The Worker's Compensation Claim Acceptance Process (7:VII): Difference between revisions

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by the Law Students' Legal Advice Program on July 21, 2022.

LSLAP Manual
This page is from the Law Students' Legal Advice Program Manual. See the full contents.
LSLAP Manual
Introduction
Chapters
1. Criminal Law · I. Introduction · II. Governing Legislation and Resources · III. Etiquette · IV. Criminal Charges · V. Substantive Law · VI. Resolving Prior to Trial · VII. Pleading Not Guilty/Trial · VIII. Other Issues · IX. Charter of Rights and Freedoms · X. LSLAP Policies · XI. Information for LSLAP Students · XII. Etiquette for Law Students · XIII. Practice Recommendations · Appendix A: Initial Sentencing Position · Appendix B: Sample Information · Appendix C: Diversion Application · Appendix D: Sentencing Hearing · Appendix E: Trial Books · Appendix F: Glossary
2. Youth Justice · I. Introduction · II. Governing Legislation and Resources · III. Youth Criminal Justice Act · IV. Youth Justice Act · Appendix A: Glossary
3. Family Law · I. Introduction · II. Governing Legislation and Resources · III. Marriage · IV. Divorce · V. Uncontested Divorce · VI. Simple Divorce Procedure · VII. Alternatives to Divorce · VIII. Family Violence · IX. Assets · X. Spousal and Child Support · XI. Parenting Orders/Guardianship/Contact · XII. Children and the Law · XIII. Adoption · XIV. Name Changes · XV. Court Procedures · Appendix A: Glossary
4. Victims · I. Introduction · II. Governing Legislation · III. Crime Victim Assistance Program · IV. Avenues to Address Crime · V. Victims of Sexual Assault · VI. Victims of Relationship Violence · VII. Abuse of the Seniors & Disabled · VIII. Victims of Human Trafficking · IX. Missing Persons and Abductions · X. TIP & Restorative Justice · XI. Resources for Indigenous Victims · XII. Referrals and Follow-up
5. Public Complaints · I. Introduction · II. Governing Legislation & Resources · III. Review of Administrative Decisions · IV. Privacy or Access to Information · V. Police Conduct Complaints · VI. Security Guard Conduct Complaints · VII. The Right to Vote · VIII. Complaints & Appeals UBC · IX. Complaints & Appeals SFU · X. Complaints against Other Universities · XI. Complaints against Doctors · XII. Complaints against Lawyers · XIII. Complaints against other Professionals · XIV. LSLAP Program Information · Appendix A: Glossary · Appendix B: Sample Notice Letter
6. Human Rights · I. Introduction · II. Governing Legislation and Resources · III. BC Human Rights Code · IV. Canadian Human Rights Act · V. BC Civil Rights Protection Act · VI. Rights of the Child · VII. LSLAP's Role · VIII. Indigenous Complainants · IX. Online Mediations & Hearings
7. Workers' Compensation · I. Introduction · II. Legislation, Policy & Guidelines · III. Introduction to Worker Compensation Claims · IV. LSLAP's Role at Initial Decision · V. Limitation Periods & Timing of Decisions · VI. Making a Claim · VII. The Claim Acceptance Process · VIII. Worker Status · IX. Disability and Causation · X. Time Limits & Procedures · XI. Claim Benefits · XII. Appeals · XIII. Health and Safety Regulations · XIV. Assessments of Employers · XV. WCB Fair Practices Office · Appendix A: Abbreviations · Appendix B: List of Cases · Appendix C: Referrals · Appendix D: Resources · Appendix E: Small Claims Flow Chart · Appendix F: Checklist for Interviews · Appendix G: Checklist for Appeals · Appendix H: Sample Authorization Form
8. Employment Insurance · I. Introduction · II. Governing Legislation and Resources · III. Qualifying for EI · IV. Types of Benefits · V. Benefit Period · VI. Quantifying Benefits · VII. Benefit Entitlement · VIII. Penalties, Violations, and Offences · IX. Keeping Out of Trouble · X. Timing for Reporting · XI. Overpayment and Collections · XII. Reconsideration · XIII. Social Security Tribunal · XIV. Appeals · XV. Judicial Review · XVI. LSLAP's Use of This Chapter · Appendix A: Initial Application Checklist
9. Employment Law · I. Introduction · II. Governing Legislation and Resources · III. Checklist · IV. Preliminary Matters · V. Employment Issues · VI. Remedies · VII. Strategies and Tips · Appendix A: Glossary
10. Creditors and Debtors · I. Introduction · II. Governing Legislation and Resources · III. Creditors' Remedies · IV. Debtors' Options · V. Dealing with Debt · Appendix A: Relevant Forms · Appendix B: Examination Checklist
11. Consumer Protection · I. Introduction · II. Governing Legislation and Resources · III. Contracts for Sale of Goods · IV. Consumer Protection · V. Direct Sales · VI. Conditional Sales Contracts & Security Agreements · VII. Motor Dealer Act · VIII. Miscellaneous · IX. Forum of Redress · X. Checklist for Consumer Transactions
