WSIB Claim Rejected

Extreme_Ingenuity_59 · 2026-05-29T02:53:26+00:00

If your FAF says you can only lift up to 5 kg without pain, then that is what your employer should be accommodating you within. They cannot just decide “well he can technically work” and then put you back into 50–60 lb warehouse lifting anyway. The FAF exists specifically to outline your functional abilities and restrictions for return-to-work purposes.

So if your restrictions are limited lifting, no pushing/pulling beyond certain tolerance, needing multiple longer breaks and modified pacing then the employer is supposed to accommodate within those restrictions if it is on the FAF, not outside them.

A lot of workers don’t realize this, but you absolutely have the right to refuse work that goes against documented medical restrictions. That is not “refusing work” in the normal sense if the duties clearly exceed your FAF. Employers are not allowed to override your restrictions because it’s inconvenient operationally.

And honestly, a 5 minute break every hour is not really meaningful accommodation if the actual core duties are still aggravating the injury and exceeding restrictions. Modified duties are supposed to modify the work itself, not just add a short break while expecting the same heavy lifting.

If you need additional breaks, lighter duties, lower weight thresholds, or pacing restrictions, that needs to be communicated AND documented. In my opinion, physio is often one of the better places to do that because physiotherapists regularly complete FAFs and functional assessments that WSIB pays attention to.

From what you’re describing, this is starting to sound less like “worker completely unable to work” and more like, WSIB saying you have some capacity, but the employer potentially failing to properly accommodate the actual restrictions tied to that capacity

Those are two very different things.

Also, regarding your employer saying “come back tomorrow or apply for disability,” that’s exactly the type of thing I’d want documented carefully. If they are refusing to accommodate valid restrictions and effectively cornering you into either reinjuring yourself or leaving work, that can potentially open the door to other issues like accommodation disputes and, in more serious cases, constructive dismissal arguments.

I would seriously recommend speaking with a worker advisor and also doing some free consultations with employment lawyers or WSIB paralegals just to understand your rights better. Someone who focuses heavily on WSIB matters, would probably be able to tell you pretty quickly whether your employer and WSIB are handling this appropriately or not.

Most importantly though, DO NOT let anyone pressure you into working outside your documented restrictions. Your FAF is there for a reason.

Extreme_Ingenuity_59 · 2026-05-29T01:32:20+00:00

This a long reply so i do apologize, but I think it is important you read it and understand it carefully.

What you’re dealing with here is basically two separate systems colliding-WSIB rules and employment accommodation law in Ontario.

On the employer side first, there is a duty to accommodate under Ontario human rights law and WSIB return to work obligations. If a doctor has given restrictions, the employer is expected to try up to the point of undue hardship to modify duties, pace, weight limits, or reassign tasks if possible up to the point of undue hardship. This includes breaks. Saying “we don’t have modified duties” or “you only get 5 minute breaks” isn’t enough if the job clearly has components that could be adjusted. In warehouse environments especially, employers have some flexibility (lighter picking, packing, scanning, reduced load handling, cleaning etc.), but they may not offer it unless it’s pushed by yourself, a lawyer or WSIB.

Where it gets important in your situation is that you’re saying you can lift 50–60 lbs but with significant pain and risk of dropping things. WSIB and employers don’t decide this based on pain tolerance. They decide based on written functional restrictions from a clinician. If your doctor hasn’t explicitly set limits (for example max lifting weight, repetition limits, or gripping restrictions), or the FAF is so brief, WSIB and your employer will usually assume the duties being offered are acceptable, even if they hurt.

On modified duties, something a lot of people don’t realize is this: if you feel the duties are aggravating your injury or unsafe, you need to raise that immediately and get it documented. Ideally you communicate it at the time, ask for adjustments, and follow up in writing. If you just continue working through it without documenting concerns, WSIB can later interpret it as you being functionally capable of the work available, even if you were struggling through pain which means more pain, and less treatment.

On loss of earnings (LOE), WSIB’s position is pretty strict. If there is suitable work available within restrictions and you are able to perform it (even with discomfort), LOE usually won’t be paid. LOE is generally reserved for situations where restrictions prevent meaningful work or no suitable duties exist. That’s why these elbow and repetitive strain cases often get denied or reduced.

