Skip to main content
Français

Workers’ Compensation 101

road sign

By Michelle Mraz, former director of the Ontario WSIB’s Occupational Disease and Survivor Benefits Program

In the following article, I provide an overview of what happens following a critical workplace injury and how workers’ compensation gets involved. While I frame the article from the point of view of a critical/physical injury, the information also applies to psychological injuries, occupational diseases and related deaths.

How did this happen?

A critical injury or death at work leaves families overwhelmed with shock, grief, and unanswered questions. It can also shake the company, the supervisor and co-workers with guilt (What could I have done to prevent this?) and disbelief (How is this possible?).

In the midst of these swirling emotions, several agencies engage with the family and the employer to gather information and piece together the story of what occurred at work and how it could have been prevented. The investigation involves the employer, labour ministry , and sometimes police and the coroner. Because investigations need to be protected, family members may not get many details right away and this is often very hard on them.

Tip: A ministry investigator may not share information about an ongoing investigation, but you may be able to get some information by speaking with the investigator’s supervisor, who is not personally involved in questioning witnesses and assessing the facts.

When should I submit a claim to the compensation board?

Make sure the accident or illness is reported to the workers’ compensation board within required timelines located on the compensation board’s website . If you are considering claiming compensation benefits, file a claim even if you’re not yet ready to deal with everything emotionally and tell the adjudicator assigned to your claim that you need a few weeks to process what happened before you will be ready to speak with them. They will understand.

You may also assign someone to represent you, like a friend or family member, to reduce the stress of having to deal with challenging processes at a very difficult time in your life.

Finally, you may have the right to sue a ‘third party’ if the accident was caused by someone other than the employer or an employee of the company. The compensation board will tell you if you have an option to choose between compensation benefits or suing a third party.

Tip: It’s okay to submit a claim now and sort out benefits later. You may also assign someone to speak to the compensation board on your behalf.

What compensation benefits will I receive? 

Much like insurance adjusters, workers’ compensation adjudicators use policies and legislation to guide their decisions. Benefit rates are set out in legislation and policy and vary from one jurisdiction to another. Policies can be found on the compensation board’s website. Depending on your situation and jurisdiction, benefits/support may include:

  • Income replacement, healthcare expense coverage, disability benefits, and return to work or work transition services for injured/ill workers
  • Survivor pensions, funeral expense coverage, bereavement counseling and work transition services for dependants
  • Possible additional benefits through employers, unions, or government programs

Tip: You can apply for support from more than one source—just let each agency know what other benefits you’re receiving.

What if my claim is rejected?
You have the right to appeal if your claim is not allowed. Make sure to do so within the appeal time limit, most often provided in the decision letter. Tell the adjudicator why you disagree with the decision and the remedy you are seeking.

While there are specialized services available through lawyers and paralegals that you can pay for, free services are available through the union (if applicable) and government agencies. For example, the Office of the Worker Advisor (OWA) in Ontario educates, advises and represents non-unionized workers and survivors of deceased workers impacted by work-related injury or disease.

Tip: Free worker advisory services, such as the Workers’ Advisor or Advocate Offices Across Canada , can help you understand your options. To preserve your right to appeal a claim decision, you must submit your objection within the specified time limit, usually found in the decision letter.

Don’t Overlook Emotional Support
The effects of trauma and grief can last a long time. Counseling, peer support, and organizations like Threads of Life can help you feel supported by people who understand.

Questions?

If you have a question about compensation, please send it to us at [email protected] . We will do our best to address your question directly, and we may publish questions and responses in a future article.