Appealing a Workers' Compensation Decision

What is Workers’ Compensation?

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 www.worksafebc.com.

The Workers Compensation Act is available at www.bclaws.ca.

Who can get Workers’ Compensation?

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.

Types of benefits

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

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.

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.

3. Health care benefits

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

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 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.

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.

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.

Reviews and Appeals – if you disagree with the WorkSafeBC decision 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.

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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The testing of the claims in a court proceeding at a formal hearing before a judge with the jurisdiction to hear the proceeding. The parties present their evidence and arguments to the judge, who then makes a decision resolving the parties' claims against one another that is final and binding on the parties unless successfully appealed. See "action," "appeal," "argument," "claim," "evidence" and "jurisdiction."

In law, the re-examination of a term of an order or agreement, usually to determine whether the term remains fair and appropriate in light of the circumstances prevailing at the time of the review. In family law, particularly the review of an order or agreement provided for the payment of spousal support. See "de novo," "family law agreements," "order" and "spousal support."

In law, a legal incapacity to do certain things, like enter into a contract or start a court proceeding. Legal disabilities include insanity and being under the age of majority. See "age of majority."

A mandatory direction of an arbitrator, binding and enforceable upon the parties to an arbitration proceeding, made following the hearing of the arbitration trial proceeding or the parties' settlement, following which the only recourse open to a dissatisfied party is to challenge or appeal the award in court. See "appeal," "arbitration," and "family law arbitrator."

In law, any proceeding before a judicial official to determine questions of law and questions of fact, including the hearing of an application and the hearing of a trial. See "decision."

(1) The assertion of a legal right to an order or to a thing; (2) the remedy or relief sought by a party to a court proceeding.

A person licensed to practice law in a particular jurisdiction by that jurisdiction's law society. See "barrister and solicitor."

In law, to formally deliver documents to a person in a manner that complies with the rules of court. Service may be ordinary (mailed or delivered to a litigant's address for service), personal (hand-delivered to a person), or substituted (performed in a way other than the rules normally require). See "address for delivery," "ordinary service," "personal service" and "substituted service."

In law, (1) a judge's conclusions after hearing argument and considering the evidence presented at a trial or an application, (2) a judgment, or (3) the judge's reasons. A judge's written or oral decision will include the judge's conclusions about the relief or remedies claimed as well as their findings of fact and conclusions of law. A written decision is called the judge’s "reasons for judgment." See "common law," "conclusions of law" and "findings of fact."

An application to a higher court for a review of the correctness of a decision of a lower court. A decision of a judge of the Provincial Court of British Columbia can be appealed to the Supreme Court of British Columbia. A decision of a judge of the Supreme Court can be appealed to the Court of Appeal for British Columbia. See "appellant" and "respondent."