12. Auto Insurance (ICBC) I. Introduction · II. Governing Legislation & Resources · III. Enhanced Care System · IV. Optional Insurance · V. Seeking Legal Counsel · VI. Disputes with ICBC · VII. When You Can Still Sue · VIII. ICBC's Previous Autoplan Insurance System · IX. Limitation on Experts · X. Compulsory Coverage
13. Motor Vehicle Law · I. Introduction · II. Governing Legislation & Resources · III. At the Roadside · IV. Duties after a Collision · V. Violation Tickets · VI. Provincial Driving Offences · VII. Vehicle Impoundment · VIII. Superintendent of Motor Vehicle Prohibitions · IX. Alcohol & Drug Driving Offences · X. Federal Driving Offences · XI. Provincial Driving While Prohibited Offences · XII. ICBC Breaches · XIII. Bicycles & Motor Assisted Cycles · XIV. LSLAP Program Information · Appendix A: Penalty Points and Fines
14. Mental Health Law · I. Introduction · II. Governing Legislation & Resources · III. Theory and Approach · IV. Legal Rights · V. Patient Admission · VI. Consent to Medical Treatment · VII. Involuntarily Admitted Patients · VIII. Mental Health Act and Youth · IX. Criminal Code · X. Complaints · XI. References · XII. LSLAP Program Information
15. Adult Guardianship · I. Introduction · II. Governing Legislation · III. Mental Capacity · IV. Substitute Decision Making · V. Adult Guardianship · VI. Adult Abuse and Neglect · VII. Sources and Resources · Appendix A: EPOA · Appendix B: Decision Tree on Adult Abuse and Neglect
16. Wills and Estate Administration · I. Introduction · II. Governing Legislation & Resources · III. Making and Executing a Will · IV. Will Mistakes and Alterations · V. Court's Power · VI. Revocation · VII. Wills Variation Claims · VIII. Intestacy · IX. Property · X. Estate Administration · XI. Duties of Personal Representative · XII. Tax: RRSP & RRIF & TFSA · XIII. LSLAP Program Information · Appendix A: Will Instructions Questionnaire · Appendix B: Will Drafting and Execution Checklist · Appendix C: Glossary
17. Citizenship · I. Introduction · II. Governing Legislation & Resources · III. Who is a Canadian Citizen? · IV. Citizenship Advantages & Responsibilities · V. Citizenship Grants · VI. Applying for Citizenship Grant · VII. Loss and Renunciation of Citizenship · VIII. Proof of Citizenship · IX. Search of Citizenship Record · X. Referrals
18. Immigration Law · I. Introduction · II. Governing Legislation & Resources · III. Immigration Players · IV. Categories of Persons under IRPA · V. Applying for Permanent Residency · VI. Identification for PR · VII. Immigration and Refugee Board · VIII. Loss of PR Status · IX. In-Canada Temporary Residence Matters · X. Removal Orders · XI. Appeals · XII. Offences · XIII. Immigration Issues at Sentencing · XIV. Contacts
19. Landlord and Tenant Law · I. Introduction · II. Governing Legislation · III. Residential Tenancy Act & Laws · IV. Tenancy Agreements · V. Moving In & Moving Out · VI. Security Deposits · VII. Repair & Service · VIII. Rent Increase · IX. Tenant's Rights · X. Subletting & Assignment · XI. Termination & Eviction · XII. Dispute Resolution · XIII. Common Law · XIV. Strata & Condos · XV. Assisted Living · XVI. Manufactured Homes · XVII. Guidelines & Resources
20. Small Claims and the CRT · I. Introduction · II. Governing Legislation & Resources · III. Do You Have a Claim? · IV. Choosing the Proper Forum · V. Starting a Claim · VI. Responding to a Claim · VII. Default Order · VIII. How a Claim Proceeds · IX. Pre-Trial Applications · X. Mediation · XI. Settlement Conferences · XII. Trial & Pre-Trial Conferences · XIII. Trial Preparation · XIV. Trials · XV. Costs and Penalties · XVI. Appeals · XVII. Enforcement of a Judgement · XVIII. LSLAP Program Information · Appendix A: Registries · Appendix B: Demand Letter · Appendix C: Notice of Claim · Appendix D: Reply to Claim · Appendix E: Glossary · Appendix F: Limitation Periods · Appendix G: Causes of Action · Appendix H: Court Fees · Appendix I: Tribunal Fees · Appendix J: Settlement Conference · Appendix K: Payment Hearing · Appendix L: Appeal
21. Welfare Law · I. Introduction · II. Governing Legislation & Resources · III. Eligibility · IV. Special Situations · V. Eligibility Factors · VI. Hardship Assistance · VII. Overpayments & Fraud · VIII. Rates & Payment Issues · IX. Additional Allowances & Benefits · X. Health Supplements · XI. Appeals
22. Strata Law · I. Introduction · II. Governing Legislation · III. Strata Concept · IV. Strata Plan · V. Common Property & Assets · VI. Governance · VII. Management · VIII. Finances · IX. Collections · X. Bylaws & Rules · XI. Rentals & Accommodations · XII. Privacy · XIII. Insurance · XIV. Repair & Maintenance · XV. Dispute Resolution · XVI. Recourse to the Courts
23. Referrals · I. General · II. Family Law & Women · III. Residential Tenancy · IV. Human Rights · V. Wills & Estates · VI. Immigration & Refugee · VII. Disability · VIII. Employment · IX. Debt · X. Indigenous · XI. Police Complaints · XII. Chinese Language · XIII. Others
v • d • e

