E-TRACKR

1
Claim Number* This field is required.
2
Email* This field is required.
example@example.com
3
Date* This field is required.
Date
Month
Day
Year
4
The following section pertains to the activity regarding your claim that you are participating in.
5
Check the appropriate activity* This field is required.
Made phone call
Received phone call
Sent an email
Received an email
Sent letter
Received letter
Sent a fax
Received a Fax
Setup a Meeting
Had a Meeting
Other
6
Who was the activity with?Select from the list the title of the individual (s) who participated in the activity. For example, select Case Manager if your activity was with your Case Manager, or Employer if your activity was with your employer. You can also pick more than one person if your activity was with more than one individual.
Case Manager
Eligibility Adjudicator
Case Manager
Nurse Consultant
Return-to-Work Specialist
Appeals Resolution Officer
My Family Doctor
Other Health Care Professional
WSIB Specialt Clinic
Non-Economic Loss Assessment (NEL)
My Employer
My Union Rep
My retraining facility (College, University, ESL)
Functional Abilities Evaluation
The Workplace Safety & Insurance Appeals Tribunal
The Canada Revenue Agency
7
Name of individual who the activity was with.* This field is required.
First Name
Last Name
8
Additional names and Title
9
Describe what took place during the activity* This field is required.Provide a brief description of the nature of the activity and the outcome. For example. I spoke with my Case Manager on the phone regarding my LOE benefits. The Case Manager advised me that a decision would be made by tomorrow and that she would call me with the results at 4 pm tomorrow
10
Expected outcome from that activity?The expected outcome can be anything from a promise from your WSIB Case Manager to get back to you with a decision on a specific date, or an appointment with a specialist to review test results, a meeting with your employer regarding return to work, etc.
11
Document Upload
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Upload any documents specifically pertaining to this activity
Cancelof
12
WSIB Settlements
First Name
Last Name
Should be Empty: