Key takeaways: WSIB Claim Denied
If the Workplace Safety and Insurance Board (WSIB) denies your claim:
- Review the WSIB decision letter and note the reason for the denial.
- Submit your Intent to Object before the deadline listed in the decision.
- Request and review your WSIB claim file for missing or inaccurate information.
- Gather medical and workplace evidence that directly addresses the reason for denial.
- Consider getting WSIB denials paralegal representation before submitting the Appeal Readiness Form.
Review the WSIB Decision Letter
The decision letter should explain why your claim was denied and identify the evidence WSIB relied on. Common reasons for denial may include insufficient medical evidence, questions about whether the injury occurred at work, delays in reporting the injury, or a disagreement about whether your employment significantly contributed to your condition.
Read the letter carefully and make note of:
- The specific issues WSIB decided
- The reasons given for the denial
- The evidence referred to in the decision
- The deadline for submitting an objection
- Any missing or inaccurate information
Understanding the reason for the denial will help you determine what evidence may be needed to challenge it.
Protect Your Right to Object
To challenge the decision, WSIB must receive an Intent to Object form or written objection before the deadline stated in your decision letter. Most WSIB decisions have a six-month objection period, while return-to-work and re-employment decisions generally have a 30-day deadline.
You may contact the WSIB decision-maker to discuss the denial or provide new information. However, do not allow these discussions to cause you to miss the formal objection deadline. Submitting the Intent to Object form protects your ability to continue with the appeal process.
Request and Review Your Claim File
After WSIB receives your Intent to Object, you will generally receive a copy of your claim file record and an Appeal Readiness Form. Review the file before declaring that your appeal is ready to proceed.
Your claim file may contain:
- Medical reports
- Employer statements
- WSIB case notes
- Functional abilities information
- Return-to-work documents
- Reports from health-care professionals
- Previous correspondence and decisions
Look for missing records, factual errors, conflicting statements, or evidence that was not properly considered.
Gather Evidence That Addresses the Denial
A strong objection should respond directly to the reasons WSIB gave for denying the claim. Depending on the circumstances, useful evidence may include:
- Updated medical reports
- Clinical notes from your treating professionals
- A clear medical opinion connecting your condition to your work
- Witness statements
- Incident reports
- Photographs, emails, schedules, or workplace records
- Evidence explaining a delay in reporting or seeking treatment
- Information about your job duties and physical demands
More paperwork does not automatically make an appeal stronger. The evidence should be relevant and should clearly address the disputed issues.
Avoid Submitting the Appeal Before It Is Ready
Submitting the Appeal Readiness Form generally signals that you are prepared to move forward with your objection. Before doing so, make sure you understand the claim file, have gathered the available supporting evidence, and can explain why the original decision should be changed.
A clear appeal should connect the workplace incident or exposure, the medical evidence, your symptoms or limitations, and the reasons the denial was incorrect.
Get Paralegal Representation Early
WSIB appeals can become complicated when medical evidence is incomplete, the employer disputes what happened, or the denial involves a pre-existing condition, return-to-work issue, or loss of earnings.
WorkAid provides paralegal representation for injured workers appealing WSIB claim denials across Ontario. The team can review the decision and claim file, identify evidence gaps, prepare written submissions, and help you move through the objection and appeal process.
Start My WSIB Appeal Now
Book a free consultation or call 1-844-WORKAID (1-844-907-5243).