After a worker makes an application for compensation, a Board officer (typically an Entitlement Officer) issues a decision (usually in writing) accepting or denying the claim. For a compensation claim to be accepted, the Board must generally find:

STATUS: The applicant is a “worker” covered under the Act.
DISABILITY: The applicant suffered a personal injury or an occupational disease, causing disability.
CAUSATION: The worker’s disabling injury or disease arose out of and in the course of the worker’s employment.
TIME LIMITS AND PROCEDURES: The worker submitted a timely and proper application.

If a claim is denied by the Board, it is typically because one or more of the above conditions was not met. The Board decision typically sets out the reason why the claim was denied and cites the relevant policy from RSCM II. However, the evidence on which the decision is based may or may not be summarized in the decision.

All the evidence on which the decision is based will be in the claim file, which may also include memos from Case Managers and clinical opinions from Board Medical Advisors (BMAs). The claim file may also contain detailed phone memos providing the Case Managers with a summary of the worker’s evidence. The claim file evidence as a whole provides the basis for the Board’s decision and is evidence which will be available and considered by the appeal bodies, Review Division and WCAT.

Workers are entitled to a copy of their claim file (paper or CD) on request and will also automatically be sent a copy of the claim file if they file an appeal. In addition, the worker may obtain online access to parts of their claim file by calling the Board. These matters are covered in the section below on Access to Files (7-37). Disclosure may be given directly to the worker’s representative if the disclosure request or appeal notice is accompanied by a valid authorization of representation, signed by the worker. [Authorization forms are available on the Board website].

