How are WSIB Claims Different from LTD Claims?

The interplay between claims for Long Term Disability benefits and income benefits from the Workplace Safety and Insurance Board (WSIB) can be quite confusing. Generally speaking, if you have been injured in an accident that takes place at work and your workplace is covered by WSIB, a claim should be submitted to the WSIB. The benefits that are payable by WSIB are based on statute and regulation and must arise from a workplace injury. WSIB has extensive policies, regulations and prior decisions that determine whether a disabling injury is covered.

How are WSIB Claims Different from LTD Claims?

Disability Insurance

Disability Insurance, on the other hand, provides benefits in the event of a disability from either illness or an accident. So, if you are unable to work due to injury or illness you should seriously consider applying for disability benefits if they are available to you. Most group disability insurance offered as benefits by your employer, contain “offset” or “co-ordination” clauses that will not allow for double recovery. So, if you are in receipt of WSIB benefits, these would be deducted from any potential entitlement under a group disability insurance policy.

Apply For Both WSIB & Disability Insurance

If in doubt, you ought to apply for both WSIB and Disability Insurance benefits as the entitlement criteria are different and there may be circumstances where you would be entitled to one but not the other. This may create a dilemma for you depending on how clearly your workplace “accident” establishes that the reason you are unable to work are the injuries you suffered in the workplace accident.

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Let’s say you hurt you back while lifting something heavy at work.You submit a claim for WSIB which is initially accepted, but after a few weeks of benefits WSIB tells you that you should have recovered from the injury and any underlying ongoing disability is not related to your workplace injury, but rather from an underlying congenital medical condition, such as degenerative disc disease or some other auto-immune disorder, such as rheumatoid arthritis. This could result in you getting some WSIB benefits, but if you haven’t submitted a claim for disability insurance benefits through your group plan, you may miss out on the opportunity to obtain those benefits because your application may be considered to be too late.

This blog is not meant to be an exhaustive discussion of all of the factors involved in the interplay between WSIB and LTD, but rather to illustrate the potential complexity and the need for you to get clear advice if you find yourself in a situation like this.

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