WSIB Claim Denied? Here's Exactly What to Do Next

Nearly 30% of WSIB claims are initially denied. If you just received a denial letter, you're not alone—and this isn't the end.

Many successful claims start with an initial denial. The key is knowing how to respond quickly and effectively.

This guide shows you exactly what to do in the first hours and days after a denial to preserve your rights and build a winning appeal.

First: Don't Panic

A denial doesn't mean you won't get benefits. It means WSIB needs more evidence or clarification.

Common reasons for denial:

• Insufficient medical documentation
• Injury wasn't clearly work-related
• Missed deadlines or incomplete forms
• Pre-existing condition concerns
• Employer disputes the claim

Most of these can be overcome with the right approach.

Step 1: Read the Decision Letter Carefully (Immediately)

Your WSIB decision letter contains critical information:

Find These Key Details:

1. Claim number - You'll need this for all communication
2. Decision date - Starts your appeal deadline clock
3. Specific reason for denial - The exact issue you must address
4. Policy references - WSIB policies they relied on
5. Appeal rights - Deadline and process information

Identify the Denial Type:

Initial claim denial: WSIB doesn't believe the injury is work-related

Benefit denial: Claim accepted but specific benefits denied (LOE, medical costs, etc.)

Duration denial: Benefits approved but for less time than you need

Each type requires a different appeal strategy.

Step 2: Understand Your Deadlines (Critical)

You have 6 months from the decision date to request reconsideration.

But don't wait. The sooner you act:

• The easier it is to gather evidence
• The faster you can get benefits
• The more credible your case appears

Mark these dates on your calendar:

• Decision date + 30 days: Ideal objection timeline
• Decision date + 3 months: Latest for strong case
• Decision date + 6 months: Absolute deadline

Step 3: Gather Your Documentation (Within 72 Hours)

Pull together everything related to your claim:

Medical Records

• Doctor's notes from injury date
• All follow-up appointments
• Diagnostic test results (X-rays, MRIs, etc.)
• Specialist reports
• Current treatment plan
• Work restrictions

Employment Records

• Your Form 6 (Worker's Report)
• Employer's Form 7
• Incident reports
• Witness statements
• Photos of injury location
• Safety records

Communication Records

• All WSIB correspondence
• Emails with your employer
• Text messages about the injury
• Voicemail recordings (if relevant)

Tip: Organize everything chronologically in a folder—physical or digital.

Step 4: Identify the Evidence Gap

Ask yourself: "Why did WSIB deny my claim?"

Then: "What evidence would prove they're wrong?"

Common Gaps and Solutions:

Gap: "Injury not clearly work-related" Solution: Get a doctor's letter explicitly linking injury to workplace duties

Gap: "Pre-existing condition" Solution: Show how work made it worse with before/after medical evidence

Gap: "Insufficient medical documentation" Solution: Request comprehensive report from treating physician

Gap: "Incident not reported timely" Solution: Explain reason for delay with supporting evidence

Gap: "Employer disputes facts" Solution: Gather witness statements, photos, safety reports

Step 5: Get New or Better Medical Evidence

The most powerful appeals have strong medical support.

What You Need:

A medical report that clearly states:

1. Your diagnosis
2. How the injury occurred (mechanism)
3. Why it's work-related
4. How it prevents you from working
5. Expected recovery timeline

How to Get It:

Call your doctor's office:

• "I need a detailed medical report for my WSIB appeal"
• "The report should link my [injury] to my work duties"
• "WSIB denied my claim for [reason]"
• "Can you provide a report addressing this?"

Most doctors charge $50-$200 for this service. It's worth it.

If Your Doctor Won't Help:

• Get a second medical opinion
• See a specialist relevant to your injury
• Request your complete medical file
• Hire a medical-legal expert (for complex cases)

Step 6: Write Your Objection Letter

Your objection letter should:

• Reference your claim number
• State you're requesting reconsideration
• Identify the specific decision you're appealing
• Explain why the decision is wrong
• Point to evidence that supports your position
• Be professional and factual

Sample Letter Structure:

[Your Name]
[Address]
[Date]

WSIB Reconsideration Unit
200 Front Street West
Toronto, ON M5V 3J1

Re: Request for Reconsideration - Claim #[Your Claim Number]

Dear WSIB Decision-Maker:

I am writing to formally request reconsideration of the decision dated [Date] to deny my claim for [injury].

