Intent to Object Form (2397A) – WSIB in Ontario

The “Intent to Object Form” (Form 2397A) by the Workplace Safety and Insurance Board (WSIB) in Ontario is designed for workers, their representatives, employers, or employer representatives to formally object to a decision made by the WSIB. This form facilitates the process of raising disputes regarding decisions related to workplace safety and insurance claims. This form ensures that objections are documented systematically, allowing for an organized review and potential reconsideration of WSIB decisions.

Filling out this form correctly is crucial for ensuring your objection to a WSIB decision is processed efficiently. Below is a step-by-step guide to help you complete the form:

Step 1: Provide Claim Identifiers

• Worker’s Name: Enter the full name of the worker involved in the claim.
• Claim Number: Enter the claim number associated with the decision you are objecting to.

Step 2: Identify the Objecting Party

• Check the Appropriate Box: Indicate whether you are the worker, a worker representative, the employer, or an employer representative.

Step 3: General Information

• Address Verification: Check whether the address and contact information are the same as on the decision letter. If different, provide the updated details.
• Contact Details: Fill in your name, address, city/town, postal code, telephone number, email address, and preferred language (English, French, or other).

Step 4: Representation

• Representation Choice: Choose whether you will represent yourself or if you have a representative.
  • If self-representing or seeking representation, check the appropriate box.
  • If you have a representative, provide their name, organization, address, city/town, postal code, telephone number, and email address.
  • Ensure a signed Direction of Authorization for the representative is included in the claim file.

Step 5: Intent to Object

• Decision Details: List the date(s) of the decision letter(s) you are objecting to and describe the issue(s) in dispute.

Step 6: New Information/Reconsideration

• Additional Information: Indicate whether you have new information or explanations to submit that the decision maker may not have considered.
  • If you do, attach the additional information and ensure each page has the worker’s name and claim number.
  • If no new information is available, check the appropriate box.

Step 7: Reasons for the Objection

• Detailed Explanation: Clearly explain why you disagree with the decision(s). Be specific and refer to any new information you are attaching.
• Number of Pages: Indicate the number of additional pages attached, if any.

Step 8: Acknowledgment and Signature

• Read the Risks and Responsibilities: Carefully read the acknowledgment section about the use of email and associated risks.
• Signature: Sign and date the form. If submitting electronically, check the box indicating electronic submission and fill out your name and the date.

Step 9: Submit the Form

• Electronic Submission: Submit the completed form and supporting documents via wsib.ca/submit.
• Alternative Formats: If you require this form in an alternative format, contact WSIB at accessibility@wsib.on.ca.

Additional Tips

• Accuracy: Ensure all information is accurate and complete to avoid delays in processing your objection.
• Documentation: Keep copies of the filled form and any supporting documents for your records.
• Contact Information: Update WSIB if your contact information changes after submitting the form.

By following these steps, you can efficiently complete and submit the “Intent to Object Form” to ensure your objections are heard and processed promptly.