Multiple employers complain of delayed WSIB eligibility decisions

Year: 2019

In one example, it took the WSIB over 10 weeks to make a decision on a lost-time claim. Only after the employer elevated her concerns about the delay twice to a manager did the WSIB make an eligibility decision.

In late July, we spoke with an eligibility team manager who told us that eligibility adjudicators were carrying higher caseloads, which resulted in delayed decision-making. We were further told that it was taking the WSIB from six to eight weeks to make eligibility decisions.

Given this information, we elevated our inquiries on this issue: In mid-August, a senior manager told the Commission that the WSIB monitors the “inventory” of entitlement decisions that have been outstanding for longer than 10 days and there was no current concern. We were further informed that the WSIB has a process in place to assign a “SWAT team” of extra staff to make eligibility decisions when the “inventory” gets too high—a scenario they had experienced in May and June of 2019.

We made further inquiries with eligibility team managers to confirm there were no ongoing delay concerns. One manager told us that the delay was a matter of perspective, although she acknowledged that one of the WSIB’s performance targets for 2019 was to make 91% of eligibility decisions within ten days. Another manager told us that the WSIB had assigned the SWAT team to triage eligibility decisions and, as a result, caseloads were decreasing.

Further follow-up by the Commission with the senior manager confirmed that in late August, the oldest outstanding eligibility decisions were from June and that the WSIB’s SWAT team had been assigned to reduce its “inventory” of outstanding eligibility decisions. We were also told that 80.1% of manually adjudicated eligibility decisions made in July were made within 10 days—slightly below the WSIB’s target of 85% for manually adjudicated eligibility decisions.