Appeals

The right to a fair and speedy hearing

Injured worker appeals and wait times have greatly increased with the rise in claims denials that followed changes in benefit policies and decisionmaking practice. Recent changes to the appeals process at the Board have added complexity, stress and delay. By the end of 2017 the appeals “mountain” at the Workplace Safety and Insurance Appeals Tribunal (WSIAT) is 6035 cases (3.927 in 2009). Wait time (median) to get a first hearing date is 16.6 months (6 months in 2009) with 20% of appeals resolved at Tribunal within 9 months (compared to 56% in 2009). The availability of alternative dispute resolution remains limited.

In the current adversarial environment, both the Board and employers are more and more aggressively challenging claims and using private investigators to provide surveillance “evidence” of dubious value.

Current problems with appeals practice and delays threaten:

access to justice
access to critical financial and rehabilitation benefits and services
injured workers’ mental and physical well-being

The current appeal structure

Most decisions can be appealed to the WSIB’s internal Appeal Services Division. If the injured worker or employer disagrees with the decision of the Appeal Services Division, that decision in turn can be appealed to an independent review body, the Workplace Safety and Insurance Appeals Tribunal (formerly the Workers’ Compensation Appeals Tribunal). That is the final level of appeal, although the WSIAT can reconsider its own decisions. The Ontario Ombudsman can also request a reconsideration. The Supreme Court of Ontario can judicially review a decision of the WSIAT on very limited legal grounds. Though rare, the Supreme Court of Canada has ruled on issues of jurisdiction and constitutionality – such as the 2003 chronic pain appeal decision (Nova Scotia (Workers’ Compensation Bard) v Martin & Laseur).