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Workers who file compensation claims need an advocate. In some of our local unions there are benefits reps who are especially trained to deal with compensation issues. As a workplace representative / steward, you should have a basic grasp of the compensation process your members will follow.

How to make a workers’ compensation claim

In some local unions there are designated worker’s compensation advocates. If this is the case in your local, refer questions on claims and appeals to them. Otherwise, you may be called upon to help a worker make a compensation claim. Unifor Education Department offers training on workers’ compensation advocacy.

The following information will help you to make a workers’ compensation claim for yourself or to help your fellow workers establish a claim:

I was just injured on the job. What do I do now?

Get first aid if necessary, first. Next, report the injury to your employer. If you don’t report the injury right away, it might be very hard to prove later on that your injury is work related.

If no one saw the accident, tell co-workers and your supervisor right away. Remember the names of witnesses you know saw what happened. Delay in reporting throws doubt on a claim.

The employer must arrange or pay for transportation to the hospital or your doctor. It is important that you do not drive yourself or ask a friend or family member to take you. It is your employer’s duty to transport you to medical attention.

If have to go see a doctor, they must send in a Physician’s Report to the Workers’ Compensation Board. (The Board may be called something else in your province or territory, but, for the sake of brevity, we will call it the WCB.)

The employer must pay you for the day of injury.

Each province or territory sets out its own rules as to when a compensation claim must be opened for you, but generally speaking, if you need to see a doctor or you have time away from work due to the injury or if your work needs to be modified for more than a week, you should have a worker’s compensation claim filed.

What is a work related, compensable injury?

Not every injury is an “accident”. It may come on gradually over time. It may be a soft tissue injury from repetitive stress. The injury may be one of many occupational diseases from exposure to toxic substances or other hazards. You have the right to file a claim for these kinds of injuries.

It is a sure bet that if you don’t file, the hazards that caused the injury aren’t likely to get fixed.

Do I have to be treated by the employer’s doctor?

No. You have the right to choose the doctor you want. You do not have to be treated by the employer’s doctor. However, if the WCB tells you to see a doctor of their choosing, you have to go or you will be cut off benefits. Make sure you see your doctor regularly, every couple of weeks or so, or you may be cut off WCB benefits.

What should I do after I report my injury to my employer? First, go to a doctor. See your family doctor, or a doctor at your local hospital or community health clinic. There will be a number of forms that you will have to deal with after you report your injury to your employer. Keep a copy of the accident report and all forms. Make sure you know and remember the name and contact information of the attending doctor if you go to the hospital.

A work related injury is one that happens in the course of employment or arising from the work you do.

Doctor’s first report

Make sure the doctor who first treated you sends the Physician’s Report to the WCB. (This report is usually called the Form 8.) Without this, there will be no benefits paid. If you were treated at an emergency department, you can have your own doctor send a follow-up report.

The WCB looks carefully at the doctor’s report to see if the injury or diagnosis matches up (is compatible) with the accident. Make sure then your doctor has all the details of how the accident happened. Help them understand the way you normally do your job. If something changed in your usual routine and that caused the accident, the doctor has to note that. It answers the question as to why you would have an injury if you have been doing the same job for a long time.

Tell your doctor about all the parts of your body that were injured. See that they write them down. After a fracture heals, for example, it may be the secondary injuries to your neck, back, etc., that will need the most ongoing treatment. You don’t want to lose benefits you will need simply because one word wasn’t written down.

It is well worth your time to read a blank Physician’s Report or Form 8. Go on line to the website of your WCB, find it, download a copy, and study it. Look at the questions that the doctor has to answer. The more you understand the medical information needed to support a claim, the more you can help yourself or give good advice to another injured worker.

The WCB really needs to see “objective physical findings” on the doctor’s report. That means symptoms or signs of injury that can be seen by another person. In other words, pain alone, as bad as it may be for you, may not be enough proof of injury. It is too “subjective”. Bruising, swelling, limited range of motion, x-ray findings, etc are examples of “objective” facts that your doctor needs to report. The doctor must also answer the questions as to what tasks you are safely able to perform. These questions as to your medical restrictions or “functional abilities” may be answered right away or at a follow-up visit. The WCB and your employer must have this information, but the employer has no right to know the medical diagnosis of your injury.

Follow-up reports from your doctor will be necessary or your benefits may stop.

Worker’s report of injury

Once your doctor or employer sends in reports, the WCB will send you a Worker’s Report to fill out. The employer or local union may have copies as well.

It is most important to ask your union benefits representative, workers’ compensation advocate or another workplace representative who is knowledgeable about compensation for help with completing the Worker’s Report. They may also want you to help them fill out a union fact sheet. That will really help the union better represent you. The union advocates must respect the confidentiality of the information in your file.