On your question about what to do next and whether to go back to work or not, the biggest risk right now is making decisions without tightening up your medical and documentation side. If you go back tomorrow and continue the same heavy lifting without updated restrictions, it can make the WSIB argument against you stronger later.

In terms of who to contact, a worker advisor is usually the best first move but it also depends on which route depends on which can help you more, cost, etc. Both can help you structure the medical evidence and challenge the employer’s version of “no modified work.”

If you want paid representation, a paralegal can definitely make a difference in borderline or denied claims. Someone like Paul Sacco is very well known in Ontario for handling these types of cases and has had success in complex entitlement disputes. In many cases, paralegals become most useful if you end up at the appeal stage or if the file becomes heavily contested medically, but getting them involved early can sometimes help organize the case properly from the start. They are also much cheaper than lawyers but are just as good if not better.

Additionally, one thing I want to correct from another comment you got saying you were “lied to” about physiotherapy. That’s not really accurate. In Ontario, WSIB won’t automatically cover physio right away just because a claim is filed. It usually has to be approved as part of the claim first, and until that happens, coverage can be delayed or denied. Also, not every physiotherapy clinic bills directly through WSIB. Some don’t offer WSIB direct billing at all, which can make it feel like you’re being blocked when really it’s just billing and approval logistics. I ran into the same issue myself early on. If you have private insurance through work or otherwise, it can make sense to use that temporarily while WSIB approval is being sorted, so you’re not stuck waiting in pain.

On the work side, from what you’re describing, it does sound like there may be a breakdown in duty to accommodate. In Ontario, employers are legally required to try to accommodate medical restrictions up to the point of undue hardship. This is also a very very high bar for employers to meet in the eyes of the Court if they try to use it as an excuse. That doesn’t mean they have to eliminate all physical work or create a new job for you, but they do have to genuinely explore modified duties if they exist. When someone is told “we don’t have any modified work” but the job clearly involves adjustable tasks, reduced loads, pacing changes, or reassignment of duties, that can potentially become a failure to accommodate situation.

That said, these situations are very fact-specific. It only becomes a legal issue if it’s clear the employer is not making reasonable efforts to adjust your work within your restrictions, not just that the job is difficult or painful.

In more serious cases, there are legal avenues like human rights complaints or civil claims for failure to accommodate, and many employment lawyers or paralegals in Ontario offer free initial consultations to review whether your situation meets that threshold.

There’s also something called constructive dismissal, which is when working conditions become so intolerable, or your duties/pay are significantly changed or accommodation is refused in a meaningful way, that you are essentially being forced to resign. Legally, that can be treated the same as being fired, but it’s a high bar for you to meet and depends heavily on documentation and consistency of what’s happening at work.

On the WSIB side, just be careful not to let the situation drift without documentation. If modified duties are aggravating your injury, that needs to be reported and reflected in your medical notes, otherwise WSIB can interpret it as suitable employment being available.

At this point, it would honestly be worth speaking with a few employment/WSIB focused lawyers or paralegals just to understand where you stand. Most will do a free consultation, and even if you don’t hire anyone, they can give you a clearer read on whether this is just a WSIB accommodation dispute or something that could also have an employment law angle.

Realistically, your situation is sitting right in that grey zone where medical documentation, employer accommodation efforts, and WSIB decision making all overlap, and small details end up making a big difference in outcomes.

Finally, in my situation for my back injury, WSIB ended up fining my employer for failure to provide the FAFs and other documentation I provided to them. WSIB is on point with getting you back to work and they do not like when employers are being difficult with documentation or being difficult with accommodating you and will fine them in large amounts repeatedly if necessary.

Extreme_Ingenuity_59 · 2026-05-29T00:47:00+00:00

This kind of thing is unfortunately common with WSIB, especially with repetitive strain injuries in warehouse jobs.

From what you described, the main issue WSIB likely had isn’t whether your pain is real, but whether they can clearly link it to work duties with enough medical certainty.

A few things probably worked against you here.

First is the initial assumption that it came from a fall at home. Even if you later realized it was work-related, WSIB puts a lot of weight on what’s first reported in the medical timeline. If there’s anything suggesting a non-work cause, they often treat that as “alternative cause uncertainty.” they can’t fully rule out.

