Difference between revisions of "Workers' Compensation Claim Benefits (7:XI)"

Once a claim has been accepted by the Board, the process then moves to a determination of what benefits should be paid to the injured worker.

Many RSCM II chapters apply to the adjudication of claim benefits. The most important chapters can be summarized as follows:

* Chapter 5 – Wage-Loss Benefits

* Chapter 6 – Permanent Disability Benefits

* Chapter 8 – Compensation on the Death of a Worker

* Chapter 10 – Health Care; and

* Chapter 11 – Vocational Rehabilitation Services

== A. Overview: Worker Disability and Compensation Benefits ==

Of the 100,000 workers injured on the job in BC every year, about half suffer minor or inconvenient injuries and return to their pre-injury employment in quick order. Most of these claims are accepted by the Board for health care benefits only (medical treatment, medication, etc.).

The following examples are to illustrate common compensation benefits and scenarios for disability:

* The worker suffers a broken wrist in their dominant hand and cannot perform their job duties as a result. Their doctor recommends a certain number of weeks to recover after which they are cleared to return to work, full duties. The worker makes an application for compensation. If their claim is accepted, the Board sets a short-term wage rate on their claim (based on their average earnings) and the worker is paid temporary wage-loss benefits at this rate for their days of lost work. The Board also covers any health care costs such as treatment or medication. If there are no permanent medical consequences to this injury and the worker returns to work full duties, the Board issues a decision that the injury is “resolved,” and their claim is closed. The worker is not referred for any other benefits such as Disability Awards or Vocational Rehabilitation.

* The worker suffers a more serious injury to their hand (e.g., a crush injury). If their claim is accepted, they again receive temporary wage loss for their time away from work. However, after 10 weeks, the Board issues a new long-term wage rate based on a more complex formula in law and policy. At a discretionary point, the Board considers that the worker’s condition is no longer “temporary” and must make one of the following decisions about the worker’s medical condition. Either:  

:(a) their injury has “resolved” with no permanent impairment and they can return to work and perform full duties. In this case (as above), the Board will issue a “resolve” decision ending their temporary wage-loss benefits and their file will be closed; or

:(b) their injury is not fully resolved, and they are left with some permanent functional impairment. In this case, the Board will issue a “plateau decision,” setting a date at which it considers that the worker’s condition is no longer temporary, but it has reached a medical “plateau” (that is, the condition will not significantly change in the next year). This “plateau” decision also ends temporary wage-loss benefits on the plateau date, but will also refer the worker to Disability Awards to assess the nature and severity of this permanent impairment. In a separate decision, the Disability Awards will rate their impairment according to a schedule and award the worker Permanent Functional Impairment pension in a “Permanent Functional Impairment Decision.” The Permanent Functional Impairment pension is awarded regardless of whether the worker returns to work or not, as it is compensation for the permanent physical impairment, not direct compensation for lost wages.  

The plateau decision also sets out whether the Board thinks that the worker can return to their pre-injury job, performing full duties, with the impairment. If the worker can return to their pre-injury work, the Board does not need to retrain him and there is no referral made to vocational rehabilitation.

However, if the Board considers that the worker cannot return to full duties with their impairment, the “plateau decision” will state this and the worker will be referred to vocational rehabilitation for further help with employment.

The vocational rehabilitation process is set out below and goes through five phases:

* '''Phase one''': Tries to have the worker return to the same job with the same employer.

* '''Phase two''': If unable to return to the same employer, works with the worker and employer to modify the job or identify job opportunities within the same company.

* '''Phase three''': If unable to return to the same company, tries to help identify suitable job options related to the worker’s experience and skills.

* '''Phase four''': If the worker is unable to return to the suitable work in the same or related industry, tries to help the worker to identify options in other industries.

* '''Phase five''': If the worker needs additional skills in order to return to suitable work, may cover the cost of training to help develop skills.

The first phase is to see if the employer can or will accommodate the worker and their impairment. If there is no accommodation and the worker does not have a job to return to, vocational rehabilitation goes through further phases to assesses what vocational rehabilitation assistance the Board should provide to help the worker become employable, given their permanent injury. Vocational rehabilitation benefits are discretionary but typically include a vocational rehabilitation plan for the worker to re-train and/or have a job search and wage-loss benefits for this period of vocational rehabilitation time. If successful, vocational rehabilitation results in the injured worker successfully adapting to employment with a permanent injury.

It is possible that vocational rehabilitation is not successful or that a seriously injured worker is simply too disabled to ever be competitively employable.

== B. Short-Term and Long-Term Average Earnings and Wage Rates ==