Just Ask Joe Form

1
Full Name* This field is required.
First Name
Last Name
2
Phone Number* This field is required.
3
E-mail* This field is required.
example@example.com
4
Date of birth* This field is required.
Date
Month
Day
Year
5
Date of injury or illness
Date
Month
Day
Year
6
Claim Number
7
Provide a brief description of injury or illness (example; area of injury):
0/300
8
Were you granted a Non-Economic Loss award (NEL) for your injury or illness?
Yes
No
9
If yes, what is the percentage of your NEL award?
10
Have you had a NEL Redetermination? If yes, please provide the date of your redetermination?
Date
Month
Day
Year
11
If yes, did you receive an increase?
Yes
No
12
Has your condition deteriorated since your last NEL redetermination?
Yes
No
13
If yes, have you seen your health care provider regarding your deterioration?
Yes
No
14
Were you able to return to your pre-accident job following your injury?
Yes
No
15
If no, were you provided with Labour Market Re-entry Services (LMR)?
Yes
No
16
Are you in receipt of a Future Economic Loss (FEL) award?
Yes
No
17
If yes, was your Future Economic Loss (FEL) benefit calculated based on your actual earnings or deemed earnings by the WSIB?
Actual Earnings
Deemed Earnings
18
When was the final review of your FEL benefit?
Date
Month
Day
Year
19
Was your FEL award reduced, increased or eliminated following the final review? Please provide a brief explanation of what the WSIB's decision was.
0/500
20
Did you request a reconsideration of the decision regarding your final FEL review?
Yes
No
21
If yes, what was the outcome of the reconsideration?
0/500
22
Did you appeal the WSIB’s decision regarding your final FEL review, at the WSIB's Appeals Division?
Yes
No
23
If yes, please provide a brief explanation of the Appeals Resolution Officer's decision, including the date of the decision.
0/500
24
Did you appeal the Appeals Resolution Officer's decision to the Workplace Safety & Insurance Appeals Tribunal (WSIAT)?
Yes
No
25
Did the Workplace Safety & Insurance Appeals Tribunal (WSIAT) grant your appeal?
Yes
No
26
Ask your question here. In the following section you will be able to upload a document you would like us to review in responding to your question.Please be as specific with your question as possible so that we may be as thorough in our response to you.
0/500
27
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28
Terms and Conditions* This field is required.
29
WSIB Settlements
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Just Ask Joe Form