What Happens If My Claim Is Accepted?

If your claim is accepted and your doctor has properly documented that you are totally disabled and out of work as a result of the work-related accident, you are entitled to receive 2/3 of your Average Weekly Wage (AWW) up to the pre-set statutory maximum correspondent to your date of accident.  You have to miss more than seven (7) days of work in order to be entitled to benefits – this is called a “waiting period”.  You also have to have the appropriate medical documentation in the appropriate forms (C-4, C-4.2) indicating the exact percentage of disability that you have and specifically connecting your disability to the history of your work accident.  You need to see your doctor every 45 days in order to keep receiving your benefits.  The Carrier may also request that you be examined by an Independent Medical Examiner (IME) in order to verify that your doctor’s opinion regarding your condition is accurate.  If there is a difference in opinion regarding your degree of disability, the Carrier has the right to rely on the IME opinion and reduce/suspend your payments accordingly until testimony is taken and we can show that your doctor’s opinion is more credible.