WSIB Forms...


Forms Included in the WSIB System Navigator.

• Mandatory Completion of Employer's Report of Injury/Disease, Form 7
• Worker's Claim/Consent Form, Form 1492
• Functional Abilities Form for Timely Return to Work
• Employer's Subsequent Statement, Form 0009
• Employer's Continuity Report, Form WRE07
• Re-opened Claim Earnings (Nominal Rate), Form WRE07E

Form 7
Mandatory Completion of Employer's Report of Injury/Disease, Form 7:  
In every case work-related injury or disease that disables a worker from earning full wages, or results in a worker requiring health care, it is mandatory that the employer's report be submitted within three calendar days using the Employer's Report of Injury/Disease Form 7, or a pre-approved employer created version of the form.

General: A properly completed Form 7 has all the information the WSIB needs to set up a claim. Employers must answer all questions on the form and submit it fully completed to the WSIB. Employers may attach a letter to the Form 7 to provide more information.

[examples of actual output below -pre Nov. 2005 Form 7]

            
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Form 1492
Worker's Claim/Consent Form, Form 1492

The Ontario Worker's Safety and Insurance Board requires that the worker dates and signs the Form 7 prior to submission.  Bill 99 introduced a mechanism for obtaining consent by using the ancillary Form 1492 to indicate this consent.  The WSIB System Navigator now tracks the usage of this form with each claim.



Functional Abilities Form
Functional Abilities Form for Timely Return to Work

The Functional Abilities Form for a Timely Return to Work is completed in part by the employer or the worker and in part by the Health Care Professional. This form is reproduced by the WSIB System Navigator with all fields open for entry except the date of injury. This allows the employer to archive this information and save it for future use, or to be able to recall the information for review.

Form RE07
Employer's Continuity Report, Form WRE07

Guidelines The adjudicator may send the Employer's Continuity Report, Form WRE07, and Re-opened Claim Earnings, Form WRE07E, to the employer when a claim is reopened due to the recurrence of a work related injury.  For accidents that occurred prior to April 1, 1985, the form used is the RE07.

The WRE07 asks the employer for specific information outlining the employers knowledge of the recurrence of the injury, as this information is essential to the adjudicator's decision.

The WRE07E requests all the worker's earnings information usually needed to set the compensation rate for any lost time from work as a result of the recurrence.

Submitting a Form WRE07 ensures that the WSIB will not assign a new claim number to this incident.

Submitting a WRE07 can expedite the claim process and benefit the Board by avoiding the problem of amalgamating a new claim into an existing claim.

In addition, if the worker was employed by a different employer at the time of the previous incident, that employer is charged the total cost of the incident.

Re-opened Claim Earnings (Nominal Rate), Form WRE07E

Guidelines: The WRE07E requests all the workers earnings information usually needed to set the compensation rate for any time lost from work as a result of the recurrence.



Intuitive Use
Every area of work is displayed in the Switchboard. The user does not need to memorize commands or remember the steps to get to a specific point in the program.



Intuitive Use
Every area of work is displayed in the Switchboard. The user does not need to memorize commands or remember the steps to get to a specific point in the program.

 

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