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

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==What is Workers’ Compensation?==
If you think that the Workers’ Compensation Board, now called WorkSafeBC, made the wrong decision in your case, or if you don’t understand the decision, ask the WorkSafeBC officer handling your claim to explain it. Ask for a decision letter, if you didn’t already get one. If you are still not satisfied with the decision, you may request a review, and if you are not satisfied with the decision on the review, you may file an appeal.
Workers’ Compensation is a government program run by the Workers’ Compensation Board of BC and paid for by employers. The Workers’ Compensation Board now uses the name “WorkSafeBC.” The program is designed to:
*pay workers for some of their lost income and certain expenses if they suffer a workplace injury or disease – regardless of who was at fault – or to pay a worker’s family if the worker dies from the injury or disease.
*help injured workers get back to work.
*make and enforce health and safety rules and promote safety in the workplace. As of November 2013, WorkSafeBC policies deal with workplace bullying and harassment. They explain what these terms mean and set out the duties of employers, employees and supervisors to prevent and respond to workplace bullying and harassment. Details are on the WorkSafeBC website at [http://www.worksafebc.com www.worksafebc.com].  


The ''Workers Compensation Act'' is available at [http://www.bclaws.ca www.bclaws.ca].
==Reviews==
First, you have to ask WorkSafeBC’s Review Division to review the decision – within 90 days of the date of WorkSafeBC’s decision letter or, in some cases, within 90 days of the date that WorkSafeBC told you its decision orally or stopped paying you. Because WorkSafeBC routinely communicates some decisions orally, the Review Division will also accept review requests from oral decisions. After you request a review, you will receive a letter setting a time to make written submissions. The Review Division does not normally hold oral hearings.


==Who can get Workers’ Compensation?==
The Review Division considers the written submissions and WorkSafeBC’s file and gives its decision, usually within 150 days. The WorkSafeBC website, at [http://www.worksafebc.com www.worksafebc.com], has more information on reviews. The phone numbers for the Review Division are 604.214.5411 in the lower mainland and 1.888.922.8804 elsewhere in BC. At the same time, if you feel that WorkSafeBC has treated you unfairly, you can also complain to its Fair Practices Office and the Ombudsperson of BC ([http://www.ombudsman.bc.ca www.ombudsman.bc.ca] and 1.800.567.3247).
The program covers almost all workers, both full- and part-time, including office workers, farm workers, performers, and domestic workers. Unregistered labour contractors may also be entitled to benefits. Independent contractors can register with the program for personal optional protection. If they don’t do this, they are not entitled to compensation for work injuries or diseases.


If you suffer a workplace injury or disease, you may be able to get one or more of the following benefits.
==Appeals==
If you disagree with the decision of the Review Division, you can usually appeal to the Workers’ Compensation Appeal Tribunal [http://www.wcat.bc.ca www.wcat.bc.ca]). But you cannot appeal decisions of the Review Division on specific issues, such as vocational rehabilitation, commutations, prevention orders (other than penalties), and certain types of disability awards. If you want to appeal, you have to do so within 30 days of the date of the decision by the Review Division. Contact the Tribunal in writing (see address below) or phone 604.664.7800 in the lower mainland and 1.800.663.2782 (toll free) elsewhere in BC.


==Types of benefits==
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 have to follow it up with the form within 21 days. If you use a letter or the form, fax them to 604.664.7898 or mail them to:
===1. Short-term disability or wage loss benefits for temporary disability===
These benefits pay you, at least partly, for income you lose because of your workplace injury or disease. If you are injured and unable to work, the benefits are usually 90% of your net wages. These benefits pay you for lost income, but only up to a maximum wage (adjusted each year). If you remain temporarily disabled after 10 weeks, WorkSafeBC may recalculate your benefits based on your income in the 12 months before your injury or disease. Wage loss benefits continue until you are no longer temporarily disabled or your condition becomes stable and will not get any better or worse.


