Difference between revisions of "Appealing a Workers' Compensation Decision (No. 286)"

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{{REVIEWEDPLS | reviewer = [http://www.wcat.bc.ca/index.aspx Tim Martiniuk], Workers’ Compensation Appeal Tribunal (WCAT)|date= January 2018}} {{Dial-A-Law TOC|expanded = work}}
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If you disagree with a decision on a workers’ compensation claim, you can request a '''review''' of the decision. If you’re still not satisfied, you can '''appeal''' to a tribunal.
  
==What is Workers’ Compensation?==
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==Understand your legal rights==
Workers’ Compensation is a government program run by the Workers’ Compensation Board of BC and paid for by employers. The Workers’ Compensation Board now uses the name “WorkSafeBC.” The program is designed to:
 
*pay workers for some of their lost income and certain expenses if they suffer a workplace injury or disease – regardless of who was at fault – or to pay a worker’s family if the worker dies from the injury or disease.
 
*help injured workers get back to work.
 
*make and enforce health and safety rules and promote safety in the workplace. As of November 2013, WorkSafeBC policies deal with workplace bullying and harassment. They explain what these terms mean and set out the duties of employers, employees and supervisors to prevent and respond to workplace bullying and harassment. Details are on the WorkSafeBC website at [http://www.worksafebc.com www.worksafebc.com].
 
  
The ''Workers Compensation Act'' is available at [http://www.bclaws.ca www.bclaws.ca].
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===Challenging a decision of Work Safe BC===
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'''Workers’ compensation''' is a BC government program run by [http://www.worksafebc.com/ Work Safe BC]. It pays benefits to workers if they suffer a workplace injury or disease, and promotes health and safety in the workplace. (We explain the [[Workers' Compensation (No. 285)|workers’ compensation program in no. 285]].)
  
==Who can get Workers’ Compensation?==
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If you disagree with a decision Work Safe BC makes on claims, assessments, or health and safety matters, you can request a '''review''' of the decision. If you’re still not satisfied, you can appeal to a tribunal. We explain the process shortly.  
The program covers almost all workers, both full- and part-time, including office workers, farm workers, performers, and domestic workers. Unregistered labour contractors may also be entitled to benefits. Independent contractors can register with the program for personal optional protection. If they don’t do this, they are not entitled to compensation for work injuries or diseases.
 
  
If you suffer a workplace injury or disease, you may be able to get one or more of the following benefits.
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===You can get help or advice===
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You can challenge a Work Safe BC decision on your own. Or you might want to ask for assistance from someone familiar with the workers’ compensation system, such as a union representative, a lawyer, or a workers’ adviser.
  
==Types of benefits==
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If you are a union member, discuss your case with the union. They may have a representative who can help you, or they may hire a lawyer for you in a serious case. You may want to hire your own lawyer anyway. Make sure the lawyer has experience in workers’ compensation.
===1. Short-term disability or wage loss benefits for temporary disability===
 
These benefits pay you, at least partly, for income you lose because of your workplace injury or disease. If you are injured and unable to work, the benefits are usually 90% of your net wages. These benefits pay you for lost income, but only up to a maximum wage (adjusted each year). If you remain temporarily disabled after 10 weeks, WorkSafeBC may recalculate your benefits based on your income in the 12 months before your injury or disease. Wage loss benefits continue until you are no longer temporarily disabled or your condition becomes stable and will not get any better or worse.
 
  
===2. Long-term or permanent disability and death benefits===
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If you don’t get help from a union or a lawyer, you should contact the '''Workers’ Advisers Office''' of the BC Ministry of Labour. Workers’ advisers are separate from Work Safe BC and there’s no charge for their services. They help workers apply for reviews and appeals, and they have detailed information on their website. Visit [http://gov.bc.ca/workersadvisers gov.bc.ca/workersadvisers] or call 604-713-0360 in Vancouver and 1-800-663-4261 elsewhere in BC.
If you are permanently disabled, totally or partly, you are entitled to permanent disability benefits. These are paid in one of two ways: a “permanent functional impairment (PFI) award” or a “loss of earnings (LOE) award.” Usually, WorkSafeBC pays a PFI award. But if WorkSafeBC finds that a PFI award does not properly compensate you – because your disability reduces your ability to continue working in your occupation to an exceptional extent – it may pay an LOE award. Although a permanent disability award covers permanent chronic pain, it does not cover loss of enjoyment of life, or damage to your clothes or vehicle.
 
