Ontario Workers' Compensation Laws PDF

**Introduction:**\ \ This section gives a brief overview of the history and evolution of workers\' compensation laws in Ontario, Canada. It explains that before modern compensation laws, injured workers had a tough time getting financial help. The Meredith Royal Commission (1910-1913) was set up to...

**Introduction:**\ \ This section gives a brief overview of the history and evolution of workers\' compensation laws in Ontario, Canada. It explains that before modern compensation laws, injured workers had a tough time getting financial help. The Meredith Royal Commission (1910-1913) was set up to fix this problem. The commission reviewed how other countries handled workers' compensation and recommended a system where workers would receive compensation for injuries but couldn\'t sue their employers for negligence. This recommendation led to the Workmen's Compensation Act in 1915, which is now called the **[Workplace Safety and Insurance Act (WSIA).]** The WSIA, passed in 1997, expanded its focus beyond just compensating injured workers to also include preventing workplace injuries and ensuring overall safety. Ontario's law became the model for other provinces, and workers in federally regulated workplaces follow the laws of the province they work in. This section also emphasizes that the laws change frequently, and the best way to stay updated is to check the latest version on the Government of Ontario's e-Laws website **Key Terms:** **Accident**: This refers to events causing injury, including deliberate harmful acts (but not by the worker), random events caused by physical factors, or injuries that happen while working. **Accommodation**: Changes made to a job or workplace, like reducing hours or providing assistive tools, so that a worker can keep working despite physical limitations, in line with human rights laws. **Earnings**: Any money a worker is paid, but it doesn't include benefits like healthcare contributions. **Essential duties**: The core tasks that are necessary to complete the job\'s main purpose or deliver the product/service. **Impairment**: Any physical or mental damage resulting from an injury, including things like disfigurement or loss of function. **Learner**: Someone who is training or working temporarily in a risky job without being fully employed or in an apprenticeship. **Spouse**: Either someone you\'re legally married to or a partner you\'re living with for at least a year, have a child with, or have a cohabitation agreement. **Suitable work**: Work that a worker can safely do after an injury, matches their abilities, and, ideally, provides the same income as before the injury. **Survivor**: A spouse, child, or dependent family member of a worker who has passed away. ### **Introduction to the WSIA Act** The Workplace Safety and Insurance Act (WSIA) is a detailed and long-standing law, over 100 years old, that has been updated multiple times. It's divided into different sections: - - - - - - - - - - - - - The **purpose of the Act** is mainly to promote health and safety in the workplace. Providing compensation and benefits for injured workers is also a key goal but is now listed further down in subsection 4. Subsections 2 and 3 focus on helping workers return to work and re-enter the job market. The Act starts by defining important terms used throughout the legislation. These terms might seem familiar in everyday language but have specific legal meanings in the WSIA. It's important to understand these definitions to correctly apply the law, especially since the same word might have different meanings in other laws. For example, the word "worker" means different things in the WSIA and the Occupational Health and Safety Act (OHSA). The definitions in section 1 of the Act apply to the whole WSIA and don\'t need to be explained again each time they\'re mentioned. You should pay close attention to terms like: - - - - - - - - - Lastly, there's a conflict between the WSIA and the Human Rights Code (HRC) regarding age. The HRC prohibits age discrimination, but the WSIA has some age-based rules. If these two laws clash, the WSIA takes priority. ### **Injury and Disease Prevention** Part II of the **Workplace Safety and Insurance Act (WSIA)**, which was introduced in 1997, gave the Workplace Safety and Insurance Board (WSIB) authority over workplace safety in Ontario. However, in 2011, this part was removed after changes were made based on a review of Ontario's prevention system. An expert panel led by Tony Dean reviewed the system in 2010 and suggested several improvements. Key recommendations included creating a **chief prevention officer** and moving control of the safe workplace associations to this new officer. In 2011, the WSIA was updated to reflect these changes, and Part II was repealed. ### **Introduction to the Schedules** The **Workmen's Compensation Act** of 1914 aimed to protect workers, especially in dangerous industries like **mining**, **forestry**, and **construction**, which were automatically included in the compensation system. Safer industries, like **banking** and **teaching**, were not included. Over time, new risks, such as **repetitive strain injuries** and **occupational diseases**, were recognized, leading to broader coverage. The system is based on the principle that high-risk industries pay higher premiums, with companies contributing to a **collective liability** pool. This ensures that even if one company goes **bankrupt**, others in the same industry group cover the costs of approved injury claims. Some organizations, like **government agencies**, don't participate in this system since they can't go bankrupt and don't need insurance. This structure resulted in two main categories: - - Most companies fall under **Schedule 1**, and there are also **Schedules 3 and 4**, explained in **Ontario Regulation 175/98**. ### **Schedule 1** When the **Workmen's Compensation Act** was first introduced, certain high-risk industries like **demolition**, **construction**, **mining**, and **pulp mills** were required to join the compensation system under **Schedule 1**. These industries pay premiums into a collective insurance fund, with rates based on both the industry\'s injury history and the company\'s payroll size. Dangerous industries pay higher premiums than safer ones, and the premiums are based on the company's **assessable payroll**, which is multiplied by a rate specific to their industry. This system, still in use today, ensures that all **Schedule 1** companies share the risks and costs through **collective liability**. This means that funds are pooled, protecting companies from financial ruin after major accidents, much like any other insurance system. Currently, Schedule 1 is divided into **sixteen industry classes** as outlined in **Regulation 175/98**. All participating companies benefit from the shared resources of the fund, helping them manage both good and bad years financially. ### **Schedule 2** **Schedule 2** employers in Ontario, unlike those in Schedule 1, do not participate in the collective insurance pool. Instead, they directly pay for all costs related to workplace injuries and diseases. These firms are usually large, funded by **tax dollars**, and often considered **less risky**, such as **railways**, **provincial governments**, **municipalities**, **school boards**, and **airlines**. The **WSIB** manages their claims and charges them directly for any costs, along with administration fees for handling the claims. These companies benefit from the **WSIB\'s expertise** in claims management, even though they aren't required to join the insurance scheme. **Federal government employees** in Ontario are treated as if the federal government were a Schedule 2 employer. Firms that operate under both schedules are classified entirely under **Schedule 1**, though **Schedule 2 employers** can choose to transfer to Schedule 1 to enjoy **collective liability** protection. Some industries, like **banks**, aren't covered under the compensation scheme because they were considered **low-risk** when the law was first enacted. Newer industries, such as **aerospace** and **computing**, can either find private insurance or request WSIB coverage. The WSIB can also add new industries to **Schedule 1** if needed by amending regulations. ### **Schedule 3** **Schedule 3** outlines the list of occupational diseases covered by workplace compensation. Originally, the law included six diseases, but now there are **thirty** recognized diseases under **Ontario Regulation 175/98**. For a worker to receive compensation, they must demonstrate they have one of these diseases and that their job involved exposure to it. If an employer can show that the disease was not caused by work or that the exposure time was too short, the claim may be denied. These diseases are considered "**rebuttable**," meaning the employer can challenge the claim. ### **Schedule 4** **Schedule 4** includes a list of only **four diseases** covered by workplace compensation, as specified in **Ontario Regulation 175/98**. For a claim to be accepted, a worker must prove they have one of these diseases and that they were employed in a listed work process. Unlike other schedules, these diseases are considered "**irrebuttable**," meaning it\'s assumed they were caused by the workplace without needing further proof. The term "**presumption**" is important here; it indicates that the Board will automatically assume the disease is work-related if the worker was in a listed job. No additional tests or measurements of exposure are required. ### **Collective Liability and Prevention** From **1997 to 2012**, the WSIB managed injury prevention. One way it motivated **Schedule 1** employers to improve safety was by raising premiums for companies with poor performance. Since insurance is mandatory, higher costs for poorly performing companies encouraged them to focus on reducing workplace injuries. In **Schedule 1**, better performance leads to lower rates and premiums, but **Schedule 2** companies don't have similar financial incentives to enhance health and safety practices. Now, while the **Chief Prevention Officer** oversees injury prevention, the WSIB can still increase premium rates for companies or industries with rising accident rates. This helps ensure there is enough funding in the insurance pools to cover costs. Sections **11 to 31** of the **WSIA** cover various topics related to the insurance plan, including: - - - - ### **Sections 11--20: Insured Employment and Injuries** **Sections 11 and 12\ **These sections outline who is covered by workers\' compensation insurance. Generally, all employees of Schedule 1 and Schedule 2 employers are included, with exceptions like casual workers (e.g., someone hired for a day to shovel snow) and executive officers. Employees who work outside Ontario are typically excluded unless certain conditions are met. Claims for mental stress are also limited; benefits are not available for stress caused by employer decisions. **Section 13\ **This section covers the types of injuries included in the insurance plan. To qualify for compensation, a worker must prove that their injury arose out of and occurred during their employment. There are specific exclusions for injuries happening outside Ontario and for mental stress not related to work conditions. **Section 14\ **Focused on post-traumatic stress disorder (PTSD), this section allows first responders to claim benefits if diagnosed with PTSD. Workers listed in this section are presumed to have incurred the disorder from their job unless proven otherwise. **Application for Coverage\ **Independent operators, sole proprietors, and partners in businesses can apply for WSIB coverage. This includes executive officers, subject to premium payments. Section 12 requires them to register with the Board within ten days of becoming independent or a partner. **Section 15\ **This section addresses occupational diseases. Workers must suffer from and be impaired by these diseases to qualify for benefits, which are treated like injuries. Occupational diseases are listed in Schedule 3, with a presumption of workplace causation unless disproven. Unlike injuries, occupational diseases can be complex to diagnose and often develop over time. **Amendments for Firefighters\ **Section 15.1, added in 2007, establishes presumptions for injuries specific to firefighters, reflecting their unique health risks. ### **Sections 21--23: Notices of Accidents and Claims for Benefits** **Notification Requirements\ **Employers must report any worker accidents to the WSIB within three days if healthcare is needed or if the worker can\'t earn full wages. The report uses \"Form 7.\" Failing to notify can result in fines. **Worker Claims\ **Workers can file claims within six months of an accident or learning of an occupational disease. Claims from survivors after a worker\'s death also must be filed within six months. Workers must agree to share medical information and notify the Board of any significant changes in their situation within ten days. ### **Sections 24--25: Wages and Employment Benefits** **Employer Responsibility\ **Employers must pay workers for the entire day of an injury, regardless of when it occurred. If the worker is off work, the employer covers employment benefits for the first year, provided the employer was paying those benefits before the injury. ### **Sections 26--31: Rights of Action** **Restrictions on Lawsuits\ **Workers cannot sue for benefits from workplace injuries. The WSIB decides who gets benefits, and this decision is final. This restriction extends to the survivors of deceased workers. **Legal Actions and Third Parties\ **If a worker is injured but can also sue another party (e.g., for defective equipment), they must notify the WSIB within three months of the accident. If the third party isn\'t covered by WSIA, the worker can choose between accepting WSIB benefits or pursuing the lawsuit. **Subrogation\ **If a worker accepts WSIB benefits, the Board can pursue the third party for costs. For Schedule 1 employers, the Board acts as the insurer, while for Schedule 2 employers, the employer is the insurer and can decide whether to pursue the third party. If a third party pays more than the costs incurred by the Board or employer, the surplus must be returned to the worker or their survivors. If the worker chooses to pursue their own action and wins, they lose WSIB coverage, but if they lose or receive less than what the Board would pay, they can return to the Board for compensation. ### **Health Care Overview** **Definition of Health Care\ **Section 32 defines health care broadly, including: - - - - - - - - **Worker Rights and Responsibilities\ **Injured workers have the right to choose their health care provider. The Board will pay for the care, and workers cannot be charged directly. The Board also sets the payment rates and decides on the necessity of treatments. Workers must cooperate with the Board\'s health care requirements; otherwise, their benefits might be reduced or suspended. The Board can request that workers be examined by their selected health professionals. Employers can also ask for their own examinations, but workers can object, although the Board\'s decision is final and not appealable. **Confidentiality and Information Sharing\ **The Board can collect information from health care providers about the worker's treatment and abilities, keeping this information confidential except for those helping the worker return to work. **Employer Responsibilities\ **After an injury, employers must provide transportation for injured workers to medical facilities, and the cost is covered by the employer. The Board also covers damage to assistive devices or prosthetics due to the workplace accident, including prescription glasses. ### **Introduction to Return to Work** **Employer Responsibilities\ **Employers must help workers return to work safely and quickly after an injury. This includes: - - - - **Worker Responsibilities\ **Workers must also participate actively in their return to work by: - - - **Construction Industry Considerations\ **In construction, workers may face less stable employment due to project cycles. If injured for an extended period, they may find their job has ended when they recover. Both employers and workers must cooperate to support the worker\'s return. **Volunteer Workers\ **For volunteers in emergency services, there is a distinction between the \"deemed\" employer (the emergency service) and the \"actual\" employer (the regular employer). The actual employer is responsible for re-employment, while the deemed employer covers associated costs. **Monitoring and Dispute Resolution\ **The Board may check in with both the employer and the worker to ensure they are meeting their obligations. If there are disputes, either party can notify the Board, which will resolve the issue through mediation or a decision within 60 days, though this period can be extended if needed. **Re-employment Obligations\ **According to Section 41, employers must re-employ workers who have been injured and were continuously employed for at least one year. This obligation does not apply to employers with fewer than 20 employees. If a worker hasn\'t returned to work, the Board can assess whether the worker can perform their original job or suitable alternative work. This assessment can happen on the Board\'s initiative or due to a dispute. ### **Practices of Return to Work** **Re-employment Responsibilities\ **When a worker is capable of performing the essential duties of their pre-injury job, the employer must: - - If the worker can do suitable work but not the exact pre-injury tasks, the employer must give them the first chance to take any suitable jobs that open up. **Workplace Accommodation\ **Employers are required to make reasonable accommodations for the worker's return, as long as it doesn't cause undue hardship. This can include: - - - As the worker's abilities improve, the need for accommodations may decrease, making the job more like the one they had before the injury. However, in some cases, permanent accommodations might be necessary if the worker's abilities are limited. If the employer can provide these accommodations without undue hardship, they must do so to help the worker perform essential tasks. **Timeframe for Obligations\ **Employers must meet these re-employment obligations until the earliest of: - - - In the construction industry, these obligations differ slightly, focusing less on the length of employment. **Termination After Re-employment\ **If an employer re-employs a worker under section 41 and then terminates them within six months, it's assumed that the employer didn't meet their re-employment obligation. However, the employer can prove that the termination was unrelated to the injury. The Board can investigate re-employment fulfillment, usually prompted by the worker within three months of termination. If the Board finds the employer failed to re-employ the worker, it can impose a fine and provide payments to the worker for up to a year. This section takes precedence over collective agreements but does not override seniority provisions. ### **Labour Market Re-Entry** In some cases, a worker may not return to their previous job due to: - - - **Labour Market Re-Entry Plans\ **When a worker cannot regain the ability to perform their prior job, a Labour Market Re-Entry Plan may be necessary. This plan often includes training or education tailored to the worker's situation. The Board can initiate a labour market re-entry plan (section 42) based on their assessment of suitable job opportunities. The plan is developed in consultation with: - - - This individualized plan will outline the necessary steps for the worker to re-enter the job market in suitable employment. The Board covers all costs associated with the plan.