===2. Long-term or permanent disability and death benefits===
:'''WCAT'''
If you are permanently disabled, totally or partly, you are entitled to permanent disability benefits. These are paid in one of two ways: a “permanent functional impairment (PFI) award” or a “loss of earnings (LOE) award.” Usually, WorkSafeBC pays a PFI award. But if WorkSafeBC finds that a PFI award does not properly compensate you because your disability reduces your ability to continue working in your occupation to an exceptional extent – it may pay an LOE award. Although a permanent disability award covers permanent chronic pain, it does not cover loss of enjoyment of life, or damage to your clothes or vehicle.
:150 4600 Jacombs Road
:Richmond, BC V6V 3B1


Normally, if benefits are more than $200 a month, they are paid monthly. If benefits are less than $200 a month, you will probably get a lump-sum payout. Even if WorkSafeBC plans to pay you benefits monthly, you can apply for a “commutation” (a lump-sum payout) of all or part of your award. Generally, you won’t get a commutation if the benefits are more than $200 a month. You may get a commutation only if it improves your income. And you must have another stable income source, apart from the benefits.
==What the Tribunal does==
The Tribunal will send you a letter to confirm that it got your appeal and give you an appeal number. You should always include this appeal number, and your WorkSafeBC 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 WorkSafe BC.


Families of workers who are killed on the job or die from a workplace injury or disease, may qualify for an award and vocational training help.
The Tribunal must apply the law and the policies of the WorkSafeBC Board of Directors that apply to your appeal. You should find out what policies apply to your case. You can see previous Tribunal decisions on its website.


===3. Health care benefits===
==Preparing for reviews and appeals==
Health care benefits pay for doctors, hospitals, nursing care, home care, prescription drugs, and other health care professionals like physiotherapists, dentists, and chiropractors. They also cover other expenses, including medical supplies, appliances like crutches, hearing aids, dentures, and eyeglasses, and modifications to home, vehicles, and workplace.
Before you start, see the information guides on the Tribunal’s website, at [http://www.wcat.bc.ca www.wcat.bc.ca]. Click on “Information Guides” for detailed information on appeals. Decide whether you want to handle your own appeal or have someone help you. 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.


===4. Vocational rehabilitation benefits===
If you don’t get help from a union or lawyer, you should contact the Workers’ Advisers Office of the BC Ministry of Labour and Citizens’ Services. Workers’ Advisers are separate from WorkSafeBC and there’s no charge for their service. They can help workers apply for reviews and appeals, and they have detailed information on their website at [http://www.labour.gov.bc.ca/wab www.labour.gov.bc.ca/wab]. Their phone numbers are 604.713.0360 in Vancouver and 1.800.663.4261 elsewhere in BC.
If WorkSafeBC decides that you cannot return to your pre-injury job because of your injury and your employer cannot offer a modified job, you may be entitled to vocational rehabilitation services. These benefits are for vocational retraining, workplace redesign or job modification, training on the job, and job search activity. If your injury or disease eventually forces you to change your occupation, you should think about your future educational and vocational needs. You should ask WorkSafeBC for rehabilitation guidance to help you plan your future. You have to take charge of your own rehabilitation. If you have a good idea of what you want, you explain it, and it is appropriate, the more likely you are to get it.


How to apply
If you are an employer, you should contact the Employers’ Advisers. They provide independent advice, assistance, representation and training to employers, potential employers and employer associations concerning workers' compensation issues. There is no charge for their service. They have detailed information on their website at [http://www.labour.gov.bc.ca/eao www.labour.gov.bc.ca/eao].
If you suffer a workplace injury or illness, report it immediately to your employer, your doctor and WorkSafeBC. You can get application forms from your employer, your union, or the WorkSafeBC website at www.worksafebc.com. Call 604.231.8888 in the lower mainland and 1.888.967.5377 elsewhere in BC (free of charge). Your employer and your doctor must report your injury or disease to WorkSafeBC within 3 days of when you tell them about it.


You have only one year from your accident or disease to apply for compensation. After that, you may lose your right to benefits unless special circumstances stopped you from applying on time.
==What you need to show==
Reviews and appeals are serious. 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.


A WorkSafeBC officer will examine your claim and decide if you get benefits, and if so, the type and amount. WorkSafeBC won’t decide about any permanent disability until your condition becomes stable, meaning that it stays the same and does not get any better or worse.
==Check the Information Guides and your WorkSafeBC file==
To prepare your case, in addition to looking at the Tribunal’s Information Guides, you should also look at your WorkSafeBC file. You have the right to see it and you should automatically get it when you ask for a review. You will automatically get updated disclosure when you appeal a Review Division decision.