LSLAP Manual

Introduction

Acknowledgements

Chapters 1-7
Criminal Law · Youth Justice · Family Law · Victims · Public Complaints · Human Rights · Workers Compensation

Chapter One: Criminal Law	I. Introduction · II. Governing Legislation and Resources · III. Etiquette · IV. Criminal Charges · V. Substantive Law · VI. Resolving Prior to Trial · VII. Pleading Not Guilty/Trial · VIII. Other Issues · IX. Charter of Rights and Freedoms · X. LSLAP Policies · XI. Information for LSLAP Students · XII. Etiquette for Law Students · XIII. Practice Recommendations · Appendix A: Initial Sentencing Position · Appendix B: Sample Information · Appendix C: Diversion Application · Appendix D: Sentencing Hearing · Appendix E: Trial Books · Appendix F: Glossary

Chapter Two: Youth Justice	I. Introduction · II. Governing Legislation and Resources · III. Criminal Offences: Youth Criminal Justice Act · IV. Provincial Offences: Youth Justice Act · Appendix A: Glossary

Chapter Three: Family Law	I. Introduction · II. Governing Legislation and Resources · III. Marriage · IV. Divorce · V. Uncontested Divorce · VI. Simple Divorce Procedure · VII. Alternatives to Divorce · VIII. Family Violence · IX. Assets · X. Spousal and Child Support · XI. Parenting Orders/Guardianship/Contact · XII. Children and the Law · XIII. Adoption · XIV. Name Changes · XV. Court Procedures · Appendix A: Glossary

Chapter Four: Victims	I. Introduction · II. Governing Legislation · III. Crime Victim Assistance Program · IV. Avenues to Address Crime · V. Victims of Sexual Assault · VI. Victims of Relationship Violence · VII. Abuse and Neglect of Seniors or Those with Disabilities · VIII. Victims of Human Trafficking · IX. Missing Persons and Abductions · X. Trauma Informed Practice and Restorative Justice · XI. Resources for Indigenous Victims · XII. Referrals and Follow-up

Chapter Five: Public Complaints	I. Introduction · II. Governing Legislation and Resources · III. Review of Administrative Decisions · IV. Privacy or Access to Information · V. Complaints Concerning Police Conduct · VI. Complaints against Security Guards · VII. The Right to Vote · VIII. Complaints and Appeals UBC · IX. Complaints and Appeals SFU · X. Complaints Against Other Colleges and Universities · XI. Complaints against Doctors · XII. Complaints against Lawyers · XIII. Complaints against other Professionals · XIV. LSLAP Program Information · Appendix A: Glossary · Appendix B: Sample Notice Letter

Chapter Six: Human Rights	I. Introduction · II. Governing Legislation and Resources · III. BC Human Rights Code · IV. Canadian Human Rights Act · V. BC Civil Rights Protection Act · VI. Rights of the Child · VII. LSLAP's Role in Human Rights Proceedings · VIII. Alternative Processes for Indigenous Complainants · IX. Online Mediations & Hearings

Chapter Seven: Workers' Compensation	I. Introduction · II. Governing Legislation, Policy & Guidelines · III. Introduction to Compensation Claims for Injured Workers · IV. LSLAP's Role at the Initial Decision Level · V. Limitation Periods and Timing of Decisions · VI. Making a Claim · VII. The Claim Acceptance Process · VIII. Worker Status · IX. Disability and Causation · X. Time Limits and Procedures · XI. Claim Benefits · XII. Appeals · XIII. Health and Safety Regulations · XIV. Assessments of Employers · XV. The WCB Fair Practices Office · Appendix A: Abbreviations · Appendix B: List of Cases · Appendix C: Referrals · Appendix D: Resources · Appendix E: Small Claims Flow Chart · Appendix F: Checklist for Interviews · Appendix G: Checklist for Appeals · Appendix H: Sample Authorization Form

Chapters 8-14
Employment Insurance · Employment Law · Creditors and Debtors · Consumer Protection · Auto Insurance (ICBC) · Motor Vehicle Law · Mental Health Law

