Difference between revisions of "Appealing a Workers' Compensation Decision"

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{{REVIEWEDPLS | reviewer = [http://www.wcat.bc.ca/index.aspx Tim Martiniuk], Workers’ Compensation Appeal Tribunal (WCAT)|date= January 2018}} {{Dial-A-Law TOC|expanded = work}}
{{REVIEWEDPLS | reviewer = [https://www.ascentemploymentlaw.ca/about-us Richard Johnson], Ascent Employment Law and [https://www.mooreedgarlyster.com/lawyers/sara-hanson Sara Hanson], Moore Edgar Lyster LLP|date= August 2021}} {{Dial-A-Law TOC|expanded = work}}
If you disagree with a decision on a workers’ compensation claim, you can request a review of the decision. If you’re still not satisfied, you can appeal to a tribunal.
If you disagree with a decision on a workers’ compensation claim, you can request a review of the decision. If you’re still not satisfied, you can '''appeal to a tribunal'''.


==Understand your legal rights==
==Common questions==
===If my claim for workers’ compensation is denied, can I appeal?===
Yes. You can ask WorkSafeBC (the agency that operates BC’s workers’ compensation program) to review a decision on a workers’ compensation claim. If you’re unhappy with the outcome of the review, you can appeal to a tribunal.


===Challenging a decision of Work Safe BC===
The [https://www.wcat.bc.ca/ Workers’ Compensation Appeal Tribunal] hears appeals of workers’ compensation decisions. We explain the process in our guidance [https://www.peopleslawschool.ca/appealing-a-workers-compensation-decision/ on appealing a workers’ compensation decision].
'''Workers’ compensation''' is a BC government program run by [http://www.worksafebc.com/ Work Safe BC]. It pays benefits to workers if they suffer a workplace injury or disease, and promotes health and safety in the workplace. (We explain the [[Workers' Compensation (No. 285)|workers’ compensation program in no. 285]].)


If you disagree with a decision Work Safe BC makes on claims, assessments, or health and safety matters, you can request a '''review''' of the decision. If you’re still not satisfied, you can appeal to a tribunal. We explain the process shortly.  
===Can any workers’ compensation decision be appealed?===
No. Only certain types of decisions can be appealed to the Workers’ Compensation Appeal Tribunal. Among those that can be appealed are decisions on:


===You can get help or advice===
* whether a certain type of injury or illness is covered by workers’ compensation
You can challenge a Work Safe BC decision on your own. Or you might want to ask for assistance from someone familiar with the workers’ compensation system, such as a union representative, a lawyer, or a workers’ adviser.
* whether a workers’ injury or illness arose out of and during the course of employment
* whether someone was a worker when they were injured


If you are a union member, discuss your case with the union. They may have a representative who can help you, or they may hire a lawyer for you in a serious case. You may want to hire your own lawyer anyway. Make sure the lawyer has experience in workers’ compensation.
Some WorkSafeBC decisions that can’t be appealed include:


If you don’t get help from a union or a lawyer, you should contact the '''Workers’ Advisers Office''' of the BC Ministry of Labour. Workers’ advisers are separate from Work Safe BC and there’s no charge for their services. They help workers apply for reviews and appeals, and they have detailed information on their website. Visit [http://gov.bc.ca/workersadvisers gov.bc.ca/workersadvisers] or call 604-713-0360 in Vancouver and 1-800-663-4261 elsewhere in BC.
a decision regarding vocational rehabilitation benefits
a decision about whether or not to refer a decision back to WorkSafeBC
a decision not to give you more time to bring your review


For employers, the [http://www.gov.bc.ca/employersadvisers Employers’ Advisers Office] provides independent advice, assistance, and representation to employers concerning workers' compensation issues. There is no charge for their services.
We explain this in greater detail in our guidance on [https://www.peopleslawschool.ca/appealing-a-workers-compensation-decision/ appealing a workers’ compensation decision].


==The steps in the process==
===How can I get a copy of my claims file?===
 
On the [https://www.worksafebc.com/en/claims/manage-claim/view-submit-claim-information WorkSafeBC website], you can view all the information associated with your claim. You can also request a copy of your claim, and WorkSafeBC will send the information to you.
===Step 1. Ask for a review===
The first step in challenging a Work Safe BC decision is to ask for a '''review''' of the decision. The Work Safe BC website at [https://www.worksafebc.com/en/review-appeal worksafebc.com] explains how to ask for a review. The phone numbers for the review division are 604-214-5411 in the Lower Mainland and 1-888-922-8804 elsewhere in BC.
 
