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

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{{Dial-A-Law TOC|expanded = employment}}
{{Dial-A-Law TOC|expanded = employment}}
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.
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.


==Reviews==
==Understand your legal rights==
The first step is to ask [https://www.worksafebc.com/en/review-appeal WorkSafeBC’s Review Division] to review the decision. In a few cases, you can only appeal to the Workers’ Compensation Appeal Tribunal (you can’t ask for a review). These cases are Board decisions to reopen (or not reopen) a matter, and decisions on discriminatory action complaints (that an employer punished you for raising safety concerns at work).


'''Time limit to ask for review'''—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 that WorkSafeBC told you its decision orally or stopped paying you. An employer who wants to ask for a review of a decision or an order issued by WorkSafeBC on an occupational health and safety matter, has only '''45 days''' to ask for a review.
===Challenging a decision of Work Safe BC===
'''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 (Script 285)|workers’ compensation program in no. 285]].)


Because WorkSafeBC routinely issues some decisions orally, the Review Division accepts 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.
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.  


The Review Division considers the written submissions and WorkSafeBC’s file and gives its decision, usually within 150 days. The [http://worksafebc.com/claims/review_and_appeals/default.asp WorkSafeBC website] has more information on [https://www.worksafebc.com/en/review-appeal reviews and appeals]. 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 [https://www.bcombudsperson.ca/ Ombudsperson of BC] (1.800.567.3247).
===You can get help or advice===
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.


==Appeals==
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 disagree with the decision of the Review Division, you can usually appeal to the [http://www.wcat.bc.ca/ Workers’ Compensation Appeal Tribunal]. 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.  


'''Time limit to appeal'''—if you decide to appeal, you must do so within '''30 days''' 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. For cases that go directly to the Tribunal, the time limit is 90 days.
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.


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. If you use a letter or the form, fax them to 604.664.7898 or mail them to:
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.


:'''WCAT'''
==The steps in the process==
:150 – 4600 Jacombs Road
:Richmond, BC V6V 3B1


==What the Tribunal does==
===Step 1. Ask for a review===
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 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.


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.  
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.


==Preparing for reviews and appeals==
Because Work Safe BC routinely issues some decisions orally, the review division accepts review requests from oral decisions.  
Before you start, see the [http://www.wcat.bc.ca/research/wcat_publications/appeal_guides/index.html information guides] on the [http://www.wcat.bc.ca/ Tribunal’s website] for detailed information. 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 [http://www.labour.gov.bc.ca/wab Workers’ Advisers Office] of the BC Ministry of Labour. 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 [http://www.labour.gov.bc.ca/wab website]. Their phone numbers are 604.713.0360 in Vancouver and 1.800.663.4261 elsewhere in BC.  
====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.  


If you are an employer, you should contact the [http://www.labour.gov.bc.ca/eao Employers’ Advisers Office]. 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 [http://www.labour.gov.bc.ca/eao website].  
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.


==What you need to show==
{| class="wikitable"
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.
|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).
|}


It is not the role of the Review Division or the Tribunal to tell you what evidence you need or how to proceed with a review or an appeal.
===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.


==Check the Information Guides and your WorkSafeBC file==
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.
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 (by mail or email) 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 [http://www.worksafebc.com/ WorkSafeBC website], to:
====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====
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
:WorkSafeBC
:Work Safe BC
:PO Box 4700 Stn Terminal
:PO Box 4700 Stn Terminal
:Vancouver BC V6B 1J1  
:Vancouver BC V6B 1J1  
:Fax: 604.233.9777 or toll free 1.888.922.8807
:Fax: 604-233-9777


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 ''[http://www.bclaws.ca/civix/content/complete/statreg/1198514681/96165/292428220/?xsl=/templates/browse.xsl Freedom of Information and Protection of Privacy Act]'', 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
:Phone: 1-866-266-9405
:Fax: 604.279.7401
: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.
==Get help==


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, check the ''[http://www.bclaws.ca/civix/content/complete/statreg/1198514681/96165/292428220/?xsl=/templates/browse.xsl Freedom of Information and Protection of Privacy Act]''.
===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.  
:Telephone: 604-231-8888 in the Lower Mainland
:Toll-free: 1-888-967-5377
:Web: [http://www.worksafebc.com/ worksafebc.com]
 
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]  


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




[updated January 2018]
[updated January 2018]


'''The above was last reviewed for accuracy and edited by John Blois.'''
'''The above was last reviewed for legal accuracy by [http://www.wcat.bc.ca/index.aspx Tim Martiniuk], Workers’ Compensation Appeal Tribunal (WCAT).'''
 
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