Workers’ claims still not accepted, but at least they know why

Complainant: Representative for injured workers
Problem: Concern that WSIB had rejected claims without gathering information needed to make a decision.
Resolution: The WSIB did not gather more information, but explained more clearly why the claims were denied.

Four health care workers filed claims for respiratory problems, and were denied. Neither they nor their representative understood why. Had the WSIB even gathered the necessary information required to fairly adjudicate the claims?

The decision letters for each of the four claims stated that because respiratory illnesses like the flu are common, it was not possible to determine whether the workplace had significantly contributed to their illness. The public health unit had documented an outbreak of respiratory illnesses at the workplace, but the WSIB’s letters made no mention of it.

The Commission asked for clarification and discussion. The WSIB told the Commission that there is no policy on communicable illness, and that they make decisions on a case-by-case basis.

The WSIB manager reviewed the claims, and said he was confident in the decision-making process and the decision itself. The public health unit’s declaration is only one factor used to make a decision, he explained. But, the Commission said, the decision letters didn’t contain enough detail about the reasons for denying the claims.

Although the four claims were reconsidered, the denial stood. The new decision letters, however, were more substantial. They described:

■ Whether there was a Form 7 on file or other information relevant to the decision-making process;
■ Whether the worker had sought medical attention; and,
■Time away from work and whether those dates correlated with the timing of the respiratory illness outbreak at work.