Just Ask Joe Form

1
Full Name* This field is required.
First Name
Last Name
2
Phone Number
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* This field is required.
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 you answered yes, did you receive an increase?
12
Has your condition deteriorated since your last Non-Economic Loss redetermination?
Yes
No
13
If yes, have you seen your health care provider regarding your deterioration?
Yes
No
14
Are you currently in receipt of LOE benefits?
Yes
No
15
Were you able to return to your pre-accident job?
Yes
No
16
If no, were you provided with Work Reintegration Services?
Yes
No
17
If yes, was a Suitable Occupation (SO) identified?
Yes
No
18
Were you successful in obtaining employment in your SO?
Yes
No
19
Did the WSIB conduct the 72-month Lock-in review of your LOE benefits?* This field is required.
Yes
No
Not sure
20
If yes, please provide the date of the 72-month Lock-in review.
Date
Month
Day
Year
21
Was your LOE benefit reduced or taken away at the 72-month Lock-in review?
Yes
No
22
If you answered yes, please provide the reason(s) the WSIB gave you to reduce or stop your LOE benefits at the 72-month Lock-in review.
0/300
23
If the WSIB reduced or took away your LOE benefit at the 72-month Lock-in review, did you request a reconsideration of their decision?
Yes
No
24
If yes, please provide a brief explanation as to the outcome of the reconsideration review?
0/300
25
If the WSIB decided to maintain the original decision, did you appeal to the WSIB's Appeals Division?NEXT
Yes
No
26
If yes, please provide a brief explanation of the Appeal Resolution Officer's decision including the date of the decision.
0/500
27
Did you appeal to the Workplace Safety & Insurance Appeals Tribunal?
Yes
No
28
If your answer was yes, was your appeal granted by the Workplace Safety & Insurance Appeals Tribunal?
Yes
No
29
Ask your question here. Please note that in the next section you may upload a document for our review, including an Appeal Resolution Officer's decision if it is pertinent to your question.
0/500
30
Click here to upload If necessary, you may upload a document that is relevant to your question, such as an appeals decision, or letter from your Case Manager
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31
Terms and Conditions* This field is required.
32
WSIB Settlements
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Just Ask Joe Form