Deciding whether you get benefits can be complicated. You should discuss your case with your union, a lawyer, or the Workers’ Advisers Office. Workers’ Advisers work for the Ministry of Labour and Citizens’ Services to help workers with their claims. They are separate from WorkSafeBC and there’s no charge for their service. Their website is www.labour.gov.bc.ca/wab and their phone numbers are 604.713.0360 in Vancouver and 1.800.663.4261 elsewhere in BC.
Even if you don’t have an active review or appeal, you can request disclosure of your claim file by sending a written request, using a form on the WorkSafeBC website ([http://www.worksafebc.com www.worksafebc.com]), to:


Reviews and Appeals – if you disagree with the WorkSafeBC decision
:Disclosure Department
If WorkSafeBC decides that you are not eligible for benefits, or if you don’t understand its decision, ask the WorkSafeBC officer handling your claim for an explanation. Ask for a decision letter if you didn’t already get one. If you’re still not satisfied, you can ask the Review Division of WorkSafeBC to review the decision. But you must ask for a review within 90 days of the date of WorkSafeBC’s decision letter or, in some cases, within 90 days of the date when WorkSafeBC told you its decision orally. WorkSafeBC should automatically give you a copy of your claim file and you can use the information in it for your review. After you request a review, you will receive a letter setting a time to make written submissions. The Review Division does not normally hold oral hearings.
:WorkSafeBC
:PO Box 4700 Stn Terminal
:Vancouver BC V6B 1J1
:Fax: 604 233-9777 or toll free 1 888 922-8807


The Review Division considers the written submissions and WorkSafeBC’s file and gives its decision, usually within 150 days. The WorkSafeBC website, at www.worksafebc.com, has more information on reviews. The phone numbers for the Review Division are 604.214.5411 in the lower mainland and 1.888.922.8804 elsewhere in BC. At the same time, if you feel that WorkSafeBC has treated you unfairly, you can also complain to its Fair Practices Office and the Ombudsperson of BC (www.ombudsman.bc.ca and 1.800.567.3247).
All your personal information is usually in your claim file, but sometimes other WorkSafeBC records also have personal information. To see these records, under the ''Freedom of Information and Protection of Privacy Act'', send a written request to:


If you’re not satisfied with the decision of the Review Division, in most cases you have the right to appeal to the Workers’ Compensation Appeal Tribunal (www.wcat.bc.ca). You must appeal within 30 days of the date of the decision of the Review Division.
:'''Freedom of Information and Protection of Privacy Office'''
:WorkSafeBC
:PO Box 2310 Stn Terminal
:Vancouver, BC V6B 3W5
:Phone 1.866.266.9405
:Fax 604.279.7401


For more information
You can also see most of your claim file information online on the WorkSafeBC website. You will need your claim number and your personal access number.
Check the WorkSafeBC website at www.worksafebc.com for more information on workers’ compensation and reviews.


Check script 286, called “Appealing a Workers’ Compensation Decision”, and the Tribunal’s website at www.wcat.bc.ca for more information on appeals. Also, check the Workers’ Advisers website at www.labour.gov.bc.ca/wab for detailed information on reviews and appeals. Employers should check the Employers’ Advisers website at www.labour.gov.bc.ca/eao.
For more on this, check script [[Freedom of Information and Protection of Privacy (Script 235)|235]], called “Freedom of Information and Protection of Privacy”. As well, the ''Freedom of Information and Protection of Privacy Act'' is available at [http://www.bclaws.ca www.bclaws.ca].


==For more information==
*Check script [[Workers' Compensation (Script 285)|285]], called “Workers’ Compensation”, and the Tribunal’s website at [http://www.wcat.bc.ca www.wcat.bc.ca], including its Information Guides.
*Check the Workers’ Advisers website, at [http://www.labour.gov.bc.ca/wab www.labour.gov.bc.ca/wab] or Employers’ Advisers website at [http://www.labour.gov.bc.ca/eao www.labour.gov.bc.ca/eao].


[updated February 2014]
 
[updated January 2014]





Revision as of 23:29, 18 December 2014

If you think that the Workers’ Compensation Board, now called WorkSafeBC, made the wrong decision in your case, or if you don’t understand the decision, ask the WorkSafeBC officer handling your claim to explain it. Ask for a decision letter, if you didn’t already get one. If you are still not satisfied with the decision, you may request a review, and if you are not satisfied with the decision on the review, you may file an appeal.

