If you've been injured at work, filing a claim with the Workplace Safety and Insurance Board (WSIB) is often the first step in getting support for your recovery.
But what happens when your claim is denied?
A denial can feel overwhelming – especially when you're already dealing with pain, time off work, and financial stress. The good news? A denial doesn't necessarily mean the end of the road. Understanding why your claim was denied is the first step toward getting it back on track.
Common Reasons for WSIB Claim Denials
WSIB claims can be denied for a number of reasons, some of which may be fixable or appealable. Here are a few of the most common:
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Lack of Medical Evidence
WSIB requires medical documentation to support your claim. If your injury or illness isn't clearly linked to your work duties in the medical records submitted, your claim may be denied. For example, if your doctor didn't specifically state that your injury was caused or worsened by your job, WSIB may not accept the claim.
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Late Reporting
There are strict timelines for reporting workplace injuries or illnesses. If you wait too long to report the incident to your employer or to WSIB, they may question the legitimacy of the claim. Even if the delay was unintentional, it could create doubt.
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Employer Dispute
Sometimes employers may dispute that an injury is work-related. They might argue that the injury happened outside of work hours or wasn't connected to your job duties. WSIB takes employer input into account when reviewing a claim.
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Inconsistent or Missing Information
If your claim form, your employer's report, and your doctor's notes all describe the injury differently, that inconsistency can raise red flags. Clear and consistent documentation from all parties is crucial.
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Ineligibility Based on WSIB Rules
Some workers may not be covered by WSIB, depending on their industry, employment status, or the type of work being performed. WSIB also has criteria about what qualifies as a compensable injury or illness.
What You Can Do Next
A denied claim can feel like a closed door, but you may still have options. The first step is to read the decision letter carefully. It should explain the reason for the denial and outline your right to request a review or appeal.
Here's what you can consider doing next:
- Request an Internal Review: WSIB allows you to ask for a reconsideration of your claim. This usually involves submitting additional medical evidence or clarifying information.
- File an Appeal with the Workplace Safety and Insurance Appeals Tribunal (WSIAT): If the internal review doesn't resolve the issue, you may appeal to WSIAT. This is a more formal legal process and often benefits from legal or paralegal representation.
- Speak to a WSIB Paralegal: Navigating WSIB processes can be complex. A licensed paralegal experienced in WSIB matters can help you understand your rights, gather supporting evidence, and meet important deadlines.
How a legal professional can help.
At Nelligan Law, we understand how stressful it can be to deal with a WSIB claim, especially after a denial. Our team includes a WSIB paralegal who can work with you to assess your options and help you move forward.
If your claim has been denied and you're not sure what to do next, we're here to help. Contact us at info@nelliganlaw.ca to set up a consultation and get the guidance you need.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