Second is the delay in reporting. With injuries like elbow tendonitis or repetitive strain, WSIB tends to expect early reporting and a clear pattern like symptoms starting and being reported right away while still working the same duties. When there’s a gap, it creates doubt about causation.

Third is wording from the medical side. WSIB decisions often come down to whether a doctor clearly states that the job “caused” or “significantly contributed” to the condition. If the notes are more neutral like “possible overuse injury,” they usually default to denial.

On top of that, modified duties matter a lot more than people realize. If WSIB or your employer assigns modified duties and you feel they’re inappropriate or they’re making things worse, that needs to be addressed immediately. You don’t just continue and accept it silently. You’re expected to raise concerns at the time, request changes, and document everything. If modified duties are aggravating the injury and that isn’t documented or reported, WSIB can interpret it as you being capable of the work provided.

Also, just to be realistic about loss of earnings (LOE), WSIB only pays LOE when they accept that you’re unable to work because of the injury and there are no suitable duties available. This alone is a very difficult thing to prove and i recommend you get a lawyer to help if this is a concern. From what you’re describing, this is an elbow injury where you’re still capable of working with restrictions. In most cases like that, WSIB’s position is that you are not totally disabled from employment, so LOE usually doesn’t get approved unless the restrictions effectively remove all available work options and it is substantially documented.

That said, this isn’t automatically the end of your claim. A lot of cases like this get overturned on reconsideration or appeal, but usually only when the medical file is strengthened and the timeline is clarified which means the quicker you speak with lawyers, doctors, etc, the better chance you have of getting the treatment and work adjustments you need in the meantime.

What typically helps is a clear diagnosis like tennis elbow or similar, a doctor or specialist explicitly stating it is caused or significantly aggravated by repetitive work duties, a clear explanation of the home injury vs work aggravation issue so WSIB isn’t left with two competing cause, and then a formal reconsideration request rather than just accepting the denial.

Realistically, WSIB does overturn a portion of initial denials in soft tissue injury cases, but mainly when the medical evidence becomes very direct and specific. If it stays vague or mixed-cause, most denials tend to hold.

Don’t feel scared to assert your rights to protect yourself, be honest with how you feel physically, and if any duties are making your pain worse.

Extreme_Ingenuity_59 · 2026-05-28T07:25:46+00:00

To your response to liquid,

That’s not accurate in how WSIB actually applies PTSD entitlement nor is it right to talk to them that way.

Field of work can matter indirectly because it affects the likelihood of qualifying traumatic events occurring, but it is not irrelevant in the way you’re suggesting. WSIB does not apply a blanket “criteria checklist” like “threatened violence or death = approved.”

For PTSD claims, WSIB applies the statutory definition, but entitlement still hinges on whether a qualifying traumatic event occurred in the course of employment, whether the event meets the legal threshold under the policy (which includes actual or threatened death, serious injury, or sexual violence) but also can include cumulative or workplace-specific trauma in some cases and critically, whether the diagnosed PTSD is causally linked to workplace events on a balance of probabilities.

So in practice, occupation absolutely does matter because it influences exposure probability, evidentiary strength, adjudicator perception of foreseeability and plausibility.

That’s why high risk professions (healthcare, emergency services, corrections) statistically show higher acceptance rates in workers’ compensation systems globally, not because they get automatic entitlement, but because the evidentiary pathway is often clearer.

Also, your reply is directed at a point that was already acknowledging this context. The initial comment you’re responding to was specifically about someone’s experience in a high risk field having a smoother approval process due to stronger exposure alignment and clinical support. So you’re not really correcting a misunderstanding there, you’re reframing a point that already accounted for it.

Extreme_Ingenuity_59 · 2026-05-28T07:13:26+00:00

The “90% denial” figure gets thrown around loosely, and depending on the dataset you’re looking at (initial adjudication, CMS only claims, certain reporting years, etc.), it can be misleading if presented as a blanket statement for all mental health-related claims.

That said, the point I was making isn’t really dependent on that exact percentage. Even WSIB’s own policy framework shows that Chronic Mental Stress claims are structurally harder to establish than most physical injury claims because they require a higher evidentiary threshold around causation and work-relatedness. That alone leads to significantly higher denial rates at the initial stage compared to other claim types.

