Difference between revisions of "Appealing a Workers' Compensation Decision"

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{{REVIEWEDPLS | reviewer = [https://www.ascentemploymentlaw.ca/about-us Richard Johnson], Ascent Employment Law and [https://www.mooreedgarlyster.com/lawyers/sara-hanson Sara Hanson], Moore Edgar Lyster LLP|date= August 2021}} {{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?==
==Common questions==
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:
===If my claim for workers’ compensation is denied, can I appeal?===
*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.
Yes. You can ask WorkSafeBC (the agency that operates BC’s workers’ compensation program) to review a decision on a workers’ compensation claim. If you’re unhappy with the outcome of the review, you can appeal to a tribunal.
*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].
The [https://www.wcat.bc.ca/ Workers’ Compensation Appeal Tribunal] hears appeals of workers’ compensation decisions. We explain the process in our guidance [https://www.peopleslawschool.ca/appealing-a-workers-compensation-decision/ on appealing a workers’ compensation decision].


==Who can get Workers’ Compensation?==
===Can any workers’ compensation decision be appealed?===
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.
No. Only certain types of decisions can be appealed to the Workers’ Compensation Appeal Tribunal. Among those that can be appealed are decisions on:


If you suffer a workplace injury or disease, you may be able to get one or more of the following benefits.
* whether a certain type of injury or illness is covered by workers’ compensation
* whether a workers’ injury or illness arose out of and during the course of employment
* whether someone was a worker when they were injured


==Types of benefits==
Some WorkSafeBC decisions that can’t be appealed include:
===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===
a decision regarding vocational rehabilitation benefits
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.
a decision about whether or not to refer a decision back to WorkSafeBC
a decision not to give you more time to bring your review


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.
We explain this in greater detail in our guidance on [https://www.peopleslawschool.ca/appealing-a-workers-compensation-decision/ appealing a workers’ compensation decision].


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.
===How can I get a copy of my claims file?===
On the [https://www.worksafebc.com/en/claims/manage-claim/view-submit-claim-information WorkSafeBC website], you can view all the information associated with your claim. You can also request a copy of your claim, and WorkSafeBC will send the information to you.


===3. Health care benefits===
To request a copy, complete and send a [https://www.worksafebc.com/en/resources/claims/forms/request-for-disclosure-form-25m13?lang=en '''request for disclosure''' form] to this address:
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.


===4. Vocational rehabilitation benefits===
:Disclosure Department
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.
:WorkSafeBC
:PO Box 4700 Stn Terminal
:Vancouver, BC V6B 1J1


How to apply
All your information is usually in your claim file, but sometimes other WorkSafeBC records have personal information too. To see these records, send a written request to:
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.
:Freedom of Information and Protection of Privacy Office
:WorkSafeBC
:PO Box 2310 Stn Terminal
:Vancouver, BC V6B 3W5


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.
==Who can help==
 
===With more information===
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.
:'''WorkSafeBC'''
 
:Deals with complaints about unsafe working conditions and injuries on the job.
Reviews and Appeals – if you disagree with the WorkSafeBC decision
:Call 1-888-967-5377
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.
:[https://www.worksafebc.com/ Visit website]
 
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).
 
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.
 
For more information
Check the WorkSafeBC website at www.worksafebc.com for more information on workers’ compensation and reviews.
 
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.
 
 
[updated February 2014]
 
 
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:'''Workers’ Advisers Office'''
:A government office that helps workers with claims for workers’ compensation benefits. They are separate from WorkSafeBC and there’s no charge for their services.
:Call 1-800-663-4261
:[https://www2.gov.bc.ca/gov/content/employment-business/employment-standards-advice/personal-injury-and-workplace-safety Visit website]


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Latest revision as of 00:24, 8 November 2023

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by Richard Johnson, Ascent Employment Law and Sara Hanson, Moore Edgar Lyster LLP in August 2021.
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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.

Common questions

If my claim for workers’ compensation is denied, can I appeal?

Yes. You can ask WorkSafeBC (the agency that operates BC’s workers’ compensation program) to review a decision on a workers’ compensation claim. If you’re unhappy with the outcome of the review, you can appeal to a tribunal.

The Workers’ Compensation Appeal Tribunal hears appeals of workers’ compensation decisions. We explain the process in our guidance on appealing a workers’ compensation decision.

Can any workers’ compensation decision be appealed?

No. Only certain types of decisions can be appealed to the Workers’ Compensation Appeal Tribunal. Among those that can be appealed are decisions on:

  • whether a certain type of injury or illness is covered by workers’ compensation
  • whether a workers’ injury or illness arose out of and during the course of employment
  • whether someone was a worker when they were injured

Some WorkSafeBC decisions that can’t be appealed include:

a decision regarding vocational rehabilitation benefits a decision about whether or not to refer a decision back to WorkSafeBC a decision not to give you more time to bring your review

We explain this in greater detail in our guidance on appealing a workers’ compensation decision.

How can I get a copy of my claims file?

On the WorkSafeBC website, you can view all the information associated with your claim. You can also request a copy of your claim, and WorkSafeBC will send the information to you.

To request a copy, complete and send a request for disclosure form to this address:

Disclosure Department
WorkSafeBC
PO Box 4700 Stn Terminal
Vancouver, BC V6B 1J1

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

Freedom of Information and Protection of Privacy Office
WorkSafeBC
PO Box 2310 Stn Terminal
Vancouver, BC V6B 3W5

Who can help

With more information

WorkSafeBC
Deals with complaints about unsafe working conditions and injuries on the job.
Call 1-888-967-5377
Visit website
Workers’ Advisers Office
A government office that helps workers with claims for workers’ compensation benefits. They are separate from WorkSafeBC and there’s no charge for their services.
Call 1-800-663-4261
Visit website
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