Delay in adjudication of claims for entitlement to secondary disabilities

Year: 2020

In 2020, the Commission received several complaints from injured workers who were awaiting adjudication of their entitlement claims for psychotraumatic or chronic pain disabilities.
According to two WSIB policies— Psychotraumatic Disability (15-04-02) and Chronic Pain Disability (15-04-03)—a worker may be entitled to benefits for a psychotraumatic disability or a chronic pain disability when the disability occurs as a result of a work-related injury.

The WSIB’s target for reviewing these entitlement claims is 28 business days. However, the Commission noted that in some cases, workers were waiting almost four months for these decisions to be made. WSIB staff told the Commission that the Secondary Entitlement team, which is responsible for reviewing these claims, was overwhelmed and had thus been unable to meet their 28-day target.

In late 2020, a director told the Commission that it had an inventory of approximately 1,400 claims awaiting review. The WSIB advised that additional case managers had been assigned to adjudicate these claims. The WSIB also ensured that it was prioritizing claims involving financial hardship—where a worker may be entitled to loss of earnings (LOE) benefits.

The WSIB is also developing training to enable non–Secondary Entitlement case managers to make decisions on some matters that are currently referred to the Secondary Entitlement team. The WSIB anticipates that this should reduce the number of referrals that the Secondary Entitlement team receives.

The Commission continues to monitor the WSIB’s progress on addressing delays in this area.