The appeal levels
There are two levels of appeal in Ontario’s workers’ compensation system, an internal appeal at the Workplace Safety and Insurance Board (WSIB) before the Appeals Resolution Officer (ARO) and following that appeal, an external appeal at the Workplace Safety and Insurance Appeals Tribunal (WSIAT). Appeals proceed on an issue by issue basis and must pass through each level. It is common for workers to appeal several issues at a time, and to make several appeals during the lifetime of a claim.
The initial decision/time limits
Initial benefit decisions are made by a WSIB Case Manager. Initial decisions about health care are made by a Nurse Consultant and work transition (or labour market re-entry) decisions are made by a Work Transition Specialist. There are time limits to appeal each decision; most initial decisions have a 6 month time limit but Work Transition Specialist decisions normally have a 30 day time limit. The decisions are by letter, which ought to have the time limit date at the end of the letter. The time limit requirement is met by sending in an Intent to Object form. This form can be accessed from the WSIB website. It is very important that each decision that the worker wishes to appeal be mentioned in an Intent to Object form; it is often necessary to send in several forms to comply with various time limits in decisions. It is possible, but not easy, to obtain an extension of time for appeal.
Reconsideration/file access/appeal readiness
The Case Manager (or Nurse Consultant or Work Transition Specialist) will review the issue under appeal once an Intent to Object form is sent in. If no changes are made, a copy of the file and an appeal readiness form will be sent to the worker. There is no time limit to complete the readiness form.
Appeals Resolution Officer appeal
After the Readiness form is sent in, the WSIB Appeals Manager will decide whether the appeal will be decided after an oral hearing or after written submissions, and then pass the file on to the ARO. If there is an oral hearing, the worker will normally testify. Some time after the oral hearing is finished or the written submissions are sent in, the ARO will make a written decision. The appeals process from start to finish typically takes 12-20 months.
Appeals Tribunal appeal
Workers can appeal from adverse ARO decisions to the Appeals Tribunal by sending in a Notice of Appeal form and a copy of the ARO decision to the Appeals Tribunal. The Notice of Appeal form is accessible off the WSIAT website; there is a six month time limit from the date of the ARO decision to file the Notice of Appeal form. An extension of time is possible, but not easy, to get.
The Appeals Tribunal process is more involved than the ARO one, with two additional forms, a Readiness form and a Confirmation of Appeal form, as well as an additional telephone contact with a Tribunal Legal Worker before the appeal moves on to be scheduled for hearing. Each step takes some time. The great majority of WSIAT appeals are decided after an oral hearing. Decisions are made in writing after the hearing. The process from start to finish typically takes 18-36 months.
The Appeals Tribunal is the final level of appeal within the system. There are some possibilities to deal with adverse Appeals Tribunal decisions, but they are very limited.
The WSIB website has further information on its appeals process here.
The WSIAT website has further information on its appeals process here.