The WSIB’s Approach to Adjudicating COVID-19 Claims
March 27, 2020 By: Peggy King Read Time: 2 minutes
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At this time, the WSIB is not allowing claims for workers who are symptom free, even if they are quarantined or sent home, as a precaution against potentially infecting their coworkers.

This may however change, should the worker become symptomatic while in quarantine, and could entitle the worker to benefits and services.

In assessing the work relatedness of COVID-19 claims, the adjudicator will consider whether:

  • the nature of the worker’s employment created the risk of contracting the disease; and
  • the WSIB is satisfied the worker’s COVID-19 condition has been confirmed.

If the above conditions are established, generally this would be considered persuasive evidence that a worker’s employment was a significant contributing factor to their illness.  If a claim does not meet these guidelines, the file will be reviewed on its own based on the circumstances of the individual case.

Key Factors Which Will Be Investigated

At this time, the WSIB is not allowing claims for workers who are symptom free, even if they are quarantined or sent home.

  • whether the nature of the worker’s employment created an increased risk of contracting the virus;
  • has a contact source within the workplace been identified?
  • does the nature and location of work activities place the worker at risk for exposure to the infection?
  • was there an opportunity for transmission of the virus in the workplace due to a compatible route of transmission for the virus?
  • are the incubation period, the time from the date of exposure, and the onset of the illness compatible with the virus that has been confirmed to exist in the workplace?
  • is the diagnosis confirmed by testing? If not, are the symptoms compatible with those produced by the virus and is this supported by a health professional?

Although a claim may not initially be approved for lost time from work, if a worker is diagnosed with COVID-19, we recommend submitting a claim for benefits by filing a Worker’s Report of Injury (Form 6), or by filing a form with the WSIB for exposure to the virus through the WSIB’s Program for Exposure Incident Reporting (PEIR) program.  It is also important to advise your employer if you are filing a claim with the WSIB, and the reasons why you believe you have been exposed, or are ill.

The WSIB’s current approach to the adjudication of COVID-19 claims may change as time passes.

For more information about WSIB claims, please contact our Employment Law group.

This content is not intended to provide legal advice or opinion as neither can be given without reference to specific events and situations. © 2020 Nelligan O’Brien Payne LLP.

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