  
Normally, if benefits are more than $200 a month, they are paid monthly. If benefits are less than $200 a month, you will probably get a lump-sum payout. Even if WorkSafeBC plans to pay you benefits monthly, you can apply for a “commutation” (a lump-sum payout) of all or part of your award. Generally, you won’t get a commutation if the benefits are more than $200 a month. You may get a commutation only if it improves your income. And you must have another stable income source, apart from the benefits.
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For employers, the [http://www.gov.bc.ca/employersadvisers Employers’ Advisers Office] provides independent advice, assistance, and representation to employers concerning workers' compensation issues. There is no charge for their services.
  
Families of workers who are killed on the job or die from a workplace injury or disease, may qualify for an award and vocational training help.
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==The steps in the process==
  
===3. Health care benefits===
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===Step 1. Ask for a review===
Health care benefits pay for doctors, hospitals, nursing care, home care, prescription drugs, and other health care professionals like physiotherapists, dentists, and chiropractors. They also cover other expenses, including medical supplies, appliances like crutches, hearing aids, dentures, and eyeglasses, and modifications to home, vehicles, and workplace.
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The first step in challenging a Work Safe BC decision is to ask for a '''review''' of the decision. The Work Safe BC website at [https://www.worksafebc.com/en/review-appeal worksafebc.com] explains how to ask for a review. The phone numbers for the review division are 604-214-5411 in the Lower Mainland and 1-888-922-8804 elsewhere in BC.
  
===4. Vocational rehabilitation benefits===
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In a few scenarios, you can’t ask for a review but need to appeal directly to the Workers’ Compensation Appeal Tribunal. For example, if you are challenging a decision to reopen (or not reopen) a matter, or challenging a decision on a discriminatory action complaint (where an employer punished you for raising safety concerns at work). Appeals are explained shortly.
If WorkSafeBC decides that you cannot return to your pre-injury job because of your injury and your employer cannot offer a modified job, you may be entitled to vocational rehabilitation services. These benefits are for vocational retraining, workplace redesign or job modification, training on the job, and job search activity. If your injury or disease eventually forces you to change your occupation, you should think about your future educational and vocational needs. You should ask WorkSafeBC for rehabilitation guidance to help you plan your future. You have to take charge of your own rehabilitation. If you have a good idea of what you want, you explain it, and it is appropriate, the more likely you are to get it.
 
  
How to apply
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Because Work Safe BC routinely issues some decisions orally, the review division accepts review requests from oral decisions.  
If you suffer a workplace injury or illness, report it immediately to your employer, your doctor and WorkSafeBC. You can get application forms from your employer, your union, or the WorkSafeBC website at www.worksafebc.com. Call 604.231.8888 in the lower mainland and 1.888.967.5377 elsewhere in BC (free of charge). Your employer and your doctor must report your injury or disease to WorkSafeBC within 3 days of when you tell them about it.
 
  
You have only one year from your accident or disease to apply for compensation. After that, you may lose your right to benefits unless special circumstances stopped you from applying on time.
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====Time limit to ask for a review====
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A worker must ask for a review within '''90 days''' of the date of Work Safe BC’s decision letter or, in some cases, within 90 days of the date that Work Safe BC told the worker its decision orally or stopped paying them.  
  
A WorkSafeBC officer will examine your claim and decide if you get benefits, and if so, the type and amount. WorkSafeBC won’t decide about any permanent disability until your condition becomes stable, meaning that it stays the same and does not get any better or worse.
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An employer who wants to ask for a review of a decision or an order issued by Work Safe BC on an occupational health and safety matter, has '''45 days''' to ask for a review.
  
