Other Claim Costs

Injury costs covered by the WSIB

Once a claim is accepted the WSIB provides the following benefits:

• LOE
• health care
• health care equipment and supplies
• NEL benefits
• work transition (WT) services for workers or surviving spouses (to assist in WR)
• loss of retirement income (LRI)
• future economic loss (FEL) for injuries occurring between 1990 and 1997
• costs covered under the occupational disease and survivor benefit program
• benefits for seriously injured workers, and
• compensation for the worker’s survivors.

How the WSIB decides whether a worker is entitled to LOE payments and other services

The WSIB decides if the claim is work-related. In order for a claim to be considered work-related, all of the following conditions must exist:

• the employer’s business activity is covered under the WSIA
• the worker is covered under the WSIA
• there is a personal work-related injury
• there is proof of accident, and
• the medical diagnosis is compatible with the accident or disablement history.

Following an injury, the WSIB weighs the evidence and makes a decision based on the merits of the particular claim, ensuring that its decision is consistent with the provisions of the WSIA and WSIB policies. In cases where evidence is approximately equal on both sides of an issue, the WSIB will decide in favor of the worker (or spouse or dependant) who is making the claim. This provision is known as the “benefit of doubt”.