The Worker's Compensation Claim Acceptance Process (7:VII)
|This information applies to British Columbia, Canada. Last reviewed for legal accuracy by the Law Students' Legal Advice Program on August 1, 2023.|
After a worker makes an application for compensation, a Board officer (typically an Entitlement Officer) issues a decision (usually in writing) accepting or denying the claim. For a compensation claim to be accepted, the Board must generally find:
- Status: The applicant is a “worker” covered under the Act.
- Disability: The applicant suffered a personal injury (physical or psychological) or an occupational disease, causing disability.
- Causation: The worker’s disabling injury or disease arose out of and in the course of the worker’s employment.
- Time Limits and Procedures: The worker submitted a timely and proper application.
If a claim is denied by the Board, it is typically because one or more of the above conditions was not met. The Board decision typically sets out the reason why the claim was denied and cites the relevant policy from RSCM II. However, the evidence on which the decision is based may or may not be summarized in the decision.
All the evidence on which the decision is based will be in the claim file, which may also include memos from Case Managers and clinical opinions from Board Medical Advisors (BMAs). The claim file may also contain detailed phone memos providing the Case Managers with a summary of the worker’s evidence. The claim file evidence as a whole provides the basis for the Board’s decision, and is evidence which will be available and considered by the appeal bodies, Review Division, and WCAT.
Workers are entitled to a copy of their claim file (paper or CD) on request, and will automatically be sent a copy of the claim file if they file an appeal. In addition, the worker may obtain online access to parts of their claim file by calling the Board. These matters are covered in the section below on Access to Files (7-47). Disclosure may be given directly to the worker’s representative if the disclosure request or appeal notice is accompanied by a valid authorization of representation, signed by the worker. [Authorization forms are available on the Board website.]
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