Active Members | Forms

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.

Upload Now

Submit by mail:

LiUNAcare Local 506
3750 Chesswood Drive, Suite 1
Toronto, ON M3J 2W6

Get Mobile Access to Your Benefits

LiUNAcare Local 506 mobile apps submit it faster and easier to make claims and get medical assistance – from wherever you are with your smartphone, tablet or desktop.

Check Out Our Mobile Apps

See how easy it is to submit claims and get medical support using our apps – and download them right now!

Go to Mobile Apps

Workplace Safety Insurance Board (WSIB) Information Form

Coverage Details

Submit your form online:

Submit by mail:

Get Mobile Access to Your Benefits

Check Out Our Mobile Apps

Contact Information

Office Hours

Navigation

Workplace Safety Insurance Board (WSIB) Information Form

Coverage Details

Submit your form online:

Submit by mail:

Get Mobile Access to Your Benefits

Check Out Our Mobile Apps

Welcome to LiUNAcare Local 506