Deciding whether you get benefits can be complicated. You should discuss your case with your union, a lawyer, or the Workers’ Advisers Office. Workers’ Advisers work for the Ministry of Labour and Citizens’ Services to help workers with their claims. They are separate from WorkSafeBC and there’s no charge for their service. Their website is www.labour.gov.bc.ca/wab and their phone numbers are 604.713.0360 in Vancouver and 1.800.663.4261 elsewhere in BC.
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{| class="wikitable"
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|align="left"|'''Tip'''
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While your review is being considered, if you feel that Work Safe BC has treated you unfairly, you can also complain to Work Safe BC’s Fair Practices Office and to the [http://www.ombudsman.bc.ca/ Ombudsperson of BC] (who can be reached at 1-800-567-3247).
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|}
  
Reviews and Appeals – if you disagree with the WorkSafeBC decision
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===Step 2. Prepare your case===
If WorkSafeBC decides that you are not eligible for benefits, or if you don’t understand its decision, ask the WorkSafeBC officer handling your claim for an explanation. Ask for a decision letter if you didn’t already get one. If you’re still not satisfied, you can ask the Review Division of WorkSafeBC to review the decision. But you must ask for a review within 90 days of the date of WorkSafeBC’s decision letter or, in some cases, within 90 days of the date when WorkSafeBC told you its decision orally. WorkSafeBC should automatically give you a copy of your claim file and you can use the information in it for your review. After you request a review, you will receive a letter setting a time to make written submissions. The Review Division does not normally hold oral hearings.
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After you request a review, you will receive a letter setting a time to make '''written submissions'''. Work Safe BC’s review division does not normally hold oral hearings.
  
The Review Division considers the written submissions and WorkSafeBC’s file and gives its decision, usually within 150 days. The WorkSafeBC website, at www.worksafebc.com, has more information on reviews. The phone numbers for the Review Division are 604.214.5411 in the lower mainland and 1.888.922.8804 elsewhere in BC. At the same time, if you feel that WorkSafeBC has treated you unfairly, you can also complain to its Fair Practices Office and the Ombudsperson of BC (www.ombudsman.bc.ca and 1.800.567.3247).
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To prepare your case, carefully review your Work Safe BC file. You have the right to see it and you should automatically get it when you ask for a review.
  
If you’re not satisfied with the decision of the Review Division, in most cases you have the right to appeal to the Workers’ Compensation Appeal Tribunal (www.wcat.bc.ca). You must appeal within 30 days of the date of the decision of the Review Division.
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====What you need to show====
 +
Reviews and appeals are serious. In bringing a review or appeal of a Work Safe BC decision, you need to show clearly what’s wrong with the decision. You may need new evidence to support your appeal. You may need more evidence than you had when you first made your claim, such as medical evidence from doctors and specialists. It’s important to get all the evidence you need, as soon as you can.
  
For more information
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===Step 3. Appeal the review decision===
Check the WorkSafeBC website at www.worksafebc.com for more information on workers’ compensation and reviews.
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The review decision is usually made within 150 days. If you disagree with the review decision, you can usually '''appeal''' to the Workers’ Compensation Appeal Tribunal. You cannot appeal review decisions on some issues, such as vocational rehabilitation benefits, certain types of disability awards, and whether benefits are paid as a lump sum.  
  
Check script 286, called “Appealing a Workers’ Compensation Decision”, and the Tribunal’s website at www.wcat.bc.ca for more information on appeals. Also, check the Workers’ Advisers website at www.labour.gov.bc.ca/wab for detailed information on reviews and appeals. Employers should check the Employers’ Advisers website at www.labour.gov.bc.ca/eao.
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====Time limit to appeal====
 +
If you decide to appeal, you must do so within '''30 days''' of the decision by the review division. (For cases that go directly to the tribunal, the time limit is 90 days.)
  
 +
The tribunal’s website at [http://www.wcat.bc.ca/research/wcat_publications/appeal_guides/index.html wcat.bc.ca] has information guides on how to appeal and how to prepare for an appeal hearing.
  
[updated February 2014]
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You can appeal by phone or letter, or you can use the '''notice of appeal''' form on the tribunal’s website. If you appeal by phone, you must follow it up with the form within 21 days. The tribunal’s phone numbers are 604-664-7800 in the Lower Mainland and toll-free 1-800-663-2782 elsewhere in BC.
  
 +
====The tribunal will follow up with you====
 +
The tribunal will send you a letter to confirm it received your appeal and give you an appeal number. You should always include this appeal number, and your Work Safe BC file number, in any material you submit. The tribunal will ask you to make your submissions in writing or tell you the date for your oral hearing. Normally, the tribunal decides a case within 180 days of when it receives your claim file from Work Safe BC.
  
