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Difference between revisions of "Time Limits and Procedures in Workers' Compensation (7:X)"
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Time Limits and Procedures in Workers' Compensation (7:X) (view source)
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These WCB employees, together with a number of other WCB “players”, interact considerably during initial decision processes. For example, a projected loss of earnings assessment, while made by a Disability Awards Officer, is based on a report from the Rehabilitation Officer stating which jobs are suitable and available to the worker, and what earnings can be anticipated. Throughout a claim, the Board’s salaried medical staff (doctors, psychologists etc.) may be consulted regarding medical issues. Furthermore, board medical advisors may be consulted where a second medical opinion is needed. | These WCB employees, together with a number of other WCB “players”, interact considerably during initial decision processes. For example, a projected loss of earnings assessment, while made by a Disability Awards Officer, is based on a report from the Rehabilitation Officer stating which jobs are suitable and available to the worker, and what earnings can be anticipated. Throughout a claim, the Board’s salaried medical staff (doctors, psychologists etc.) may be consulted regarding medical issues. Furthermore, board medical advisors may be consulted where a second medical opinion is needed. | ||
== D. Procedure After Application == | |||
The family doctor plays a crucial role in the acceptance and continuance of the worker’s claim as well as their treatment. The WCA requires that the doctor file an initial report with the Board, as well as progress reports for each visit. Doctors are also required to give all necessary advice and assistance to a worker making an application for compensation, including furnishing proof that may be required. Some doctors are very helpful to injured workers, while others refuse to get involved in what they consider to be a legal issue. Such an attitude can be very harmful if there is a medical dispute between the Board and the worker. | |||
The Board has extensive inquiry and investigative powers. It may require the worker to be medically examined by a WCB staff doctor or by independent consultants. WCB officers called Entitlement Officers, Case Managers, Disability Awards Officers, and Rehabilitation Consultants decide whether to accept the claim and what benefits, if any, should be paid. Although rarely used, the Board has the authority to conduct a formal inquiry at which the claimant and other witnesses are compelled to appear and be questioned. Important decisions occur at various times as a result of the interaction and correspondence between various WCB officers, the worker, the family doctor, and any specialist. | |||
As set out above, making a claim to the Board results in obligations arising for the worker and for their healthcare professionals (see RSCM II Policies #93.26 and 95.00 – 95.40). A failure to provide information on the part of the worker can result in the claim being suspended (see RSCM II Policy #96.22). | |||
If there is a delay in obtaining outside evidence, the Board may decide to make a preliminary determination and begin paying benefits while waiting for further information (see RSCM II Policy #96.21). | |||
== E. Evidence and Investigation == | |||
As in any legal arena, at all stages of the Workers’ Compensation process it is vital to support claims with evidence. Often this can be especially challenging when dealing with medical issues for many reasons: for example, these issues require specialized knowledge, they often do not lend themselves to certainty even for professionals, and most injured workers have limited time and money to spend collecting evidence. | |||
Conversely, WCB has salaried Board Medical Advisors (BMA) and WCAT is “presumed to be an expert in all matters over which it has exclusive jurisdiction” ([http://www.canlii.org/en/bc/bcca/doc/2014/2014bcca499/2014bcca499.html?autocompleteStr=2014%20BCCA%20499%20&autocompletePos=1 Fraser Health Authority v Workers’ Compensation Appeal Tribunal, 2014 BCCA 499 (Fraser Health)]). Nevertheless, WCB and WCAT are not presumed to have medical or scientific expertise and, as such, they are not permitted to ignore uncontradicted expert advice ([http://www.canlii.org/en/bc/bcsc/doc/2009/2009bcsc493/2009bcsc493.html?autocompleteStr=2009%20BCSC%20493&autocompletePos=1 Page v British Columbia (Workers’ Compensation Appeal Tribunal), 2009 BCSC 493]) particularly in light of the “as likely as not” standard. | |||
While it may be useful to document subjective claims of injury, pain, and limitations, workers should bring as much objective expert evidence as possible. This may include evidence from physiotherapists, massage therapists, chiropractors, and dentists in addition to a family doctor. If necessary and possible, ask to be referred to a specialist. | |||
Also, recall that medical diagnosis and medical causation does not need to be proved to the level of scientific certainty. The finder of fact is permitted to make common sense inferences ([http://www.canlii.org/en/bc/bcsc/doc/2012/2012bcsc1820/2012bcsc1820.html?autocompleteStr=2012%20BCSC%201820&autocompletePos=1 Snell v Farrell, [1990] 2 SCR 311]; [http://www.canlii.org/en/ca/scc/doc/1990/1990canlii70/1990canlii70.html?autocompleteStr=snell%20v&autocompletePos=1 McKnight v Workers’ Compensation Appeal Tribunal, 2012 BCSC 1820]) | |||
As with all evidence in the claims process, there is no onus on the worker to prove their injury. Rather, once a claim has been made, the Board gathers the relevant evidence it needs to make a sound conclusion. However, the worker does need to provide some basic evidence of an injury to start the process. As set out above, the standard of proof is “as likely as not”, i.e. if the evidence is weighed 50/50, the tie goes to the worker. (See RSCM II, Policy #97.00) | |||
Workers also benefit from several evidentiary assumptions set out at RSCM II Policy #97.20. The RSCM II sets out a number of detailed policies on investigation of claims, use and weighing of evidence, and the powers that the Board has in investigating claims issues for determination. These powers are wide reaching and can be used at any stage of a claim. However, the need for extensive investigation typically occurs at the outset of a claim or when a worker seeks to have a new injury / symptom added to a claim. These policies, as well as policies governing acceptance and disclosure of information on a claim file, are set out at RSCM II Policies # 97.00 – 99.90 and number more than 50 policies. These policies are useful to review generally, but should always be specifically consulted when any issues around evidence / information arises on a claim file. | |||
Also note that certain costs and expenses incurred by a worker in the course of a Board investigation / inquiry / appeal related to a claim can be reimbursed. These policies are set out at RSCM II Policies #100.00 – 100.83) | |||
