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Difference between revisions of "Introduction to Compensation Claims for Injured Workers (7:III)"
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Introduction to Compensation Claims for Injured Workers (7:III) (view source)
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*accepts or rejects claims; | *accepts or rejects claims; | ||
*approves wage loss benefits, determines the initial wage rate, and terminates or reduces wage loss benefits; | *approves wage loss benefits, determines the initial wage rate, and terminates or reduces wage loss benefits; | ||
*investigates and decides “long term” average earnings, which are implemented eight weeks after the injury (10 weeks for injuries occurring on or after June 30, 2002); | |||
*approves or rejects operations or other major treatments; | |||
*approves workers’ expenses for WCB payment; | |||
*determines when to terminate wage loss benefits because the worker’s disability is considered to have “plateaued”; | |||
*generally makes most decisions involving workers including whether to register the worker for vocational rehabilitation services and pension assessments; and | |||
*determines whether the worker has suffered a loss of earnings that is “so exceptional” that the functional pension does not adequately compensate for it. | |||
==== b) Vocational Rehabilitiation Consultant ==== | |||
*Works with the worker, employer, and union (if any) to get the worker back to work as soon as medically possible, perhaps to a modified job; | |||
*approves job retraining courses; | |||
*determines training allowances (usually paid at wage loss levels) and expenses for attending courses; | |||
*can agree to subsidize a new employer for a limited time; | |||
*determines “continuity of income” benefits to bridge the gap between termination of wage-loss benefits and determination of a permanent pension; and | |||
*assesses a worker’s long-term employability, and the earnings he or she is considered capable of achieving after the worker has “maximized” his or her earning capacity in a suitable and available job. This assessment is the core of the Disability Awards Officer’s decision concerning a loss of earnings pension. While the decision is made by the Officer, who can reject the recommendation of the consultant, the consultant’s assessment is a crucial step in the pension process. | |||
==== c) Disability Awards Officer ==== | |||
*Determines the degree of permanent disability on a physical impairment basis; for workers whose permanent disability is considered to have occurred on or after June 30, 2002, this will determine the pension in the great majority of cases. | |||
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.) are consulted regularly regarding medical issues, and their advice is regularly accepted by the Board over that of the worker’s own family doctor and specialist if there is a dispute. | |||
==== d) EXCEPTION: Electing to Proceed Outside the WCB ==== | |||
In certain cases, an employee may choose to sue the person or company responsible for causing a work injury rather than making a claim for Workers’ Compensation. If the injury is caused by a person not covered by the WCA (i.e. a delivery driver injured by a private citizen in a motor vehicle accident), then the worker can elect to sue a non-covered “third party” instead of claiming compensation. | |||
The Board can also sue the third party in the worker’s name; this is termed “subrogation”. If the worker claims compensation, the Board has exclusive jurisdiction to decide if it will take legal action against a third party. If it does take action and recovers more than the total value of the worker’s benefits, the worker receives the difference minus a 29% administration fee. If the Board recovers less than the total value of benefits, the worker will keep the full compensation. A worker cannot waive or assign his or her right to compensation. | |||
An “election” is an important and complex decision (see s. 10 of the WCA) and workers should be referred to the Workers’ Advisors Office online at [http://www.labour.gov.bc.ca/wab] before deciding whether to claim compensation. If a worker chooses to pursue court action and is unsuccessful, or the award is less than he or she would have received under the compensation regime, the worker may still be able to receive compensation. However, the original claim for compensation must have been made within the time limits outlined below. | |||
