Understanding WSIB: What is a “Material Change” in Circumstances?
If you are receiving workers compensation benefits in Ontario, one of the most important things you need to communicate to WSIB is any “material change” in your circumstances. What does that mean?
A “material change in circumstances” is any change that affects your entitlement to WSIB benefits or services. These changes generally fall into one of six categories.
1. Changes in your health status
This could be your work-related injury improving or getting worse, changes to your treatment (including discontinuing treatment or beginning new ones), or a need for surgery, or a new or changing need for an assistive or prosthetic device.
2. Changes in your earning/income
This includes getting a wage increase or decrease, receiving any other disability benefits related to your work injury (such as CPP), or changes in the amount of those disability benefits.
3. Changes in work status
This could be changes to your duties or hours related to your injury, being let go from your job, or deciding to retire or look for other work.
4. Changes in availability for, or co-operation in, health care or return-to-work activities
This may apply if you have another medical condition or injury that prevents you from working, if you move or leave the province, if you go to prison, or if your work visa ends or you are expecting to be deported.
5. Changes in insurance coverage
If you applied for optional WSIB coverage (for instance, because you are an independent operator, sole proprietor, etc., and are not automatically covered by WSIB), and your earnings change, that must be communicated to WSIB, since your earnings are used to set the amount of coverage.
6. Changes in dependant’s entitlement to benefits
If dependant children are receiving survivor benefits, it must be reported when a dependant child turns 19 and continues to go to school, or when a dependant child who was previously physically or mentally unable to earn wages becomes able to earn.
As you can see, there are many circumstances in which you need to report changes to WSIB. If you are unsure whether you need to report sometimes, it is better to err on the side of caution and report it.
When do I need to report?
You must report material changes in circumstance to WSIB within 10 days of the change (the 10 days includes the day the change occurred).
What if I don’t report?
WSIB will presume that you deliberately didn’t communicate, unless you can show otherwise. This can be serious business; if you fail to report a material change can lead to fines or prosecution.
That said, in order to receive a conviction, WSIB has to prove that you willfully intended not to inform them of a change in order to keep getting benefits that you knew you’d no longer be entitled to.
Who does this rule apply to? Who must report?
This rule applies to workers receiving WSIB benefits, or a surviving spouse/dependant. Employers have their own set of material changes that must be reported to the WSIB.
It does not apply to people receiving WSIB temporary disability benefits, permanent disability benefits, or survivors’ benefits for an accident that happened before 1990.