The WSIB has typically dealt with infectious or communicable diseases adjudication claims through the WSIB’s Occupational Disease and Survivor Benefits Program. This Program is composed of a specialized team that has dealt with previous infectious or communicable diseases such as SARS, Lyme Disease, and H1N1. An occupational disease is a medical condition caused by exposure to a workplace health hazard.
Obtaining WSIB Benefits
In order to successfully obtain WSIB benefits, a worker must be diagnosed with an illness and the exposure leading to the diagnosed illness occurred at the workplace or was a significant contributing factor in the development of the illness.
This means that if a worker is to receive WSIB benefits due to COVID-19, the worker must be diagnosedwith COVID-19 as a result of a work-related exposure. If a worker has cold or flu-like symptoms this will not automatically indicate that they have a covered illness, or that the illness is work-related. A worker choosing to self-isolate as a precaution, or being sent home as an employer’s preventive decision, would likely not qualify for workers’ compensation coverage.
Like other claims if a worker is entitled to benefits, the worker may be eligible for wage loss benefits that include any period in quarantine pre-diagnosis, healthcare benefits, and permanent impairment benefits arising from the disease. In cases of fatality, the worker’s survivors could receive benefits from the WSIB.
Employer’s Reporting Obligations Have Not Changed
The employer’s obligation to report claims has not changed.
Therefore, regardless of whether the employer agrees that the case meets the criteria for adjudication or allowance, employers should still be reporting the claim to the WSIB (i.e. filing a Form 7). As the WSIB has noted on their website “While the nature of some people’s work may put them at greater risk of contracting the virus, for example those treating someone with COVID-19, any claims received by the WSIB will need to be adjudicated on a case-by-case basis, taking into consideration the facts and circumstances.”
If the status of the worker’s health changes, an employer who has filed a claim is required to report a ‘material change’ to the WSIB within 10 days of awareness of that change. Examples of a material change in the COVID-19 situation include (but are not limited to): general symptoms becoming a confirmed COVID-19 diagnosis, and awareness of a work exposure not previously known that is relevant to the adjudication of a claim.
We will continue to update our clients with information as soon as it becomes available. If you have any questions about this topic, other COVID-19 related questions, or would like assistance with developing and/or reviewing pandemic plans, please do not hesitate to contact a Compclaim Consultant, a Mathews Dinsdale lawyer, or refer to the Firm’s COVID-19 website resources.