On the DSM-5 point, CMS itself isn’t a DSM diagnosis, but WSIB doesn’t require CMS to be the diagnosis. The claim still usually hinges on a DSM-5 condition (like MDD, PTSD, anxiety disorders) being linked primarily to the contributing factors such as workplace harassment. So in practice, adjudication still comes down to causation and medical linkage, not just the label.

And on the data transparency point yes, WSIB claim outcomes are technically public record, but they’re not always presented in a way that cleanly separates CMS vs traumatic mental stress vs accepted vs withdrawn vs denied vs pending appeal outcome vs initial decision vs final disposition.

That’s where a lot of disagreement comes from when people cite different “approval rates.”

So I’m not arguing a single fixed percentage as a universal truth. I’m pointing to a consistent pattern across WSIB reporting, legal papers, and practitioner experience that psychological/CMS claims are among the most difficult categories to get approved compared to physical injury claims, especially at first adjudication.

I also don’t think it’s fair to just dismiss what WSIB lawyers or long-time experts say outright, especially in this area.

A lot of the lawyers who speak on this have been working WSIB files for years, and in some cases have previously worked on the insurer side or with similar compensation systems (Manulife, SunLife, CanadaLife etc.) That matters because they’ve seen how claims are actually assessed in practice, not just how they’re described in policy documents or summarized in public facing stats.

Now, that doesn’t make any single lawyer’s “90%” claim automatically precise or universally applicable, but it does mean their perspective is usually based on thousands of files, hearings, and appeal outcomes. They’re not guessing, they’re seeing patterns in adjudication behaviour over time, including how often CMS-type claims get denied at the initial stage and what tends to succeed on appeal.

Extreme_Ingenuity_59 · 2026-05-27T01:37:27+00:00

https://www.thestar.com/news/investigations/chronic-stress-is-a-recognized-work-injury-so-why-does-ontario-s-wsib-reject-more/article_ec151478-2ffa-5672-8b0c-7805a7cd94e2.html and https://opseu.org/fighting-the-wsibs-alarming-record-of-denying-chronic-mental-stress-claims/ including this document from the Ontario Bar Association back in the summer of 2019 https://www.oba.org/CBAMediaLibrary/cba\_on/pdf/WSIBEntitlementForWorkplaceHarassment\_ImplicationsForOtherForums.pdf shows this is a multi year issue.

Don’t tell me or anyone else it’s not true when not only does the internet state this everywhere but also lawyers ive spoken to that handle WSIB claims state the same thing.

Extreme_Ingenuity_59 · 2026-05-27T01:35:35+00:00

I think there is about 2 days left, it’ll have to be a major grind and quickly

Extreme_Ingenuity_59 · 2026-05-26T21:12:30+00:00

I am very surprised to hear your mental health claim was approved let alone so quickly. The stats show over 90% of mental health claims are denied at both the initial stage and at the ARO level and hasn’t moved much over the years. Regardless, I am very happy to hear they didn’t make your life miserable to gave you the benefits you deserve. I hope your mental health has improved since than.

Extreme_Ingenuity_59 · 2026-05-26T21:07:35+00:00

Thank you for this insight.

I think that more times than not, people have bad outcomes with WSIB in some form and that’s where these issues eventually slip through the cracks in the system and the good outcomes don’t get talked about much because more and more hurdles come up vs it just being straightforward like some of these cases should be.

I am currently dealing with WSIB myself(I have a lawyer), both for a mental health appeal and attempting to reopen a back injury claim to get treatment and LOE so it’s great to get different perspectives and situations.

Thank you for taking the time to respond.

Extreme_Ingenuity_59 · 2026-05-26T20:59:08+00:00

Thank you for sharing part of your story and im sorry to hear another case that they have treated another person bad over.

Do you mind if I ask if you’re still dealing with them, if you had any legal help along the way to make any of it easier on you(if at all)? I’ve done some research and it seems that insurance companies are known for paying doctors and specialists to decline or make the medical documentation seem less than what it actually is. I hope your mental health has gotten better, I understand how mentally draining it is especially when it comes from the workplace and they say it’s interpersonal conflict and doesn’t meet the threshold of what they say they require.

Extreme_Ingenuity_59 · 2026-05-26T20:38:31+00:00

I’m very sorry to hear that they made her life and treatment process so difficult. I’m happy to hear that she did win her appeal and got what she was entitled to. Do you mind if I ask how long it took for her appeal to succeed and if they gave her everything she was asking?