In a few scenarios, you can’t ask for a review but need to appeal directly to the Workers’ Compensation Appeal Tribunal. For example, if you are challenging a decision to reopen (or not reopen) a matter, or challenging a decision on a discriminatory action complaint (where an employer punished you for raising safety concerns at work). Appeals are explained shortly.
 
Because Work Safe BC routinely issues some decisions orally, the review division accepts review requests from oral decisions.
 
====Time limit to ask for a review====
A worker must ask for a review within '''90 days''' of the date of Work Safe BC’s decision letter or, in some cases, within 90 days of the date that Work Safe BC told the worker its decision orally or stopped paying them.
 
An employer who wants to ask for a review of a decision or an order issued by Work Safe BC on an occupational health and safety matter, has '''45 days''' to ask for a review.
 
{| class="wikitable"
|align="left"|'''Tip'''
While your review is being considered, if you feel that Work Safe BC has treated you unfairly, you can also complain to Work Safe BC’s Fair Practices Office and to the [http://www.ombudsman.bc.ca/ Ombudsperson of BC] (who can be reached at 1-800-567-3247).
|}
 
===Step 2. Prepare your case===
After you request a review, you will receive a letter setting a time to make '''written submissions'''. Work Safe BC’s review division does not normally hold oral hearings.
 
To prepare your case, carefully review your Work Safe BC file. You have the right to see it and you should automatically get it when you ask for a review. 
 
====What you need to show====
Reviews and appeals are serious. In bringing a review or appeal of a Work Safe BC decision, you need to show clearly what’s wrong with the decision. You may need new evidence to support your appeal. You may need more evidence than you had when you first made your claim, such as medical evidence from doctors and specialists. It’s important to get all the evidence you need, as soon as you can.
 
===Step 3. Appeal the review decision===
The review decision is usually made within 150 days. If you disagree with the review decision, you can usually '''appeal''' to the Workers’ Compensation Appeal Tribunal. You cannot appeal review decisions on some issues, such as vocational rehabilitation benefits, certain types of disability awards, and whether benefits are paid as a lump sum.
 
====Time limit to appeal====
If you decide to appeal, you must do so within '''30 days''' of the decision by the review division. (For cases that go directly to the tribunal, the time limit is 90 days.)
 
The tribunal’s website at [http://www.wcat.bc.ca/research/wcat_publications/appeal_guides/index.html wcat.bc.ca] has information guides on how to appeal and how to prepare for an appeal hearing.
 
You can appeal by phone or letter, or you can use the '''notice of appeal''' form on the tribunal’s website. If you appeal by phone, you must follow it up with the form within 21 days. The tribunal’s phone numbers are 604-664-7800 in the Lower Mainland and toll-free 1-800-663-2782 elsewhere in BC.  


====The tribunal will follow up with you====
To request a copy, complete and send a [https://www.worksafebc.com/en/resources/claims/forms/request-for-disclosure-form-25m13?lang=en '''request for disclosure''' form] to this address:
The tribunal will send you a letter to confirm it received your appeal and give you an appeal number. You should always include this appeal number, and your Work Safe BC file number, in any material you submit. The tribunal will ask you to make your submissions in writing or tell you the date for your oral hearing. Normally, the tribunal decides a case within 180 days of when it receives your claim file from Work Safe BC.


The tribunal must apply the law and the policies of Work Safe BC that apply to your appeal. You should find out what policies apply to your case. You can see [http://www.wcat.bc.ca/search/decision_search.aspx previous tribunal decisions] on its website.
==Common questions==
===How can I get a copy of my claims file?===
Through the Work Safe BC website, workers can view all the information associated with their claim. You will need your claim number and your personal access number. You can also request a copy of your claim file from Work Safe BC. You can send a written '''request for disclosure''' form, available on the [https://www.worksafebc.com/en/claims/manage-claim/request-copy-your-claim-file Work Safe BC website], to:
:Disclosure Department
:Disclosure Department
:Work Safe BC
:WorkSafeBC
:PO Box 4700 Stn Terminal
:PO Box 4700 Stn Terminal
:Vancouver BC V6B 1J1  
:Vancouver, BC V6B 1J1
:Fax: 604-233-9777 
 
