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Workplace Safety Insurance Board (WSIB) Information Form

Coverage Details

Description

Approved for W.S.I.B. and unable to work? Complete this Information Form for fund assistance and to request to self pay for benefit coverage.

Applicable for

Member Only

Submit your form online:

Step 1

Download, print and fill out the form.

Download Form
Step 2

Upload the form using our online submission form.

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Submit by mail:

LiUNAcare Local 183
200 Labourers Way
Vaughan, ON, L4H 5H9
Suite 2100

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