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WorkSafeBC: What You Need to Know to Assist Your Members Through the Claims’ Process Summer Leadership Conference 2019
WorkSafeBC: What You Need to Know to Assist Your Members Through the Claims’ Process
Summer Leadership Conference 2019
Module 1
I. What is WorkSafeBC? II. WorkSafeBC Structure – Prevention & Compensation DivisionsIII. Role of WCB Advocate IV. Claims Process V. Types of Injuries Covered by WorkSafeBC
What is WorkSafeBC? • A British Columbia provincial crown agency that is operated
independently of the legislature and cabinet, by a Board of Directors. • Mandated to promote and enforce occupational health & safety,
provide rehabilitation and compensation to the injured.• The Board of Directors oversee the management of WorkSafeBC. The
Board consists of representatives from the employer community, worker community, the public interest, and other.
• The elected BC government (cabinet) appoint the members of the Board of Directors to terms.
• WorkSafeBC is based in Richmond, where the bulk of operations are carried out.
• There are offices across the province.
What is WorkSafeBC?
• No fault-insurance system providing coverage for most workers in British Columbia
• Employees cannot pursue civil remedy against employer or employees
• Entirely funded by premiums paid by employers, the “Accident Fund”
What is WorkSafeBC?
• The insurance premiums are paid entirely by the employers. How much an employer will pay per employee depends on the employer’s industry and experience rating.
• WorkSafeBC is structured into many different departments. The largest departments are Compensation and Prevention (Health and Safety).
• The focus of the presentation with be the Compensation Division.
What is WorkSafeBC?
• WorkSafeBC is a creation of provincial legislation, the Workers’ Compensation Act (WCA), which we call the enabling legislation.
• The WCA can only be changed by the members of the legislative assembly in Victoria.
• It is a broad legal framework.
Questions?
WorkSafeBC Structure – Prevention & Compensation
• Prevention (Health and Safety Division)
• Prevention Department has the responsibility for matters such as refusal of unsafe work, Occupational Health & Safety Regulation, investigating fatalities and serious injuries, and worksite inspections.
• Binding Occupational Health and Safety Regulations. • Non binding guidelines, handbooks, etc. • OHS Regs Enforced by Prevention officers. To request a workplace inspection, or
refusal of unsafe work, please call
• Phone: 604.276.3100 (Lower Mainland)Toll-free: 1.888.621.7233 (1.888.621.SAFE) (Canada)
• E.g. worker refuses to work in a classroom with a dangerous student present.
Prevention Cont.
• OHS Regulations are a set of binding rules creating rights and responsibilities of employers and workers with the objective of preventing work-related injuries and occupational diseases from occurring.
• https://www.worksafebc.com/en/law-policy/occupational-health-safety/searchable-ohs-regulation
• Workers Compensation Act Part 3 – Occupational Health and Safety
Prevention Cont.
• WCB Advocate does not advise the membership on prevention matters. That is the role of the Asst. Director of Health and Safety.
• Members on SIP/Health & Wellness claims may have a work-related injury or occupational disease – this is a compensationmatter.
WorkSafeBC Structure – Prevention & Compensation• Compensation Department:
• Work-related injuries & occupational diseases• Must file a claim for compensation: the Form 6• Compensation decisions apply the binding Rehabilitation Services & Claims Manual (Vol. I, II)
• Phone Teleclaim: 604.231.8888Toll Free: 1-888-WORKERS (1.888.967.5377)
• Or Submit online: https://www.worksafebc.com/en/resources/claims/forms/application-for-compensation-and-report-of-injury-or-occupational-disease-form-6?lang=en
• The worker must file the claim directly to WorkSafeBC. • It is not the same as reporting an injury to the employer (6A) or the Employer report
of an injury (Form 7).
Compensation Cont.
• Members who have suffered a work-related injury or occupational disease should be advised to contact WorkSafeBC by calling Teleclaim or completing and submitting the online form, if they have not already done so.
• Members who have questions or potential problems with their WorkSafeBC claim should be directed to contact the WCB Advocate at (604) 871-1890 or [email protected]
Questions?
Role of WCB Advocate
• To provide advice, assistance and representation to injured members in their WorkSafeBC compensation claim matters, including appeals
• Summary advice to local union representatives assisting members• Only represent teacher in an appeal if chance of success, will advise on
the merits of appealing decision • Advise teacher of other options: e.g. rehab/health care benefits
through Health and Wellness, SIP, and grievance• Intake process: Teacher inquiry -> Intake -> File review -> summary
advice -> representation
Claims Process
Claims Process: the decision makers, their roles • Case Manager (CM): Responsible for making decisions on a claim, including financial and health
care decisions, and claim acceptance • Service Coordinator: The CM assistant; obtains medical receipts and arranges reimbursement for
health care, travel, etc. that has been approved by the CM. • Entitlement Officer: One position below the CM, makes a decision on claim acceptance for more
simple claims • Claim Owner: The Case manager that has conduct over a claim• Disability Awards Officer: Responsible for calculating the permanent partial disability award • Wage Rate Officer: Responsible for calculating the short term and long term wage rates • Vocational Rehabilitation Consultant: Responsible for job retraining; create a vocational
rehabilitation (VR) plan, with a financial budget• Medical Advisor: a physician or specialist hired by WorkSafeBC to provide medical opinion• Client Service Manager (CSM): The CM’s manager. Call the CSM to complain about the CM.