The space provided on the Worker’s Report for describing the accident doesn’t usually allow for more than a few sentences. That’s why you should use the page for additional information to more fully describe exactly what happened.

For example, don’t just say, “I fell at work and hurt myself.”

Here’s an example of a more complete description of an accident at work:

“I was walking through my work area at the start of my shift. I didn’t see the oil that was on the floor. I stepped in it. My right leg went forward. I lost my balance. I fell backwards. My right shoulder hit my machine. I reached out with my right arm. I broke my fall with my right hand. When I landed, my head hit the floor. I hurt my right shoulder, my right wrist, my hip, my neck, and the back of head. I remained there on the floor until my co-worker called First Aid for help.”

Again, just as you would ask the doctor to, you name every part of the body injured.

Include names of witnesses who you’re sure can say what happened. The WCB may contact them. If they tell a different story or say they don’t know, that will cast doubt on your claim.

Make a copy of your Worker’s Report before you send it.

Keep notes on all the telephone calls you have with the WCB.

What should I do if I don’t understand something the WCB is asking me to do?

Read carefully every letter the WCB sends you. Follow the instructions you receive from the WCB. So-called “non-compliance” or “failure to cooperate” with your duties as a worker under workers’ compensation is one of the most common reasons why benefits are stopped. If you don’t understand something the WCB is asking you to do, call the WCB and ask your claim manager to explain what you have to do to comply. If you think something they are directing you to do is unreasonable, offer a workable alternative. Ask if that would satisfy their requirements, but follow their instructions! A record is made and placed in your file of every conversation you have with the WCB. If you outright refuse to do something that the WCB is directing you to do, your benefits may be stopped or reduced.

Does my employer have to make a report?

Generally speaking, the employer has to make a report for every injury that requires more than first aid only.

In some provinces or territories you are entitled to have a copy of the Employer’s Report. If not, ask for a copy the report the employer sent anyhow. Ask your workplace representative to help you get a copy, if necessary. You can eventually get a copy of the employer’s report from if you appeal a decision and you request access to your file.

The sooner you get a copy, however, the better. It is most important to check the Employer’s Report for accuracy. Employers often make mistakes in reporting your earnings, hours of work, and other things that will affect the calculation of your loss of earnings benefits.

Read the Employer’s Report carefully for anything that will cast doubt on your claim. Employers often put down things that challenge a claim because they don’t want to pay anything more to the WCB than they have to or because they get rebates, money back, from if there are no lost time claims.

If the employer has reported something that is not true or incomplete, you need to send the correct information to the WCB right away. You can also ask your workplace representative for help in getting the employer to send correct information.

Some Unifor Local Unions have reduced the number of claims that are unnecessarily held up or disallowed. They did this by negotiating a procedure whereby a union worker’s compensation advocate will always be present when the worker’s and employer’s reports are completed. This provides the injured worker with representation right from the start. It has solved a lot of problems at the source.

I was still able to work. Can I get benefits from the WCB?

Yes. There are two types of WCB claims. Lost time claims are for payment of lost wages and medical expenses. No lost time claims cover medical expenses. Medical expenses can be:

  • doctor’s bills
  • physiotherapy
  • chiropractor
  • other therapy
  • prescription drugs
  • artificial aids such as hearing aids or braces
  • travel costs to get back and forth to your treatment
  • clothing allowance if a brace or wheelchair damages your clothing.

You have to pay these expenses and then ask the WCB for the money back. Get receipts for everything. Keep track of your mileage. Send these to the WCB. Keep copies of everything, in case the WCB loses something.

Make sure your physiotherapist or chiropractor sends in forms to the WCB so they know you’ve gone for
treatment.

What happens if the WCB takes a long time to decide on my claim?

Where can I get money to live on until then?

There are a number of places that you can go to for help while you are waiting for your WCB claim to be decided. Apply for everything. They’ll let you know if you are not eligible.

  • Sickness and accident (weekly indemnity) benefits through work.
  • Employment Insurance (EI) sick benefits
  • Canada Pension Plan disability benefits.
  • Welfare or social assistance.

If you apply for these other kinds of benefits, you must let them know that you feel your injury or illness is work related and that you are applying for WCB benefits.

They will probably tell you to sign an assignment of benefits or subrogation of benefits form. This form is a promise to pay back the money you receive from them once you get it from WCB.

Is there a time limit on making a WCB claim?

It is best to report right away. Delay in reporting causes a lot of claims to be denied. However, check to see what the maximum the time frame is for making a claim in your province or territory. There are situations where a worker has a good reason or explanation for not having filed right away.

What should I do if my employer tries to get me to take sick pay instead of making a WCB claim?