All your information is usually in your claim file, but sometimes other WorkSafeBC records have personal information too. To see these records, send a written request to:


All your personal information is usually in your claim file, but sometimes other Work Safe BC records also have personal information. To see these records, send a written request to:
:Freedom of Information and Protection of Privacy Office
:Freedom of Information and Protection of Privacy Office
:Work Safe BC
:WorkSafeBC
:PO Box 2310 Stn Terminal
:PO Box 2310 Stn Terminal
:Vancouver, BC V6B 3W5
:Vancouver, BC V6B 3W5
:Phone: 1-866-266-9405
:Fax: 604-279-7401
==Get help==


==Who can help==
===With more information===
===With more information===
The '''Work Safe BC''' website includes extensive information on workers’ compensation benefits, how to apply for benefits, and the process to review or appeal a decision.  
:'''WorkSafeBC'''
:Telephone: 604-231-8888 in the Lower Mainland
:Deals with complaints about unsafe working conditions and injuries on the job.
:Toll-free: 1-888-967-5377  
:Call 1-888-967-5377
:Web: [http://www.worksafebc.com/ worksafebc.com]
:[https://www.worksafebc.com/ Visit website]
 
The '''Workers’ Advisers Office''' is a government office that helps workers with claims for workers’ compensation benefits. They are separate from Work Safe BC and there’s no charge for their services.
:Telephone: 604-713-0360 in Vancouver
:Toll-free: 1-800-663-4261 
:Web: [http://gov.bc.ca/workersadvisers gov.bc.ca/workersadvisers]  


:'''Workers’ Advisers Office'''
:A government office that helps workers with claims for workers’ compensation benefits. They are separate from WorkSafeBC and there’s no charge for their services.
:Call 1-800-663-4261
:[https://www2.gov.bc.ca/gov/content/employment-business/employment-standards-advice/personal-injury-and-workplace-safety Visit website]


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Latest revision as of 00:24, 8 November 2023

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by Richard Johnson, Ascent Employment Law and Sara Hanson, Moore Edgar Lyster LLP in August 2021.
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If you disagree with a decision on a workers’ compensation claim, you can request a review of the decision. If you’re still not satisfied, you can appeal to a tribunal.

Common questions

If my claim for workers’ compensation is denied, can I appeal?

Yes. You can ask WorkSafeBC (the agency that operates BC’s workers’ compensation program) to review a decision on a workers’ compensation claim. If you’re unhappy with the outcome of the review, you can appeal to a tribunal.

The Workers’ Compensation Appeal Tribunal hears appeals of workers’ compensation decisions. We explain the process in our guidance on appealing a workers’ compensation decision.

Can any workers’ compensation decision be appealed?

No. Only certain types of decisions can be appealed to the Workers’ Compensation Appeal Tribunal. Among those that can be appealed are decisions on:

  • whether a certain type of injury or illness is covered by workers’ compensation
  • whether a workers’ injury or illness arose out of and during the course of employment
  • whether someone was a worker when they were injured

Some WorkSafeBC decisions that can’t be appealed include:

a decision regarding vocational rehabilitation benefits a decision about whether or not to refer a decision back to WorkSafeBC a decision not to give you more time to bring your review

We explain this in greater detail in our guidance on appealing a workers’ compensation decision.

How can I get a copy of my claims file?

On the WorkSafeBC website, you can view all the information associated with your claim. You can also request a copy of your claim, and WorkSafeBC will send the information to you.

To request a copy, complete and send a request for disclosure form to this address:

Disclosure Department
WorkSafeBC
PO Box 4700 Stn Terminal
Vancouver, BC V6B 1J1

All your information is usually in your claim file, but sometimes other WorkSafeBC records have personal information too. To see these records, send a written request to:

Freedom of Information and Protection of Privacy Office
WorkSafeBC
PO Box 2310 Stn Terminal
Vancouver, BC V6B 3W5

Who can help

With more information

WorkSafeBC
Deals with complaints about unsafe working conditions and injuries on the job.
Call 1-888-967-5377
Visit website
Workers’ Advisers Office
A government office that helps workers with claims for workers’ compensation benefits. They are separate from WorkSafeBC and there’s no charge for their services.
Call 1-800-663-4261
Visit website
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