Your Entitlements Once You Have a Claim

You are entitled to 85% of your net income once your claim is approved on Total Temporary Disablement Benefits (so called TTB in short form).

Depending on your injury and the work you do, you may be asked to go on modified duties with your accident employer. As long as it is within your restrictions given by the doctors and the Claims Adjudicator agrees with them, it is wise for you to do the work, because if you will not try the modified work that is offered, you could be cut off of benefits. Please try to cooperate as it is in your best interest.

Medical Benefits:

Once you have a Claim you must give your claim number to your Pharmacy and your medication for your injury is covered under WSIB. Please try to stay with one Pharmacy.

Devices and some treatments have to be pre-approved like physiotherapy, medication and treatments recommended by you doctor.

You are entitled to mileage benefits to see your specialist if he is from out of town and if there is no bus connection to physiotherapy or on scheduled visits to the board and hearings.

There are different types of Benefits after it is determined by the WSIB that you have a permanent disability due to your injury.

Up to 1990 benefits were:

PPD Pension (Permanent Partial Disability Pension). You will be asked to see a doctor at the WSIB office for an examination, to determine the percentage of your disability. That happens 1 year after injury if it is proven that you have a permanent disablement. You will receive a monthly pension if you are entitled to these benefits for as long as you live if it is over 10 per cent, if it is lower you may get a lump sum.

1990 up to present time:

PPD now is NEL (Non Economic Lost). After it is determined that you suffered a partial disability it is then determined under MMR (Medical Maximum Recovery). You will be sent a list of doctors who you can choose from. The pension that you are entitled to will be offered in a lump sum or monthly payments for the rest of your life.

Wage Loss Supplement:

Before 1990 to 1990:

This wage loss supplement is given to workers that have experienced a wage loss after returning to work or unable to return to work due to their work related injury.

This supplement is equal to the old age pension of Canada Pension Plan. Due to the low amount it was determined that old pensioners become eligible for an extra maximum of two hundred dollars when qualified for the wage loss supplement. This is paid till the age of 65.

After 1990 to Present:

FEL (Future Economical Loss) is now a wage loss supplement. It is different as it goes by your real lost of income after you return to work or if you cannot return to work. In some cases we seen the FEL paid till the age 65 at 100% as the worker could not go back to work. The WSIB is now allowed to offset your Canada Disability Benefits with the FEL award since 1990.

In many cases it is seen that the wage loss supplement is calculated mostly on statistics with employment agencies and their proposed wages.

Medical Supplement:

This supplement is paid to workers that have a reoccurrence with their work related injury after they have become entitled to the FEL or wage lost supplement. You have to notify the WSIB so the right forms are being sent to you once you have a reoccurrence with your injury. Medical forms will be sent out to you to re-establish if you are entitled to TTB.

Rehabilitation: Then and till present:

The WSIB by legislation has out-contracted rehabilitation since 1998 when Bill 99 came in effect. These benefits are being paid to workers who cooperate fully in a rehabilitation program that he or she will be setting out with an LMR counselor.

It is always wise that you should try to cope and adjust to your limitations and during your recovery time think and speak with your doctor what he or she feels you could do for future employment.

Try to get as much information as you can to help you with the changes you have to make for future employment. In our area we have a lot of services that are free to us.

Always remember it is your life so be on the better out-look on life and be the best you can be.

When a worker is Permanent Totally Disabled for life he or she has the right to 100% Future Economical Loss benefits. Also in the policy by WSIB your spouse is allowed benefits if she or he stays home to take care of you. If he or she is the lower income he or she is entitled to better job retraining, see WSIB legislation or contact us.

Appeals Up to Present:

When you receive a letter from the WSIB that denies either benefits, treatments, or other issues, it will tell you a time limit that you have to appeal that decision. Make sure that you have all your information and help with your appeal. Once the appeal is launched you will have to see what your alternatives are if you do not receive benefits. It is a must not to let your pride get in the way and suffer financial hardship, which can create a lot of extra stress on you and your family. If you need to, you have to seek help with Family Benefits or Welfare. Info on help for appeals is available on this web site.

There are three stages of appeal and appeals can take up to 2 to 4 years due to the overload and help which is limited do to the process, not too many people can help in claim files as WSIB legislation is not easy to understand.

If you have problems your local union should help if you are in a union as your union has the bargaining power in your plant.

If you are not in a union you can come and see us! At times we helped unionized workers too.

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