Do not let your employer talk you out of making a WCB claim. If your injury is related to your work, you should claim WCB benefits. WCB benefits are often higher than benefits under other plans. If you have complications, recurrences, or secondary effects from your injury later on, you may not receive benefits and coverage for treatment you need unless there is a worker’s compensation claim on file.

Can I appeal a decision to disallow my claim?

Yes, you can! It is important though to check the time limits on appeal and make sure you file before the time expires. You can ask the local union for help in making your appeal.

However, you can still ask an adjudicator to reconsider or review the decision. If you ask the WCB to reconsider their initial or first decision, just be sure not to let the time limit to appeal expire! Read the appeal steps carefully.

New information?

If your claim is denied or if your benefits are cut-off or reduced for any reason but you have new information or facts the WCB did not have or consider, you can ask for reconsideration or a review of the decision. You will need to provide the adjudicator or case manager the information they need to change their decision.

Read the letter where the claim is disallowed. Note all the reasons. Ask yourself what new facts and information would answer the questions and give the WCB reason to reconsider. Talk to witnesses who can correct wrong information. Go back to your doctor if there’s a question of medical proof of injury. Ask if they can provide any new information that would clear up doubt. You may need a second medical opinion.

In Ontario, the Occupational Health Clinics for Ontario Workers will assess a worker’s condition in strictest confidence if s/he believes they are sick or injured because of work and provide medical diagnostic services for workers with workplace injuries. To find out to contact OHCOW, go on line to www.ohcow or call 1 877 817 0336. The Unifor Education Department has courses to help workplace representatives who are not experts on workers’ compensation develop a basic understanding of the system and how to help injured workers troubleshoot problems with claims.

Return to work

In recent years the workers compensation system has be radically changed. A much greater emphasis is now placed on getting the injured worker back to work as soon as possible. This has both good and bad features. It is important for workplace representatives to look out for the best interests of the injured worker in the return to work phase of a claim.

The injured worker needs to know that any statements or actions that can be construed by the WCB as “noncooperation” with return to work can and will be used to stop benefits.

Employers, generally speaking, must offer the injured worker work that the worker can safely do. The stronger requirement of an employer to accommodate a worker with a disability is provided by the human rights code.

So, if an injured worker is not offered an opportunity to come back to their job or to modified work, the circumstances should be investigated. There could be grounds for a grievance. Unlike workers compensation, human rights codes set no time limit on the duty to accommodate.

It is just as likely, however, the employer will bring the injured worker back and offer modified work for as long as they are required to do so under workers’ compensation legislation. This is where the injured worker will need good representation. Often such return to work plans are undignified, demeaning, unsafe, inappropriate, and do not respect the collective agreement and human rights of the worker. There is no easy fix to these problems. Fixing them requires careful examination of all alternatives and strong representation by the workplace representatives.

Grievance handlers, health and safety representatives, workers’ compensation advocates, and equity or human rights representatives need to work together with the injured worker and the employer and the WCB to make sure the best possible return to work plan is set up.

Worker’s compensation & the duty to accommodate

Worker’s compensation laws outline a duty to accommodate workers with work related injuries. However, human rights codes define disability in the broadest terms possible and without the time limits and restrictions on the duty to accommodate we often find in worker’s compensation legislation. For instance, the Ontario Workplace Safety and Insurance Act says employers do not have to provide employment for injured workers after two years from the date of the first injury. By contrast, under the human rights code, there is no time limit on the employer’s duty to accommodate a worker with a disability. Any such arbitrary time limit on the worker’s right to return from disability which is written into the collective agreement is in conflict with the human rights code and is therefore unlawful.

In a case of an injured worker demanding accommodation, an employer violates the human rights code, and thus the collective agreement, when the employer relies only on the medical reports and opinions of the worker’s compensation board. A worker’s compensation board has no power to enforce the human rights code. The employer must do its own investigation on how the worker might be accommodated in a suitable job with the human rights code in mind.

The union should demand that the employer provide the union with all employer reports to the worker’s compensation system and all reports on any injured worker’s functional abilities so that we can do what is necessary to protect the worker’s interests without delay.

All human rights codes cover disabilities which are both work related and not work related. Unlike most other grounds of discrimination, disability is one which can happen to any worker at any time. Disability may be visible or not visible.

We must challenge assumptions about disability. A worker with a disability could be the victim of discrimination because an employer perceives or assumes that they are not capable of doing productive work. This is called “social handicapping.” It is wrong and against the law.

Anything that has the effect of undermining the dignity and self-esteem of a person with a disability is discrimination.

Unifor offers a series of courses for workplace reps to better equip you to support workers seeking accommodation and pursuing compensation claims.

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