Reporting Novel Coronavirus (COVID-19) WSIB Claims
My office has received several inquiries about WSIB claims arising from the COVID-19 virus. While the virus is a new phenomenon which most organizations were not equipped to manage when it arrived, the WSIB process for determining entitlement is unchanged – on a case-by-case basis.
“When Do I Report A COVID-19 Claim?”.
As with any and all claimed work-related injuries/illnesses, the obligation to report is set out in Section 21 of the WSIA, 1997.
An employer must report to the WSIB within 3 days after learning an accident to a worker required health care or resulted in the worker not being able to earn full wages.
The legislation explained further by the WSIB policy 15-01-02 (Employers’ Initial Accident-Reporting Obligations) providing definitions, circumstances and timelines.
The Employer’s Exposure Incident Reporting Form—PEIR can be used to report Novel Coronavirus claims. Employers in the construction industry should use the CEIR form. Both forms can be found at www.wsib.ca/business/resources/forms.
The Adjudicative Approach document of March 23, 2020 guides the Adjudicators in determining entitlement. Again, as we see with reporting, the determination of entitlement is set out in Section 13 of the WSIA, 1997.
A worker who sustains a personal injury by accident arising out of and in the course of employment is entitled to benefits under the insurance plan (Act).
Novel Coronavirus claims are adjudicated in the same manner. In order for the Adjudicator to determine entitlement, consideration must be given to:
The risk of contracting the disease created by the worker’s employment is greater than the public at large exposure.
Has a contact source to COVID-19 within the workplace been identified?
Does the nature and location of employment activities place the worker at risk for exposure to infected persons or infectious substances?
Was there an opportunity for transmission of COVID-19 in the workplace via a compatible route of transmission for the infectious substance?
The WSIB is satisfied the worker’s COVID-19 condition has been confirmed.
Are the incubation period, the time from the date of exposure and the onset of illness, clinically compatible with COVID-19 that has been established to exist in the workplace?
Has a medical diagnosis been confirmed?
If not, are the worker’s symptoms clinically compatible with the symptoms produced by COVID-19?
Is this supported by an assessment from a registered health professional?
Multiple potential sources of COVID-19 exist in the community, at home and outside of work, creating challenges in establishing work-relatedness when adjudicating claims.
The Adjudicator having gathered the evidence then weighs the evidence with the key focus on determining whether the worker’s employment was a significant contributing factor in the contracting of the disease.
Does the worker’s employment activities, their symptoms and a diagnosis of COVID-19 exist?
Is the worker’s employment activities a significant contributing factor to their exposure of COVID-19?
Symptom-free workers will not be given coverage (entitlement) even if they are quarantined or sent home on a precautionary basis.
Employers should be mindful that the WSIB is the adjudicative body mandated to determine entitlement. An employer should not draw a conclusion on the cause of exposure – leave this to the WSIB. Voice your opinion on the PEIR form, submit to the WSIB within the required time frame and follow up with the WSIB for a decision in writing.