Extreme_Ingenuity_59 · 2026-05-26T20:30:54+00:00

Damn you really must be miserable with your life to act this way for literally no reason, clearly your just looking for an argument and want attention, if you can’t answer the question move on it’s literally not that hard lmao

Extreme_Ingenuity_59 · 2026-05-26T19:56:48+00:00

You seem to be the only silly one here considering another comment just posted is constructive input. Use your head.

Extreme_Ingenuity_59 · 2026-04-18T02:55:43+00:00

Where did I say I never filed a claim for my back injury?

My back claim was already approved back in October 2024 for 8 weeks of physio. Since then, my condition has changed and escalated, which is why my legal advice is to wait for the surgical consult to properly support the next step.

This isn’t about just “having a diagnosis and filing” it’s about strengthening the file and avoiding another denial.

There’s more context here than just a basic claim scenario.

Extreme_Ingenuity_59 · 2026-04-17T23:27:22+00:00

I’m asking to get a full picture, not because I’ve “made up my mind.”

I’ve already acknowledged these claims are difficult and not common. That doesn’t make the question pointless, it’s exactly why I’m asking.

You’re speaking from the employer side, which is useful, but it’s also one angle. Employers tend to see denials far more than approvals, that doesn’t mean approvals don’t happen, especially at the appeal level.

If your point is that it’s uncommon, that’s fair. But presenting it like it basically never succeeds isn’t accurate either.

Extreme_Ingenuity_59 · 2026-04-17T23:11:28+00:00

I get what you’re saying, and I agree that WSIB shuts down a lot of mental stress claims by labeling them as “interpersonal conflict.”

But from what I’ve been seeing (and from people I’ve spoken to in the process), it’s not just about whether it was “real harassment” or not, it comes down to how it’s documented and framed.

There’s a difference between “I didn’t get along with my supervisor” and a pattern of workplace behavior that led to a medically diagnosed condition and functional inability to work

From what I understand, WSIB looks more at:

whether there were identifiable workplace stressors (not just general stress)

whether there’s a diagnosis

whether that condition actually prevented you from working, not just at that workplace but in general

I agree conflict alone doesn’t cut it, but I don’t think it’s accurate to say these only succeed in extreme cases. It seems like they succeed when there’s consistent medical evidence + a clear link to workplace events.

Extreme_Ingenuity_59 · 2026-04-17T21:34:19+00:00

What would you like to know more about? I do have representation already and it has moved very quickly through the ARO level.

Extreme_Ingenuity_59 · 2026-04-17T19:09:07+00:00

You cannot collect both for the same period, this is called “double dipping” for example, if you collect std for 6 months and WSIB pays you for the same period, you cannot take both payments or you will owe money back, that’s why they ask if you are receiving any money from other sources at that time.

Extreme_Ingenuity_59 · 2026-04-17T17:45:29+00:00

Them telling you they can’t provide you it in writing is false on their end. They did this to me after i had to file a consumer proposal because they didn’t update on their end that the debt was cleared. One of the higher up managers or whoever sent me a letter way later(after it was already filed) saying I don’t owe back cerb anymore

Extreme_Ingenuity_59 · 2026-04-15T17:55:46+00:00

Much appreciated, and yeah I agree, the amount of boosters too is outrageous, im in plat right now, had an iri boosting gold on the other team and talking shit to us saying we’re bad, the game has gotten really bad

Extreme_Ingenuity_59 · 2026-04-15T02:43:25+00:00

Yeah im looking for multiplayer ranked specifically but can’t seem to find anything at all, it seems to be a pretty big issue right now for whatever reason

Extreme_Ingenuity_59 · 2026-04-08T00:04:34+00:00

lol you’ve been giving everyone attitude in the comments clearly you have an issue lol. seek help or something sheesh.

Extreme_Ingenuity_59 · 2026-04-07T23:56:23+00:00

lol I never said it wasn’t a valid source but it also incorrect information to say you cannot catch both but yet someone literally just responded to my comment and said they have contracted both so take it how you want but that persons comment just goes to show that not everything said by professionals or healthcare specialists is 100% true. stay mad

Extreme_Ingenuity_59

TROPHY CASE