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Time Limits and Procedures in Workers' Compensation (7:X): Difference between revisions

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== A. Time Limits ==
As set out above, the key time limits that apply to making a claim are the reporting time limits and the time limits for filing a claim.
Injuries must be reported by workers to their employers and by employers to the Board as soon as possible. See paragraph VI.A.1 above for details.
Section 151 [Former Act, s. 55] of the WCA requires that generally, a worker must apply for compensation '''within one year''' of the date of injury. Subsections 151(4) and (5), as well as section 152 [Former Act, s. 55(3.2)], provide several exceptions for when late applications may be accepted:
# If exceptional circumstances exist which precluded the worker from making an application within one year and the application is less than three years after the date of injury (WCA, s. 151(4) [Former Act, s. 55(3.1)]), the worker’s application may be accepted. If a worker’s application has been denied because of a late application, please consult Policy #93.22 of the RSCM II to assess what evidence of “exceptional circumstances” may be relevant in that case;
# Even after more than three years post-accident, the Board may still accept a claim based on “exceptional circumstances”, however the Board can only pay compensation from the date of the application forward, not from the date of the injury (WCA, s. 151(5) [Former Act, s. 55(3.1)]);
# If death or disablement is due to an occupational disease but sufficient scientific evidence did not exist at the time of the application to prove this and there is new scientific evidence regarding the occupational disease causation, the application may be accepted. However, the worker must make the application no more than three years after sufficient medical or scientific evidence became available to the board (WCA, s 152(1) [Former Act, s. (3.2)]); or
# The Board may also reconsider an old occupational disease decision that meets the Subsections 152(1) and (2) criteria.
== B. Application Procedures ==
Applications to the Board must be made by submitting a Form 6, which will be provided to the worker by the Board when a report is received. This form can also be [http://www.worksafebc.com/en/resources/claims/forms/application-for-compensation-and-report-of-injury-or-occupational-disease-form-6 found online]. This form can also be submitted online. Workers can also call Teleclaim at 1.888.967.5377 from 8am to 6pm Monday to Friday.
Note that, even when submitted online, a typed or printed name is not sufficient to meet the signature requirement. The worker must either have a handwritten digital signature they can apply to the form or must print and sign the form before scanning and submitting. See RSCM II Policy #93.25.
Finally, the Board does have the discretion to accept and adjudicate a claim without an application in certain circumstances. See RSCM II Policy #93.23.
== C. The Case Management Process ==
Claims procedures are governed by Chapter 12 of the RSCM II. This manual will not cover all of the policies in that chapter, so it is important to review the nature of the policies in that chapter in order to be able to spot policy related issues in a case.
Once an application has been made, it moves into the case management process whiere initial decision makers will consider the application and decide whether to accept or reject the claim on the criteria set out above. The key feature of case management is a case manager who oversees the delivery of services for the entire life of the claim.  This process may also include regular multidisciplinary team meetings, clinical care planning, site visits, and a return to work plan, which sets out expectations surrounding medical treatment, physical rehabilitation, and a Return to Work option.  The worker, union or other representative, the worker’s doctors, and the employer are all expected to participate.
On May 11 2009, WCB launched a Claims Management Solutions ('''“CMS”''') System to streamline and manage the claims process more effectively and improve service to customers. The CMS System manages all data related to previous, current, and future claims and helps integrate services throughout the life cycle of a claim. It is supposed to result in faster case handling and claim payments, more support for injured workers, and less administrative work for employers and service providers. Workers can obtain real-time access to their claim file by registering online and can authorize a representative to have access as well.
=== 1. Initial Decision-Making Process ===
Most decisions are made by frontline WCB officers. The major issues to be decided are: whether the worker is covered by the WCA; whether the injury arose out of and in the course of employment; and what benefits the worker is entitled to. The most important WCB officers, and the decisions that they make, are as follows:
==== i) Entitlement Officers (EO) ====
* Accepts or rejects claims;
* Seeks and reviews required medical documentation;
* May establish initial long-term wage rates;
* Pays short-term disability benefits;
* Authorizes health care payments;
* Calculates overpayment;
* Requests refund from claimant if overpaid;
* Identifies claims requiring claim management; and
* Monitors return-to-work.
==== ii) Case Manager (CM) ====
* Accepts or rejects claims;
* 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 ten weeks after the injury (or eight weeks for injuries before June 30, 2002);
* Approves or rejects operations or other major treatments;
* Approves workers’ expenses for WCB payments;
* Determines when to terminate wage loss benefits because the worker’s disability is considered to have “plateaued”; and
* Generally, makes most decisions involving workers including whether to register the worker for vocational rehabilitation services and pension assessments.
==== iii) Vocational Rehabilitation 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 they are considered capable of achieving after the worker has “maximized” their 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.
==== iv) 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.) may be consulted regarding medical issues. Furthermore, board medical advisors may be consulted where a second medical opinion is needed. 


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