Monday, February 21, 2005


Have you been denied WSIB benefits? Keep reading to learn how you can Win WSIB APPEALS. The following information will guide workers in dealing with the WSIB and win their WSIB appeals.

If you do not agree with the WSIB’s decision, you do have the right to appeal WSIB decisions. But keep in mind that there are time limits to appealing a decision. The majority of decisions are subject to a 6 month time limit but those involving Labour Market Reentry Programs or retraining must be filed within 30 days. The appeals must be in writing and be sure to put the date at the top of the letter with your return address. A short letter will suffice. Often times long appeal letters are confusing and not completely read. In addition, if you are angry, you may end up saying something you may regret or could damage your case. You should identify the issue you are appealing, for example - initial entitlement, ability to work, Non economic loss award and the date of the adjudicator’s decision. You should also request a full copy of your claim file. Keep a copy of the letter for your records.

The next step is to review the entire file. Every WSIB claim or appeal requires good preparation and presentation. Often times the medical evidence is key. The questions you should ask yourself include:

1. Is there medical evidence that deals with the causation of the disability? Is the evidence convincing or does it use words like "may be caused", "could be caused by" or simply does not comment on the cause of the injury?

2. Does the medical evidence identify a diagnosis? Are there conflicting opinions about the diagnosis?

3. Is there evidence that the medical problems have been continuous or are
there gaps? Make sure that all specialist reports, physiotherapy, chiropractic and family doctor records are in the file. Dates of every health care visit relating to the claim should be recorded and in the file.

4. Does the medical evidence explain or show that you did not have prior problems with preexisting conditions?

5. Do the medical reports agree about the facts of the disability?

6. Is the medical evidence based on subjective or objective findings? Decision makers prefer an opinion of a specialist to a generalist. They also prefer to see indications in the report the physician examined the worker thoroughly and contains more substantial evidence of objective signs in support of its opinion. Therefore a note with states "back pain, unable to work, will reassess in 3 weeks" will normally be given little or no weight.

Get better medical evidence if you need it. Remember quality counts, not quantity.

The next step is to identify any other missing evidence. Think of the best source you have to prove your point- a witness, a document, a photograph, or a diagram. If the issue is the type of work you were performing maybe the union or the company has a job description or physical demands analysis.

Once you’ve assessed the evidence, consider your theory. Think of the central point of your case. "Keep it simple stupid" (KISS) is a rule that I always go back to it helps to focus on theory. If you provide too much information this may only confuse the decision maker. Remember your job at the hearing is to prove your theory. Do you have all the facts or evidence necessary to convince the listener of your point of view? If not you still have some work to do.

The presentation of your case at the hearing is also important. Never assume that essential facts are understood. State them and know what you are going to say ahead of time. Stick to your theory and prepare a road map. Take the decision maker thru a logically developed presentation from beginning to end. Often times a short focused presentation is more effective that spending hours going thru the information. Remember the decision maker has read the file.

Going thru these simple steps will ensure that the issue is stated, the facts are established, and that your reasons are explained. If you follow these steps it help you win WSIB appeals.