----
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The tribunal must apply the law and the policies of Work Safe BC that apply to your appeal. You should find out what policies apply to your case. You can see [http://www.wcat.bc.ca/search/decision_search.aspx previous tribunal decisions] on its website.
----
 
  
 +
==Common questions==
  
 +
===How can I get a copy of my claims file?===
 +
Through the Work Safe BC website, workers can view all the information associated with their claim. You will need your claim number and your personal access number. You can also request a copy of your claim file from Work Safe BC. You can send a written '''request for disclosure''' form, available on the [https://www.worksafebc.com/en/claims/manage-claim/request-copy-your-claim-file Work Safe BC website], to:
 +
:Disclosure Department
 +
:Work Safe BC
 +
:PO Box 4700 Stn Terminal
 +
:Vancouver BC V6B 1J1
 +
:Fax: 604-233-9777 
 +
 +
All your personal information is usually in your claim file, but sometimes other Work Safe BC records also have personal information. To see these records, send a written request to:
 +
:Freedom of Information and Protection of Privacy Office
 +
:Work Safe BC
 +
:PO Box 2310 Stn Terminal
 +
:Vancouver, BC V6B 3W5
 +
:Phone: 1-866-266-9405
 +
:Fax: 604-279-7401
 +
 +
==Get help==
 +
 +
===With more information===
 +
The '''Work Safe BC''' website includes extensive information on workers’ compensation benefits, how to apply for benefits, and the process to review or appeal a decision.
 +
:Telephone: 604-231-8888 in the Lower Mainland
 +
:Toll-free: 1-888-967-5377
 +
:Web: [http://www.worksafebc.com/ worksafebc.com]
 +
 +
The '''Workers’ Advisers Office''' is a government office that helps workers with claims for workers’ compensation benefits. They are separate from Work Safe BC and there’s no charge for their services.
 +
:Telephone: 604-713-0360 in Vancouver
 +
:Toll-free: 1-800-663-4261 
 +
:Web: [http://gov.bc.ca/workersadvisers gov.bc.ca/workersadvisers]
 +
 +
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Latest revision as of 22:15, 29 March 2019

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by Tim Martiniuk, Workers’ Compensation Appeal Tribunal (WCAT) in January 2018.

If you disagree with a decision on a workers’ compensation claim, you can request a review of the decision. If you’re still not satisfied, you can appeal to a tribunal.

Understand your legal rights

Challenging a decision of Work Safe BC

Workers’ compensation is a BC government program run by Work Safe BC. It pays benefits to workers if they suffer a workplace injury or disease, and promotes health and safety in the workplace. (We explain the workers’ compensation program in no. 285.)

If you disagree with a decision Work Safe BC makes on claims, assessments, or health and safety matters, you can request a review of the decision. If you’re still not satisfied, you can appeal to a tribunal. We explain the process shortly.

You can get help or advice

You can challenge a Work Safe BC decision on your own. Or you might want to ask for assistance from someone familiar with the workers’ compensation system, such as a union representative, a lawyer, or a workers’ adviser.

If you are a union member, discuss your case with the union. They may have a representative who can help you, or they may hire a lawyer for you in a serious case. You may want to hire your own lawyer anyway. Make sure the lawyer has experience in workers’ compensation.

If you don’t get help from a union or a lawyer, you should contact the Workers’ Advisers Office of the BC Ministry of Labour. Workers’ advisers are separate from Work Safe BC and there’s no charge for their services. They help workers apply for reviews and appeals, and they have detailed information on their website. Visit gov.bc.ca/workersadvisers or call 604-713-0360 in Vancouver and 1-800-663-4261 elsewhere in BC.

For employers, the Employers’ Advisers Office provides independent advice, assistance, and representation to employers concerning workers' compensation issues. There is no charge for their services.

The steps in the process

Step 1. Ask for a review

The first step in challenging a Work Safe BC decision is to ask for a review of the decision. The Work Safe BC website at worksafebc.com explains how to ask for a review. The phone numbers for the review division are 604-214-5411 in the Lower Mainland and 1-888-922-8804 elsewhere in BC.

