Just Ask Joe Form

Proposed WSIB Class Action Lawsuit Registration
By completing this form, you are registering for the proposed Class Action Lawsuit against the Workplace Safety & Insurance Board of Ontario Canada (WSIB), pertaining to its' "DEEMING" practice and unlawful application of Section 43 of the Workers' Compensation Act 1997 as amended and the Workplace Safety & Insurance Act "the Act".
Full Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Date of birth*

MonthDayYear
Date
Date of injury or illness*

MonthDayYear
Date
Claim Number*
About your Loss Of Earnings Benefit (LOE)
When did you begin receiving your LOE benefit?*

MonthDayYear
Date
Did the WSIB base your LOE benefit on Deemed Earnings?*
Has the WSIB reduced or stopped your LOE benefit?*
Provide the reason the WSIB used to reduced or stop your LOE benefit.*

0/500
Do you receive Canada Pension Disability (CPP)*
Did the WSIB deduct (offset) any portion of your CPP Disability benefit from your LOE benefit?*
By signing this Class Action Lawsuit Registration Form, I agree to register for the Class Action Lawsuit against the Workplace Safety & Insurance Board ("the WSIB") and confirm that I have been prejudiced by the WSIB's application of its "Deeming Practices" insofar as my claim is concerned.

I also understand that by signing this Class Action Lawsuit Registration Form, I am not being provided with legal advice and have decided to participate in the Class Action Lawsuit of my own accord. I also know that I can withdraw my registration at any time.
Signature*

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Proposed WSIB Class Action Lawsuit Registration

About your Loss Of Earnings Benefit (LOE)