Occupational injuries and LTD.

Long Term Disability and WSIBOntario Accident Insurance Claims

Many employers provide group benefits packages to their employees, including long-term disability (LTD) benefits. In addition, some employers also have an additional LTD policy to cover workplace injuries and illnesses caused at/by the workplace, called an occupational long-term disability policy. Some Ontario industries (eg. construction) are required by law to participate in a provincial workers’ compensation plan, such as WSIB. Some other companies have an occupational long-term policy in place to cover workplace illnesses and injuries that would be covered under the provincial workers’ compensation plan, if they had one. Mental and physical illnesses and injuries that are specifically related to the workplace are covered by occupational policies.

There are many differences between a group LTD policy and an occupational policy. For example, the definition of disability under an occupational policy differs from a group LTD policy. Under an occupational policy, the reason you must be unable to work due to an illness or injury arising out of and because of your employment. Under some occupational policies, you must be unable to do any occupation within the company you work for, that you are or may be qualified for that would be at a minimum of the same pay-rate as your pre-disability income. With group LTD policies, however, you may be unable to work due to an illness or injury sustained outside of the workplace.

To be eligible for benefits under a group policy, you are required to provide evidence that you became totally disabled due to an occupational illness or injury while covered under the group policy, You must show that your disability continued past the waiting period stated in the group policy and you have sought appropriate treatment.

The payout under an occupational policy is generally a higher percentage of your monthly income than through a group policy. To be eligible for benefits under this policy, you must prove that you became totally disabled due to an occupational illness while covered under the group policy. As with a group policy, you have to show that your disability continued past the waiting period and you are seeking appropriate treatment.

LTD benefits

Although the two types of policies have differences, they also share some similarities. Both types of policies require that you be an active employee when your disability started. You must meet specific criteria as stated in both types of policies in order to qualify for disability benefits. As well, both policies usually have two different definitions of disability involving your ability to continue working in your own occupation or in any occupation, even if you were to be provided education or training in another occupation. With both types of policies, other types of benefits – such as Canada Pension Plan Disability Benefits – can be used to reduce your LTD benefit amounts. LTD policies have a waiting period before benefits are paid out, and benefits can end for a variety of reasons, such as you aren’t following the recommended treatments, if you return to work and are therefore gainfully employed, or if you turn 65.

If you were injured at work or developed an illness, such as anxiety or depression, and you decide to submit a claim, you will need to show when the illness/injury began or happened and how it relates to your workplace. It is best to include as much detail as possible, and attach an incident report (if there is one) and any other written evidence, doctor’s notes or reports regarding your illness or injury and treatments, prognosis and progression. The more information you provide, the better able your insurer will be able to assess what benefits you are entitled to.


WSIB claims and cancer ?

WSIB claims

Extension of presumption for entitlement for cancers in firefighters.

What do WSIB claims and cancer have in common ? Ontario has made it easier for firefighters to get the help and care they need by extending the presumption for entitlement to benefits to cervical, ovarian and penile cancers.

“Firefighters are vital to keeping our communities safe from life-threatening dangers. Every day, they risk their health and their lives to protect us and our communities. In return, we must protect them. That’s why the government has made it easier for firefighters and fire investigators to qualify for workplace safety and insurance benefits,” Kevin Flynn, Minister of Labour.

By adding the three cancers to the list of cancers presumed to be related to their work, firefighters and fire investigators will have greater access to healthcare and compensation. With the expanded presumption, once a firefighter is diagnosed with cervical, ovarian or penile cancer, the claims process for WSIB claims benefits will be expedited, and firefighters will not be required to prove a causal link between these cancers and a workplace exposure.

“If a firefighter is diagnosed with cervical, ovarian or penile cancer, the worker’s Workplace Safety and Insurance Board ( WSIB) claims for benefits and services will be presumed to be work-related. This will give firefighters faster access to compensation and other benefits, ultimately supporting positive recovery outcomes,” Ron Kelusky, Chief Prevention Officer

Claims related to cervical, ovarian and penile cancers will be retroactive to January 1, 1960. This will apply to full-time, part-time and volunteer firefighters, firefighters employed by band councils and fire investigators.

Quick Facts

* In 2007, the Workplace Safety and Insurance Act (WSIA) was amended to create a statutory presumption for firefighters and fire investigators to get compensation for heart injuries and certain cancers without having to prove they are work-related.

* In 2014, the Ontario government amended the Firefighter Regulation under the Workplace Safety and Insurance Act to add six cancers to the list of diseases that are work-related: multiple myeloma, testicular, breast, prostate, lung and skin cancer.

* This amended regulation makes Ontario among the leaders in this area and Ontario’s firefighters among the best protected in Canada.

* There are about 450 fire departments in Ontario made up of about 11,000 full-time firefighters, 19,000 volunteer firefighters and 200 part-time firefighters

If you, or someone you love, has been injured at work or has a work-related diagnosis of disease, give us a call. We can help you make sure that you receive the benefits that you deserve.


What you need to know about a workplace injury.

Workplace Injury

A workplace injury can happen anywhere. A workplace injury can also go far beyond the industrial and construction site accidents that we hear about in the news. Workers are often injured in offices, retail stores, restaurants and many other industries. In fact, the Association of Worker’s Compensation Boards of Canada reported in 2015 that there were 281 fatalities in Ontario: that’s one about every 31 hours. Non-fatal injuries amounted to 51,570: that’s one every 10 minutes.

Employees injured on the job and their families have a lot to cope with including a wide range of expenses and losses. If you suffer a workplace injury, you or your family are entitled to benefits or compensation to recover these losses. · Loss of Earnings · Compensation for Non-Economic Loss · Loss of Retirement Income · Compensation for Future Economic Loss · Health Care Benefits · Health Care Equipment and Supplies

Most workers are able to claim benefits for their losses either through workers’ compensation or by suing their employer for damages.

Filing a workers’ compensation claim after a workplace injury

The Workplace Safety and Insurance Board is an independent agency of the Ministry of Labour in Ontario responsible for providing workers’ compensation to Ontario workers who become injured on the job

This is a “no-fault” system which means you can get workplace insurance benefits without proving that your employer was to blame for your injury or disease. Even if you think that the accident at work was your own fault, you are still entitled to benefits and services from the WSIB. Work-related injuries include those sustained while running errands off the premises or while travelling for work. It does not cover break periods or travelling / commuting back and forth to work.

To qualify for a workplace injury insurance benefits, you must meet the requirements set out in the Ontario law that governs workplace insurance. It is really important to file the claim as soon after you are injured as possible. Employees who wait too long have a harder time gaining full compensation. As always, report early, take a lot of pictures, write down the details and get the names and numbers of any witnesses.

If you are covered by the WSIA (Workplace Safety and Insurance Act) , you cannot sue your employer in court for your injuries

Suing your employer or a third party for a work place injury

If you believe that your employer was to blame for your injury or disease, and you are not covered by the WSIA,  you can sue for damages. It is important you inform yourself of your options and of which category you fall into before you file for workers’ compensation.”

If your workplace was unsafe, the equipment was unsafe, or your employer was unintentionally reckless, you can sue . You could also sue a third party, for example a cleaner, visitor or contractor to your work place if they have unintentionally done something that contributed to your injury.

Injuries at work can be complicated. Whether filing a workers’ compensation claim or suing your employer, you should take the time to first consult with a lawyer. Consultations are free. Call us today.