Difference between revisions of "I've Been Cut off Workers' Compensation Benefits"

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{{Template:Legal Help Guide TOC}}Workers' compensation is a system of benefits for people who are injured at work—regardless of whose fault it is. Workers' compensation is operated by a government agency called WorkSafeBC.  
{{Template:Legal Help Guide TOC}}The Workers' Compensation Board (the WCB, also known as WorkSafeBC) pays benefits to people who have an injury or disease caused by their work. The WCB also pays benefits to dependents of a worker who has been killed on the job or died due to an occupational disease.


Almost all employers have to pay into workers' compensation. You can get compensation for lost pay until either you can return to work, or your disability stabilizes. You are entitled to rehabilitation services to help you get back to work, and you may be entitled to a pension if your injury results in a permanent disability.   
Workers' compensation is a no fault insurance scheme. If you have been injured at work, you <span class="noglossary">will</span> not be allowed to sue your employer or any other worker or employer who may have caused the injury. Your only recourse is to make a workers' compensation claim. That makes it very important that you report your injury to your employer and the WCB as soon as possible after it occurs, and that you and your doctor give the WCB the information it needs about your condition and prospects for recovery.   


{{Tipsbox
Initially, the WCB pays benefits equal to 90% of the net (take home) wages you were earning at the time of injury. After ten weeks the benefits <span class="noglossary">will</span> be based on your long term average earnings. If your benefits drop significantly at this point, you should consider an appeal. 
| width = 70%
 
| tips = If you are off work for more than a couple of weeks, you will probably receive quite a few letters from WorkSafeBC. Read these carefully, because each one could be a decision denying or limiting benefits.
When the WCB decides that you have recovered, your benefits <span class="noglossary">will</span> cease. If you and/or your doctor do not agree that you are ready to go back to work, you should appeal. The WCB <span class="noglossary">will</span> also terminate your benefits if they feel that your condition has stabilized and become permanent. If you or your doctor disagree, you should appeal. 
}}
 
Workers who have a permanent <span class="noglossary">disability</span> are entitled to a total or partial pension, payable until age 65. Permanently disabled workers (and sometimes others) may also be entitled to vocational rehabilitation assistance. As well, WCB plays all medical and related <span class="noglossary">costs</span> of an injury or disease.  


If a <span class="noglossary">decision</span> of the WCB limits your benefits or cuts you off benefits, the first stage of the appeal process is to request a ''review of the <span class="noglossary">decision</span>'' by the WCB Review Division.


== First steps ==
== First steps ==
   
   
# If a decision limits or cuts you off benefits, you can ask for a review of it by a Review Officer. You must apply for this review '''within 90 days''' after the decision, or the review may be turned down. (You can get the "Request for Review" and "Request for Disclosure" forms by phone at 1-888-967-5377 or online at the WorkSafe BC website, [http://www.worksafebc.com www.worksafebc.com]. Click on the "Forms" link, then the "Workers" link under the heading "WorkSafeBC Forms", and scroll down to Form 63M1, "Request for Review" and Form 25M13, "Request for Disclosure".)  
#To request a review of a <span class="noglossary">decision</span> by the WCB's Review Division, get the [http://www.worksafebc.com/forms/assets/PDF/63m1.pdf Request for Review] form online or by phone at 1-888-855-2477.  
# Complete the Request for Review with as much relevant information as you can. Send it to the WorkSafe BC Review Division.
#Complete the Request for Review form and submit it to the Review Division ''within ninety (90) days'' of the date that the WCB <span class="noglossary">decision</span> or <span class="noglossary">order</span> was made. The address is on the form.
 
{{Tipsbox
| width = 90%
| tips = If you are off work for a significant period of time, you <span class="noglossary">will</span> receive many letters from WorkSafeBC. Read these carefully, because each one could be a <span class="noglossary">decision</span> denying or limiting benefits. If in doubt, get legal advice, and if there is something in the letter that you don't agree with, challenge it. If you fail to request a review of a <span class="noglossary">decision</span> within the ninety (90) day time limit, you may lose any chance of changing it, no matter how unfair it is.
}}


