become overwhelming. A WSIB lawyer can help you navigate the complex system, keep track of where you are, and stay on top of what comes next.

If you are meeting with RTW advisors, the timeline to appeal or dispute the decision is shorter. Unlike other appeals, you have only 30 days to appeal a RTW plan. It is important that you seek support with navigating RTW issues promptly.

Is It Too Late to Fix My Claim If I Made Mistakes?

No, it’s likely not too late to fix a mistake with your WSIB appeal. WSIB claims are complex, and when employees attempt to navigate the process on their own, mistakes can happen. If you are a worker who is up against the WSIB system, a lawyer with expertise regarding WSIB claims can help you get back on track. Your case may still be winnable despite the mistakes that were unknowingly made.

How Long Do WSIB Appeals Take?

WSIB claims are complex, and it is possible that you may need to navigate many appeals at multiple levels of the process. For this reason, your WSIB appeal can take a long time to complete. However, in most instances, a WSIB lawyer can help you gain benefits along the way as they work to maximize every benefit that you may be eligible for.

As the process of a WSIB appeal can be lengthy, having a lawyer on your side can make navigating the process easier. We are committed to keeping our clients informed throughout the process. We are the pipeline keeping you up to date and informed about everything concerning your case.

Can I Appeal a Claim That is 3, 10, or even 20+ Years Old?

Yes, it is possible to appeal WSIB claims that are years or even decades old. Some may feel that old WSIB claims are impossible to win, they are wrong. We specialize in older claims and have been successful with cases that are beyond 25 years old. If you are wondering if your case is worth fighting for, you will  likely be surprised by what it may be worth. We are successful more than 85% of the time and have gained six-figure benefits for our clients.

How Many Times Can My WSIB Claim Be Denied?

Though this is not always the case, it is important that workers understand that there is potential for as many as six appeal processes or more in a single file. If your initial entitlement is denied, you then begin a review with the Appeals Resolution Office (ARO). If this appeal is unsuccessful, you may appeal to the Workplace Safety and Insurance Appeals Tribunal (WSIAT). Once you’ve successfully demonstrated entitlement, the process of gaining loss of earning (LOE) benefits can lead to further appeal processes where you could, again, need to navigate your claim with multiple ARO and WSIAT appeal hearings. Often, your WSIB appeal can feel as if it is an ever moving and elusive target.

Multiple denials at multiple levels of the process can happen, and when they do, your claim can become lengthy and complicated.But we stay the course for you as experienced WSIB lawyers, and will take the time to address each appeal as it arises. Lawyers who lack a deep understanding of the WSIB systems may give up too early in the process, leaving potential benefits on the table if they are even aware of them. We are well known for our dogged and thorough approach and our deep knowledge, and most of all our determination to obtain the most benefits for you. 

What Information Needs to Be in a WSIB Appeal

Each WSIB claim is unique, and what needs to be included to succeed can change depending on individual circumstances. Though a less-is-more approach can be helpful when submitting a WSIB claim, it is crucial that documentation supporting your claim is included. Here, we answer common questions surrounding what information should be included in a WSIB appeal.

What Should I Include in my WSIB Appeal?

It can be difficult to say what should be included in individual WSIB appeals as each case is unique and the process is complicated. There is no blueprint when it comes to WSIB appeals. To be successful, you must meet all the requirements outlined by WSIB and overcome obstacles that you may face along the way. When you turn to a WSIB lawyer for support with your claim, they will build your case from the ground up, taking the guesswork out of what should be included based on the particular circumstances of your claim.

What Should I Avoid Putting in My WSIB Appeal?

Workers often seek to be transparent with their employer and WSIB as they feel sharing details of their circumstances will support their case in every instance . Unfortunately, the more that is shared, the more there may be for WSIB or employer to pick apart if they are so inclined, and they usually are. When it comes to your appeal, less is more. Balancing the need to provide sufficient information without unnecessary and irrelevant oversharing can feel like a challenge. A WSIB lawyer can help you identify and provide only the relevant and critical  information that is needed to support your case.

What Must Be Proven in Order to Win an Appeal?

To be successful with a WSIB appeal, a worker must demonstrate that the injury is related to work. For example, a worker who has a heart attack at work may be eligible for Canada Pension Plan (CPP)  or long term disability ( LTD), but if the injury or condition is not work related they will not be entitled to WSIB. Beyond proving that the issue is work-related, workers must also demonstrate that the injury has continued and is permanent. This can be an uphill battle when WSIB doesn’t recognize that your issue is ongoing. If your injury hasn’t gotten worse but is not getting better with treatment, a WSIB lawyer can help you navigate proving your claim.

Proving invisible injuries such as chronic pain disability (CPD), and emotional or psychological injuries can be challenging. Though it may not be easy for others to see that you are suffering, a WSIB lawyer can support you in having these complex injuries recognized by WSIB .

What Documents Are Needed for a Successful Appeal?

In our experience, a successful WSIB appeal will often require new medicals to be complete and address specific issues we ask your doctors, issues they often are not aware are critical in a WSIB claim. Although you may already have medical reports, more often than not, they are inadequate to support your claim. A WSIB claims lawyer can provide guidance to effectively structure and obtain your medicals to ensure the information that is needed reaches WSIB and succeeds .

How We Can Help With Your WSIB Appeal

Yormak & Associates is the WSIB lawyer Richmond Hill and Toronto workers turn to for support with navigating complex WSIB appeals. We are particularly proud of our track record with older claims no one wants to touch having been successful with these, some more than 30 years old. No matter how old your case is,what mistakes may have been made, we can help.