Different Levels of Appeal

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There are three levels of appeal.

1. Workplace Safety and Insurance Board (WSIB) Operations Level
Operating level decisions are made by Primary Adjudicators, Eligibility Adjudicators, Short Term Case Managers, Long Term Case Managers, Second Injury and Enhancement Fund (SIEF) Case Managers, Nurse Consultants, Account Specialists, Account Analysts, Work Transition Specialists (WTSs), and others. You may file an objection if you disagree with a decision. If the decision is not changed, you may file a formal appeal with the WSIB’s Appeals Services Division (ASD).

The objection is referred from the operating level to the ASD, and is assigned to an Alternate Resolution Officer (ARO) who makes a decision on the appeal. If you disagree with the ARO’s decision, you may file an appeal with the Workplace Safety and Insurance Appeals Tribunal (WSIAT).

The final level of appeal is conducted by the WSIAT, which is independent of the WSIB.

Appeals at the WSIB’s ASD
Only certain types of appeals involving more complex issues, or credibility issues, will be decided by oral hearings. Most matters will be decided based on materials in the claim file, written submissions, and any additional documents submitted. When you are ready to proceed with your appeal, you must complete the Appeal Readiness Form (ARF) that will be sent to you. This form requires you to provide comprehensive information about your grounds for appeal, why you think you should win, and the outcome you are seeking from the WSIB once your appeal has been reviewed/heard by the ARO. Your arguments must be clear and detailed, and references should be made to specific WSIB policies, where appropriate. You likely will not be contacted by the ARO for additional information after the ARF has been submitted. If you are looking for an experienced person to represent you in the appeal, you should let your representative complete the ARF for you.

If the WSIB decides to hold an oral hearing, the ARF asks that you also provide a statement about what your witness(es), if any, will be saying. You must also provide any documentation that you will be relying on at the hearing. A detailed explanation about how hearings will be conducted, and other related matters, is in the “Appeals Services Division Practice & Procedures” document, which is available on the WSIB’s website. It is critical that you read this document if you intend to do the appeal yourself.

What happens if a worker appeals a WSIB decision
Employers will receive a Participant Form (PF) after the worker submits his/her Intent to Object (ITO) Form. The PF must be completed and returned to the WSIB as soon as possible, or you will not get any further information about the appeal until after a final decision has been made. The WSIB will send you the worker’s filed ARF, and the full claims file record. You (or your representative, if you have one) must then review these materials, provide your comprehensive submissions on the Respondent Form (RF), and submit it within 30 days. A determination will then be made on whether the appeal will be conducted in an oral or a written hearing format.