== What happens next ==
== What happens next ==
=== WCB Review Division === 
You <span class="noglossary">will</span> receive a complete copy of your WCB file, including all documents the Board has about your claim. Review it carefully to better understand why the Board made the <span class="noglossary">decision</span> you are appealing, so that you can explain to the Review Division why it is wrong.
If your review involves a medical issue, such as whether you are able to return to work, ask your doctor to write to the Board. Most successful reviews are based on new medical evidence.
Your review may also involve a policy issue. The WCB's policy manual, which is nearly 800 pages long, has the force of law, and there are detailed policies about almost every aspect of the claims process. You can read or download the [http://www.worksafebc.com/publications/policy_manuals/Rehabilitation_Services_and_Claims_Manual/default.asp ''Rehabilitation Services and Claims Manual''] from the WCB's website. 
The Review Officer <span class="noglossary">will</span> give you a deadline for sending in any new information or arguments. If you need more time, ask for it. Make sure that you tell the Review Officer about any wrong information in the file, whether it's from a WCB doctor, your employer, or anyone else, and that you explain why the Board's <span class="noglossary">decision</span> was wrong. 
The Review Division usually decides the review within six months.
    
    
The Review Officer will review your Request for Review and other relevant documents, and provide you with a decision within six months. 


If you don't like the Review Board decision, you can appeal it to the Workers' Compensation Appeal Tribunal. You must file this appeal '''within 30 days''' after the Review Board decision or the appeal may be turned down.
{{Tipsbox
| width = 90%
| tips = There are several options for seeking legal help on a WCB claim review. The Workers' Advisers Office provides free, expert advice and occasionally  <span class="noglossary">representation</span> to any worker who requests it. Contact them immediately, as you may have to wait for an appointment. Most unions also provide free, expert help to their injured members. If you belong to a union, tell them about the injury immediately. There are also community organizations that do WCB cases, and there are private lawyers and non-lawyer advocates who are experts in WCB matters.
}}
 
=== Workers' Compensation Appeal Tribunal (WCAT) ===
If you disagree with the Review Division's <span class="noglossary">decision</span>, you can appeal it to the Workers' Compensation Appeal Tribunal (WCAT). You must appeal ''within thirty (30) days'' after the date of the Review Division <span class="noglossary">decision</span>.
 
The WCAT conducts appeals by rehearing them, which means that it considers all the evidence in the file and any new evidence presented by the parties, and then makes its own findings of fact and law. You should ask for an oral hearing, so that you can explain your case to the WCAT vice-chair in person.
 
The WCAT is the final level of appeal, and its decisions can only be challenged in a judicial review proceeding in the Supreme Court of BC. The WCAT can, however, reconsider its own decisions on the basis of new evidence that couldn't have been presented at the first appeal, or because the first <span class="noglossary">decision</span> was based on a serious legal error.


== Where to get help ==
== Where to get help ==
   
   
See the [[Resource Guide]] in Part 2 for a list of helpful resources. Your best bets are:   
See the [[Resource List for Legal Help for British Columbians|Resource List]] in this Guide for a list of helpful resources. Your best bets are:   
* [[Workers' Advisers]].  
* [[Workers' Advisers]].  
* [[PovNet]].  
* [[PovNet]].  
* [[Access Justice]], [[Lawyer Referral Service]], [[Salvation Army Pro Bono Lawyer Consultation Program]], [[Private Bar Lawyers]].  
* [[Access Pro Bono]], [[Lawyer Referral Service]], and [[Private Bar Lawyers|private bar lawyers]].  
* [[Community Legal Assistance Society]].  
* [[Community Legal Assistance Society]].  
* [[Law Students Legal Advice Program]] (see Chapter 7, "Workers' Compensation" for useful information on workers' compensation issues).
* The ''Law Students' Legal Advice Program Manual'' chapter on "[http://www.clicklaw.bc.ca/resource/1723 Workers' Compensation]."  
* The WorkSafeBC website, [http://www.worksafebc.com www.worksafebc.com], has a lot of information about workers' compensation, including copies of appeal decisions.  
* The WCB's website at [http://www.worksafebc.com www.worksafebc.com] has a lot of information about workers' compensation, including its policy manuals, practice directives, past decisions of the Review Division, and all the forms needed to pursue a claim. 
* The WCAT website at [http://www.wcat.bc.ca www.wcat.bc.ca] also has a great deal of useful information, including its procedure manual and a searchable collection of its past decisions. 
* The Clicklaw common question "[http://www.clicklaw.bc.ca/question/commonquestion/1077 I’ve been cut off workers' compensation benefits]."
 
Before meeting with a lawyer or advocate, complete the form [[Preparing for Your Interview]] included in this Guide. Make sure you bring copies of all documents relating to your case.
 