Chapter Eight: Employment Insurance	I. Introduction · II. Governing Legislation and Resources · III. Qualifying for EI · IV. Types of Benefits · V. Benefit Period · VI. Quantifying Benefits · VII. Benefit Entitlement · VIII. Penalties, Violations, and Offences · IX. Keeping Out of Trouble · X. Timing for Reporting · XI. Overpayment and Collections · XII. Reconsideration · XIII. Social Security Tribunal · XIV. Appeals · XV. Judicial Review · XVI. LSLAP's Use of This Chapter · Appendix A: Initial Application Checklist

Chapter Nine: Employment Law	I. Introduction · II. Governing Legislation and Resources · III. Checklist · IV. Preliminary Matters · V. Employment Issues · VI. Remedies · VII. Strategies and Tips · Appendix A: Glossary

Chapter Ten: Creditors' Remedies and Debtors' Assistance	I. Introduction · II. Governing Legislation and Resources · III. Creditors' Remedies · IV. Debtors' Options · V. Dealing with Debt · Appendix A: Relevant Forms · Appendix B: Examination Checklist

Chapter Eleven: Consumer Protection	I. Introduction · II. Governing Legislation and Resources · III. Contracts for Sale of Goods · IV. Consumer Protection · V. Direct Sales · VI. Conditional Sales Contracts and Security Agreements · VII. Motor Dealer Act · VIII. Miscellaneous · IX. Forum of Redress · X. Checklist for Consumer Transactions

Chapter Twelve: Auto Insurance (ICBC)	I. Introduction · II. Governing Legislation and Resources · III. ICBC Enhanced Care System (Current Model) · IV. ICBC Enhanced Care System and Optional Insurance · V. Seeking Legal Counsel · VI. Disputes with ICBC · VII. When You Can Still Sue · VIII. ICBC's Autoplan Insurance System (Prior System) · IX. Limitation on Experts · X. Basic Compulsory Autoplan Coverage

Chapter Thirteen: Motor Vehicle Law	I. Introduction · II. Governing Legislation and Resources · III. At the Roadside · IV. Duties after a Collision · V. Violation Tickets · VI. Provincial Driving Offences · VII. Vehicle Impoundment · VIII. Superintendent of Motor Vehicle Prohibitions · IX. Alcohol and Drug Driving Offences · X. Federal Driving Offences · XI. Provincial Offence of Driving While Prohibited · XII. ICBC Breaches · XIII. Bicycles and Motor Assisted Cycles · XIV. LSLAP Program Information · Appendix A: Penalty Points and Fines

Chapter Fourteen: Mental Health Law	I. Introduction · II. Governing Legislation and Resources · III. Theory and Approach · IV. Legal Rights · V. Patient Admission · VI. Consent to Medical Treatment · VII. Involuntarily Admitted Patients · VIII. Mental Health Act and Youth · IX. Criminal Code · X. Complaints · XI. References · XII. LSLAP Program Information

Chapters 15-23
Adult Guardianship and Substitute Decision-Making · Wills and Estates · Citizenship · Immigration · Landlord and Tenant Rights · Small Claims · Welfare Law · Strata Law · Referrals

Chapter Fifteen: Adult Guardianship and Substitute Decision-Making	I. Introduction · II. Governing Legislation · III. Mental Capacity · IV. Substitute Decision Making · V. Adult Guardianship · VI. Adult Abuse and Neglect · VII. Sources and Resources · Appendix A: EPOA · Appendix B: Decision Tree on Adult Abuse and Neglect

Chapter Sixteen: Wills and Estate Administration	I. Introduction · II. Governing Legislation and Resources · III. Making and Executing a Will · IV. Will Mistakes and Alterations · V. Court's Power · VI. Revocation · VII. Wills Variation Claims · VIII. Intestacy · IX. Property · X. Estate Administration · XI. Duties of a Personal Representative · XII. Taxation: RRSP & RRIF & TFSA · XIII. LSLAP Program Information · Appendix A: Will Instructions Questionnaire · Appendix B: Will Drafting and Execution Checklist · Appendix C: Glossary