Reviews[edit]

First, you have to ask WorkSafeBC’s Review Division to review the decision – within 90 days of the date of WorkSafeBC’s decision letter or, in some cases, within 90 days of the date that WorkSafeBC told you its decision orally or stopped paying you. Because WorkSafeBC routinely communicates some decisions orally, the Review Division will also accept review requests from oral decisions. After you request a review, you will receive a letter setting a time to make written submissions. The Review Division does not normally hold oral hearings.

The Review Division considers the written submissions and WorkSafeBC’s file and gives its decision, usually within 150 days. The WorkSafeBC website, at www.worksafebc.com, has more information on reviews. The phone numbers for the Review Division are 604.214.5411 in the lower mainland and 1.888.922.8804 elsewhere in BC. At the same time, if you feel that WorkSafeBC has treated you unfairly, you can also complain to its Fair Practices Office and the Ombudsperson of BC (www.ombudsman.bc.ca and 1.800.567.3247).

Appeals[edit]

If you disagree with the decision of the Review Division, you can usually appeal to the Workers’ Compensation Appeal Tribunal www.wcat.bc.ca). But you cannot appeal decisions of the Review Division on specific issues, such as vocational rehabilitation, commutations, prevention orders (other than penalties), and certain types of disability awards. If you want to appeal, you have to do so within 30 days of the date of the decision by the Review Division. Contact the Tribunal in writing (see address below) or phone 604.664.7800 in the lower mainland and 1.800.663.2782 (toll free) elsewhere in BC.

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 have to follow it up with the form within 21 days. If you use a letter or the form, fax them to 604.664.7898 or mail them to:

WCAT
150 – 4600 Jacombs Road
Richmond, BC V6V 3B1

What the Tribunal does[edit]

The Tribunal will send you a letter to confirm that it got your appeal and give you an appeal number. You should always include this appeal number, and your WorkSafeBC 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 WorkSafe BC.

The Tribunal must apply the law and the policies of the WorkSafeBC Board of Directors that apply to your appeal. You should find out what policies apply to your case. You can see previous Tribunal decisions on its website.

Preparing for reviews and appeals[edit]

Before you start, see the information guides on the Tribunal’s website, at www.wcat.bc.ca. Click on “Information Guides” for detailed information on appeals. Decide whether you want to handle your own appeal or have someone help you. 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.

If you don’t get help from a union or lawyer, you should contact the Workers’ Advisers Office of the BC Ministry of Labour and Citizens’ Services. Workers’ Advisers are separate from WorkSafeBC and there’s no charge for their service. They can help workers apply for reviews and appeals, and they have detailed information on their website at www.labour.gov.bc.ca/wab. Their phone numbers are 604.713.0360 in Vancouver and 1.800.663.4261 elsewhere in BC.

If you are an employer, you should contact the Employers’ Advisers. They provide independent advice, assistance, representation and training to employers, potential employers and employer associations concerning workers' compensation issues. There is no charge for their service. They have detailed information on their website at www.labour.gov.bc.ca/eao.

What you need to show[edit]

Reviews and appeals are serious. 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.

Check the Information Guides and your WorkSafeBC file[edit]

To prepare your case, in addition to looking at the Tribunal’s Information Guides, you should also look at your WorkSafeBC file. You have the right to see it and you should automatically get it when you ask for a review. You will automatically get updated disclosure when you appeal a Review Division decision.

Even if you don’t have an active review or appeal, you can request disclosure of your claim file by sending a written request, using a form on the WorkSafeBC website (www.worksafebc.com), to:

Disclosure Department
WorkSafeBC
PO Box 4700 Stn Terminal
Vancouver BC V6B 1J1
Fax: 604 233-9777 or toll free 1 888 922-8807

All your personal information is usually in your claim file, but sometimes other WorkSafeBC records also have personal information. To see these records, under the Freedom of Information and Protection of Privacy Act, send a written request to:

Freedom of Information and Protection of Privacy Office
WorkSafeBC
PO Box 2310 Stn Terminal
Vancouver, BC V6B 3W5
Phone 1.866.266.9405
Fax 604.279.7401

You can also see most of your claim file information online on the WorkSafeBC website. You will need your claim number and your personal access number.

For more on this, check script 235, called “Freedom of Information and Protection of Privacy”. As well, the Freedom of Information and Protection of Privacy Act is available at www.bclaws.ca.

For more information[edit]


[updated January 2014]





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