{{REVIEWED | reviewer = [[Trevor Thomas]], March 2017}}


Before meeting with a lawyer or advocate, complete the form [[Preparing for Your Interview]] in Part 3 of this guide. Make sure you bring copies of all documents relating to your case. 
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{{Template:Legal Help Guide Navbox|type=problems}}
{{Creative Commons for Legal Help Guide}}

Latest revision as of 04:29, 2 May 2017

The Workers' Compensation Board (the WCB, also known as WorkSafeBC) pays benefits to people who have an injury or disease caused by their work. The WCB also pays benefits to dependents of a worker who has been killed on the job or died due to an occupational disease.

Workers' compensation is a no fault insurance scheme. If you have been injured at work, you will not be allowed to sue your employer or any other worker or employer who may have caused the injury. Your only recourse is to make a workers' compensation claim. That makes it very important that you report your injury to your employer and the WCB as soon as possible after it occurs, and that you and your doctor give the WCB the information it needs about your condition and prospects for recovery.

Initially, the WCB pays benefits equal to 90% of the net (take home) wages you were earning at the time of injury. After ten weeks the benefits will be based on your long term average earnings. If your benefits drop significantly at this point, you should consider an appeal.

When the WCB decides that you have recovered, your benefits will cease. If you and/or your doctor do not agree that you are ready to go back to work, you should appeal. The WCB will also terminate your benefits if they feel that your condition has stabilized and become permanent. If you or your doctor disagree, you should appeal.

Workers who have a permanent disability are entitled to a total or partial pension, payable until age 65. Permanently disabled workers (and sometimes others) may also be entitled to vocational rehabilitation assistance. As well, WCB plays all medical and related costs of an injury or disease.

If a decision of the WCB limits your benefits or cuts you off benefits, the first stage of the appeal process is to request a review of the decision by the WCB Review Division.

First steps[edit]

  1. To request a review of a decision by the WCB's Review Division, get the Request for Review form online or by phone at 1-888-855-2477.
  2. Complete the Request for Review form and submit it to the Review Division within ninety (90) days of the date that the WCB decision or order was made. The address is on the form.
Tipsandnotes.png
If you are off work for a significant period of time, you will receive many letters from WorkSafeBC. Read these carefully, because each one could be a decision denying or limiting benefits. If in doubt, get legal advice, and if there is something in the letter that you don't agree with, challenge it. If you fail to request a review of a decision within the ninety (90) day time limit, you may lose any chance of changing it, no matter how unfair it is.

What happens next[edit]

WCB Review Division[edit]

You will receive a complete copy of your WCB file, including all documents the Board has about your claim. Review it carefully to better understand why the Board made the decision you are appealing, so that you can explain to the Review Division why it is wrong.

If your review involves a medical issue, such as whether you are able to return to work, ask your doctor to write to the Board. Most successful reviews are based on new medical evidence.

Your review may also involve a policy issue. The WCB's policy manual, which is nearly 800 pages long, has the force of law, and there are detailed policies about almost every aspect of the claims process. You can read or download the Rehabilitation Services and Claims Manual from the WCB's website.

The Review Officer will give you a deadline for sending in any new information or arguments. If you need more time, ask for it. Make sure that you tell the Review Officer about any wrong information in the file, whether it's from a WCB doctor, your employer, or anyone else, and that you explain why the Board's decision was wrong.

The Review Division usually decides the review within six months.


Tipsandnotes.png
There are several options for seeking legal help on a WCB claim review. The Workers' Advisers Office provides free, expert advice and occasionally representation to any worker who requests it. Contact them immediately, as you may have to wait for an appointment. Most unions also provide free, expert help to their injured members. If you belong to a union, tell them about the injury immediately. There are also community organizations that do WCB cases, and there are private lawyers and non-lawyer advocates who are experts in WCB matters.

Workers' Compensation Appeal Tribunal (WCAT)[edit]

If you disagree with the Review Division's decision, you can appeal it to the Workers' Compensation Appeal Tribunal (WCAT). You must appeal within thirty (30) days after the date of the Review Division decision.

The WCAT conducts appeals by rehearing them, which means that it considers all the evidence in the file and any new evidence presented by the parties, and then makes its own findings of fact and law. You should ask for an oral hearing, so that you can explain your case to the WCAT vice-chair in person.

The WCAT is the final level of appeal, and its decisions can only be challenged in a judicial review proceeding in the Supreme Court of BC. The WCAT can, however, reconsider its own decisions on the basis of new evidence that couldn't have been presented at the first appeal, or because the first decision was based on a serious legal error.

Where to get help[edit]

See the Resource List in this Guide for a list of helpful resources. Your best bets are:

Before meeting with a lawyer or advocate, complete the form Preparing for Your Interview included in this Guide. Make sure you bring copies of all documents relating to your case.

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by Trevor Thomas, March 2017.


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