Chapter Seventeen: Citizenship	I. Introduction · II. Governing Legislation and Resources · III. Who is a Canadian Citizen? · IV. Advantages & Responsibilities of Citizenship · V. Citizenship Grants · VI. Applying for Citizenship Grant · VII. Loss and Renunciation of Citizenship · VIII. Proof of Citizenship · IX. Search of Citizenship Record · X. Referrals

Chapter Eighteen: Immigration Law	I. Introduction · II. Governing Legislation and Resources · III. Immigration Players · IV. Categories of Persons under IRPA · V. Applying for Permanent Residency · VI. Identification for PR · VII. Immigration and Refugee Board · VIII. Loss of PR Status · IX. In-Canada Temporary Residence Matters · X. Removal Orders · XI. Appeals · XII. Offences · XIII. Immigration Issues at Sentencing · XIV. Contacts

Chapter Nineteen: Landlord and Tenant Law	I. Introduction · II. Governing Legislation · III. Residential Tenancy Act & Laws · IV. Tenancy Agreements · V. Moving In & Moving Out · VI. Security Deposits · VII. Repair & Service · VIII. Rent Increase · IX. Tenant's Rights · X. Subletting & Assignment · XI. Termination & Eviction · XII. Dispute Resolution · XIII. Common Law · XIV. Strata & Condos · XV. Assisted Living · XVI. Manufactured Homes · XVII. Guidelines & Resources

Chapter Twenty: Small Claims and the CRT	I. Introduction · II. Governing Legislation and Resources · III. Do You Have a Claim? · IV. Choosing the Proper Forum · V. Starting a Claim · VI. Responding to a Claim · VII. Default Order · VIII. How a Claim Proceeds · IX. Pre-Trial Applications · X. Mediation · XI. Settlement Conferences · XII. Trial/Pre-Trial Conferences · XIII. Trial Preparation · XIV. Trials · XV. Costs and Penalties · XVI. Appeals · XVII. Enforcement of a Judgement · XVIII. LSLAP Program Information · Appendix A: Registries · Appendix B: Demand Letter · Appendix C: Notice of Claim · Appendix D: Reply to Claim · Appendix E: Glossary · Appendix F: Limitation Periods · Appendix G: Causes of Action · Appendix H: Court Fees · Appendix I: Tribunal Fees · Appendix J: Settlement Conference · Appendix K: Payment Hearing · Appendix L: Appeal

Chapter Twenty One: Welfare Law	I. Introduction · II. Governing Legislation and Resources · III. Eligibility · IV. Special Situations · V. Eligibility Factors · VI. Hardship Assistance · VII. Overpayments and Fraud · VIII. Rates and Payment Issues · IX. Additional Allowances and Benefits · X. Health Supplements · XI. Appeals

Chapter Twenty Two: Strata Law	I. Introduction · II. Governing Legislation · III. Strata Concept · IV. Strata Plan · V. Common Property and Assets · VI. Governance · VII. Management · VIII. Finances · IX. Collections · X. Bylaws and Rules · XI. Rentals and Accommodations · XII. Privacy · XIII. Insurance · XIV. Repair and Maintenance · XV. Dispute Resolution · XVI. Recourse to the Courts

Chapter Twenty Three: Referrals	I. General · II. Family Law & Women · III. Residential Tenancy · IV. Human Rights · V. Wills & Estates · VI. Immigration & Refugee · VII. Disability · VIII. Employment · IX. Debt · X. Indigenous · XI. Police Complaints · XII. Chinese Language · XIII. Others

@@ Line 5: / Line 5: @@
 * STATUS:   The applicant is a “worker” covered under the Act.
 * DISABILITY: The applicant suffered a personal injury or an occupational disease, causing disability.
 * CAUSATION:  The worker’s disabling injury or disease arose out of and in the course of the worker’s employment.
 * TIME LIMITS AND PROCEDURES: The worker submitted a timely and proper application.

The Worker's Compensation Claim Acceptance Process (7:VII): Difference between revisions

Revision as of 20:56, 13 December 2022

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The Worker's Compensation Claim Acceptance Process (7:VII): Difference between revisions

Revision as of 20:56, 13 December 2022

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