Delay after delay before success

Complainant: Worker
Problem: Claim was denied. There was much back and forth to have new medical information considered.
Resolution: WSIB approved claim.

The worker hurt his shoulder and arm in a fall at work. The WSIB adjudicator decided that the worker was not eligible for benefits. The WSIB received new medical information, which can often trigger a reconsideration, but the worker heard nothing.

The worker left a voicemail for the adjudicator, but didn’t get a response. He contacted the Commission, and was advised to give the adjudicator’s manager a chance to work this out.

The worker contacted the manager, who told him to expect a reconsideration decision by a certain date. This didn’t happen. The Commission then contacted the manager, who said that the reconsideration request was in process. The manager apologized, and said she would call the worker. She explained to the worker that the claim had been referred to a medical consultant for an opinion. The worker received a new time frame for a decision, but there was no decision within that time.

The worker went back to the Commission, which went back to the manager. The manager apologized again and committed to get this done as quickly as possible. Within a few days, the initial rejection was overturned. The worker was declared eligible for benefits.