REASON FOR DENIAL:
According to your decision letter, my claim was denied because [quote specific reason].

WHY THE DECISION IS INCORRECT:
[Explain clearly why you disagree, with specific facts]

NEW EVIDENCE:
I am providing the following new evidence that was not available at the time of the initial decision:
1. [Medical report from Dr. X dated...]
2. [Witness statement from...]
3. [Photographs showing...]

CONCLUSION:
Based on this evidence, I respectfully request that you reconsider and approve my claim.

I am available to provide any additional information needed.

Sincerely,
[Signature]
[Name]
[Contact Information]

Step 7: Submit Your Reconsideration Request

How to Submit:

Online (fastest):

• Log into WSIB portal
• Upload objection letter + evidence
• Get confirmation number

By Mail: WSIB 200 Front Street West Toronto, ON M5V 3J1

By Fax: 1-888-313-7373

What to Include:

• Objection letter
• New medical evidence
• Witness statements
• Photographs
• Any other supporting documents

Keep copies of everything you send.

Step 8: Follow Up (1 Week Later)

One week after submitting:

• Call WSIB: 1-800-387-0750
• Reference your claim number
• Confirm they received your objection
• Ask about timeline for decision
• Get the adjudicator's name if possible

What Happens Next?

After you file an objection:

1. WSIB acknowledges receipt (1-2 weeks)
2. They review your new evidence (4-8 weeks typically)
3. They may request more information
4. They issue a reconsideration decision

Possible outcomes:

• ✅ Approved: You get benefits
• ⚠️ Partially approved: Some benefits granted
• ❌ Upheld: Denial stands

If Reconsideration Fails: Appeals Tribunal

If WSIB upholds the denial, you can appeal to WSIAT (Workplace Safety and Insurance Appeals Tribunal).

WSIAT is independent from WSIB and often overturns denials.

You have 6 months from the reconsideration decision to file a WSIAT appeal.

Important: WSIAT appeals are more formal. Consider getting a representative or lawyer.

Common Mistakes That Weaken Appeals

1. Waiting too long to act

   • Evidence gets harder to find
   • Witnesses forget details
   • You miss deadlines

2. Not getting new evidence

   • Just arguing won't work
   • You need NEW information

3. Being emotional or accusatory

   • Stick to facts
   • Be professional
   • Let evidence speak

4. Giving up after first denial

   • Many claims succeed on appeal
   • Persistence pays off

5. Not keeping records

   • Track all communication
   • Save all documents
   • Note phone call details

Should You Hire a Representative?

Consider professional help if:

• Your claim is complex (psychological injury, occupational disease)
• There's a pre-existing condition issue
• Your employer is aggressively disputing
• You're appealing to WSIAT
• You're not confident handling it alone

Representatives can:

• Navigate WSIB bureaucracy
• Gather proper medical evidence
• Write effective submissions
• Argue your case at hearings

Cost: Many work on contingency (percentage of benefits awarded)

Your Appeal Checklist

Before submitting your reconsideration:

• Read decision letter thoroughly
• Identified specific denial reason
• Gathered all relevant documents
• Obtained new medical evidence
• Collected witness statements (if applicable)
• Written clear objection letter
• Organized evidence chronologically
• Made copies of everything
• Submitted before deadline
• Followed up for confirmation

You Can Still Win

A denial is not a dead end. It's a request for better evidence.

Approach your appeal:

• Systematically (follow the steps)
• Professionally (stick to facts)
• Persistently (don't give up)
• Strategically (address the specific denial reason)

Remember: WSIB denies many legitimate claims initially. Your job is to show them why yours should be approved.

---

Next Steps:

• WSIB Appeal Process Guide
• How to File a WSIB Claim
• Understanding WSIB Form 6

Need Help? ClaimNexus can help you track deadlines, organize evidence, and build a stronger appeal. Start free trial