Handling Disability Claims in Toronto: Misir & Company

Workplace injuries may fall within the Workplace Safety and Insurance Board. This is a no-fault system for workers who injured themselves in the course of their employment. If a workplace injury requires medical attention and causes lost time from work you may be entitled to certain benefits. There is a six-month limitation to apply for benefits so it is important to consult with our experienced legal team to identify the best strategy to meet your needs. If you have been denied or forced to return to work you must appeal to this decision within 30 days of the decision.

Benefits you can receive are:

Benefits for loss earnings (LOE):

  • If you miss time from work because of a work-related injury or illness, WSIB pays for loss of earnings. This benefit starts from the working day after the injury or illness occurred.

  • The calculation of the loss of earnings benefit will depend on the date the injury occurred. If your injury occurred on or after January 1, 1998, the benefit will be 80% of your take home pay

  • You will receive an LOE payment every two weeks

Benefit for Non-Economic Loss (NEL):

  • If you suffer permanent impairment from a work-related injury or illness, the WSIB will pay you a non-economic loss benefit. This is paid to compensate you for the physical, functional, or psychological loss the impairment causes

  • This benefit is determined when your condition has reached a point where no further improvement can be expected

  • You may be required to have a medical examination to assess your condition if the information on your file is not sufficient to determine your NEL benefit

Loss of Retirement Income (LRI) Benefit:

If you are under 64 years of age and have received loss of earnings benefits for 12 continuous months, the WSIB sets aside an amount equal to 5% of all subsequent LOE benefits to pay for a loss of retirement income benefit.

Health care benefits:

In addition to loss of earnings benefits, the WSIB pays for a number of other costs including:

  • Health care

  • Prescription drugs

  • Medical devices and orthotics

  • Transportation costs associated with work-related injury or illness

Survivor Benefits:

Survivor benefits

  • If you are a spouse or dependant of a worker who died as a result of a workplace injury or illness, you can claim survivor benefits

  • WSIB pays a lump sum and monthly payments to survivors and/or dependent children

Long-Term/Short-Term Claims

Survivor benefits

  • Short Term & Long Term Disability Insurance coverage protects a portion or all of your work income will you are injured or suffering from an illness:

  • The difference between short-term and long-term disability is primarily the length of injury

  • Each insurance company has different definitions of how many weeks or months you have to be disabled in order to be entitle to coverage

  • Each insurance company also has different definition on what the word disability means

  • Short Term & Long Term Disability Insurance coverage covers physical or psychological illnesses that prevent someone from performing the essential/primary/material duties of their employment.

Canada Pension Plan

  • To be eligible for Canada Pension Plan (CPP) Disability you must be under the age of 65, have contributed to the Plan and meet the Disability Criteria.

  • To qualify for a CPP disability benefit, you must have contributed to the CPP in: four of the last six years, or three of the last six years if you have contributed for at least 25 years.

  • To qualify for a disability benefit under the CPP, a disability must be both "severe" and "prolonged", and it must prevent you from being able to work at any job on a regular basis.

  • Severe means that you have a mental or physical disability that regularly stops you from doing any type of substantially gainful work.

  • Prolonged means that your disability is long-term and of indefinite duration or is likely to result in death.

  • Both the "severe" and "prolonged" criteria must be met simultaneously at the time of application.

  • You may request a reconsideration of any decision that affects your eligibility or the amount of your Canada Pension Plan disability benefit.

  • Reconsideration is a new review of your application by the Department.

  • Service Canada staff who was not involved in making the original decision will review your application, as well as any new information supplied by you, or by others on your behalf.

  • Service Canada staff may also seek more medical information on your case.

  • They may ask you to see another doctor. CPP will pay for the doctor's visit and your travel to the doctor if that is necessary.

  • You must make your request for reconsideration in writing within 90 calendar days after you are notified in writing of the decision.

  • If you disagree with the reconsideration decision, the next step is to contact the Social Security Tribunal within 90 calendar days to appeal the reconsideration decision.

  • The Social Security Tribunal (SST) is an independent administrative tribunal that provides a fair and impartial quasi-judicial appeals process under the Employment Insurance Act, the Canada Pension Plan and the Old Age Security Act. The SST operates at arm's length from Employment and Social Development Canada.

  • The SST includes two levels of appeals:

  • The General Division (first level of appeal) includes an Employment Insurance Section for Employment Insurance appeals and an Income Security Section for Canada Pension Plan and Old Age Security appeals.

  • The Appeal Division (second level of appeal) decides appeals of decisions made by the General Division.

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