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

From Clicklaw Wikibooks
Jump to navigation Jump to search
No edit summary
No edit summary
Line 1: Line 1:
{{REVIEWED LSLAP | date= July 21, 2022}}
{{REVIEWED LSLAP | date= August 1, 2023}}
{{LSLAP Manual TOC|expanded = workers}}
{{LSLAP Manual TOC|expanded = workers}}


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:  
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.  
* '''Status''': The applicant is a “worker” covered under the ''Act''.
* '''Disability''': The applicant suffered a personal injury (physical or psychological) 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.


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.  
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.


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].
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 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 (7-47). 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 Navbox|type=chapters1-7}}
{{LSLAP Manual Navbox|type=chapters1-7}}

Revision as of 19:41, 22 August 2023

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by the Law Students' Legal Advice Program on August 1, 2023.
LSLAP Manual
LSLAP Manual
This page is from the
Law Students' Legal
Advice Program Manual.
See the full contents.
LSLAP Manual
Introduction
Chapters
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
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 (physical or psychological) 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 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 (7-47). 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.]


v • d • e
 
Chapters 1-7
Criminal Law  · Youth Justice  · Family Law  · Victims  · Public Complaints · Human Rights  · Workers Compensation
Chapter One:
Criminal Law
Chapter Two:
Youth Justice
Chapter Three:
Family Law
Chapter Four:
Victims
Chapter Five:
Public Complaints
Chapter Six:
Human Rights
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
© Copyright 2024, The Greater Vancouver Law Students' Legal Advice Society.


Retrieved from "https://wiki.clicklaw.bc.ca/index.php?title=The_Worker%27s_Compensation_Claim_Acceptance_Process_(7:VII)&oldid=56326"