In a few scenarios, you can’t ask for a review but need to appeal directly to the Workers’ Compensation Appeal Tribunal. For example, if you are challenging a decision to reopen (or not reopen) a matter, or challenging a decision on a discriminatory action complaint (where an employer punished you for raising safety concerns at work). Appeals are explained shortly.

Because Work Safe BC routinely issues some decisions orally, the review division accepts review requests from oral decisions.

Time limit to ask for a review

A worker must ask for a review within 90 days of the date of Work Safe BC’s decision letter or, in some cases, within 90 days of the date that Work Safe BC told the worker its decision orally or stopped paying them.

An employer who wants to ask for a review of a decision or an order issued by Work Safe BC on an occupational health and safety matter, has 45 days to ask for a review.

Tip

While your review is being considered, if you feel that Work Safe BC has treated you unfairly, you can also complain to Work Safe BC’s Fair Practices Office and to the Ombudsperson of BC (who can be reached at 1-800-567-3247).

Step 2. Prepare your case

After you request a review, you will receive a letter setting a time to make written submissions. Work Safe BC’s review division does not normally hold oral hearings.

To prepare your case, carefully review your Work Safe BC file. You have the right to see it and you should automatically get it when you ask for a review.

What you need to show

Reviews and appeals are serious. In bringing a review or appeal of a Work Safe BC decision, you need to show clearly what’s wrong with the decision. You may need new evidence to support your appeal. You may need more evidence than you had when you first made your claim, such as medical evidence from doctors and specialists. It’s important to get all the evidence you need, as soon as you can.

Step 3. Appeal the review decision

The review decision is usually made within 150 days. If you disagree with the review decision, you can usually appeal to the Workers’ Compensation Appeal Tribunal. You cannot appeal review decisions on some issues, such as vocational rehabilitation benefits, certain types of disability awards, and whether benefits are paid as a lump sum.

Time limit to appeal

If you decide to appeal, you must do so within 30 days of the decision by the review division. (For cases that go directly to the tribunal, the time limit is 90 days.)

The tribunal’s website at wcat.bc.ca has information guides on how to appeal and how to prepare for an appeal hearing.

You can appeal by phone or letter, or you can use the notice of appeal form on the tribunal’s website. If you appeal by phone, you must follow it up with the form within 21 days. The tribunal’s phone numbers are 604-664-7800 in the Lower Mainland and toll-free 1-800-663-2782 elsewhere in BC.

The tribunal will follow up with you

The tribunal will send you a letter to confirm it received your appeal and give you an appeal number. You should always include this appeal number, and your Work Safe BC file number, in any material you submit. The tribunal will ask you to make your submissions in writing or tell you the date for your oral hearing. Normally, the tribunal decides a case within 180 days of when it receives your claim file from Work Safe BC.

The tribunal must apply the law and the policies of Work Safe BC that apply to your appeal. You should find out what policies apply to your case. You can see previous tribunal decisions on its website.

Common questions

How can I get a copy of my claims file?

Through the Work Safe BC website, workers can view all the information associated with their claim. You will need your claim number and your personal access number. You can also request a copy of your claim file from Work Safe BC. You can send a written request for disclosure form, available on the Work Safe BC website, to:

Disclosure Department
Work Safe BC
PO Box 4700 Stn Terminal
Vancouver BC V6B 1J1
Fax: 604-233-9777

All your personal information is usually in your claim file, but sometimes other Work Safe BC records also have personal information. To see these records, send a written request to:

Freedom of Information and Protection of Privacy Office
Work Safe BC
PO Box 2310 Stn Terminal
Vancouver, BC V6B 3W5
Phone: 1-866-266-9405
Fax: 604-279-7401

Get help

With more information

The Work Safe BC website includes extensive information on workers’ compensation benefits, how to apply for benefits, and the process to review or appeal a decision.

Telephone: 604-231-8888 in the Lower Mainland
Toll-free: 1-888-967-5377
Web: worksafebc.com

The Workers’ Advisers Office is a government office that helps workers with claims for workers’ compensation benefits. They are separate from Work Safe BC and there’s no charge for their services.

Telephone: 604-713-0360 in Vancouver
Toll-free: 1-800-663-4261
Web: gov.bc.ca/workersadvisers
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence Dial-A-Law © People's Law School is licensed under a Creative Commons Attribution - NonCommercial - ShareAlike 4.0 International Licence.


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