Claims Process: Resolving Complaints• When a member has issues with their case manager (CM), they will want to
call the Client Service Manager (CSM). • To get ahold of the client service manager, the member will call the claims
department at 604.231.888 or toll-free, and:1. provide the customer care agent with their claim number; 2. Request to know the name of the case manager assigned to their claim,
and the Client Service Manager in charge of that CM; 3. Obtain the name and number of the CSM and call them and leave a
message. 4. If the CSM does not resolve the complaint, the member will call the Fair
Practices Office of WSBC, at: Phone: 604.276.3053 (Lower Mainland)Toll-free: 1.800.335.9330 (B.C. and Alberta)
Claims Process: What to ReportPlease contact WCB as soon as possible if a worker:• Is taken from or leaves the jobsite for treatment at a medical facility• Misses time from work after the day of the injury• Loses consciousness• Is diagnosed with a work-related disease• Develops symptoms of a mental health disorder related to work or the
work environment• Suffers broken eyeglasses, dentures, hearing aid or artificial limb due to a
work-related incident• Employers must immediately report serious incidents and fatalities.• Note: Workers must report within one year of date of injury or diagnosis
of disease or you may lose your right to claim compensation.
Claims Process Cont.
• Report your injury to start your claim• To your employer (Form 6A) • To first aid / heath and safety rep • Report to WorkSafeBC (1-888-Workers) – Form 6 • See you doctor/ seek medical attention
• Employer Completes Form 7
• Physician Completes Form 8, 11
Questions?
Claims Process Cont. Manage Your Claim – the Claim Cycle
1. Claim Acceptance – health care, wage loss entitlement?
2. Temporary Disability – rehabilitation, referral to specialist(s)
3. Plateau – condition resolved or permanent
4. Vocational Rehabilitation – RTW, or retrain
5. Loss of Earnings
Claims Process Cont.
Health Care Benefits
• Reasonably necessary expenses
• Physiotherapy, massage, chiropractor, acupuncture – WSBC will usually only cover one modality of treatment
• Expedited specialist referral, surgery and imaging (X-ray, ultrasound, CT, MRI)
• Rehabilitation Programs (multi-disciplinary treatment)
• Additional benefits for severely disabled
Duration of Health Care Benefits
• Health care continues for as long as the Board considers it reasonably necessary with respect to the worker's compensable personal injury, occupational disease or mental disorder. In making this decision, the Board may consider medical opinion or other expert professional advice.
• Members may be eligible for health care benefits, as long as they live.
Claims Process Cont. • Wage Loss Benefits
• Financial compensation for time loss from work
• Payable for period of temporary disability, and if worker is participating in vocational rehabilitation services
• Payable at 90% of net wage up to a maximum wage rate (2019 is $84,800)
• For teachers, refer to the Local Collective Agreement (Article G – Leaves of Absence)
• WCB pays the NET wage – no TPP or extended health and dental, EI, CPP, or income tax
Duration of Wage Loss Benefit
• It is temporary. • Payable for a temporary disability until the disability is deemed to
be resolved or has become permanent • The case manager will make this decision usually relying on the
opinion of the Board medical advisor. • If the condition becomes permanent and the worker is unable to
return to their regular, full duties, transferred to vocational rehabilitation department for an assessment
• If approved for vocational rehabilitation, wage loss continues under management of the VR consultant.
Wage Loss and BCTF Members
• Wage loss is payable directly to the employer (school district) pursuant to the local collective agreement (Article G, 2013-2019)
• School district remits full salary to the member in accordance with terms of the local collective agreement
Wage Loss and BCTF Members Cont. Example #1: SD 36 (Surrey) - common local collective agreement language
• G.20.7 WORKERS' COMPENSATION • a. Where an employee is entitled to compensation under the Workers' Compensation Act,
the employee shall continue to receive full pay from their sick leave accumulation. SD No. 36 (Surrey) and Surrey Teachers’ Association 2013-2019 February 14, 2018 Page 142 of 262
• b. Monies received by the employee as compensation for loss of wages under the Act shall, in turn, be paid to the Board and credited back to the employee's sick leave accumulation.
• c. Should an employee's personal sick leave accumulation be depleted, only those monies received from WorkSafe BC on their behalf would be forwarded to them.
• d. The Board's responsibilities under the foregoing shall terminate when the employee's accumulated sick leave credits have been used up.
• e. The term "compensation" shall mean periodic payments during the period of temporary disablement and does not include a disability pension or other final settlement award arising from such disability.
Wage Loss and BCTF Members Cont. Example #2: SD 44 (North Vancouver) - the best local collective agreement language:
ARTICLE G.23 WORKERS’ COMPENSATION BOARD LEAVE1. Where an employee suffers from a disease or incurs personal injury (which disease,illness or injury is hereinafter called the "disability") and the employee gainscompensation under the Workers’ Compensation Act, the employee shall not be requiredto use the employee‘s sick leave credits for time lost, nor will the employee accumulatesick leave credits during the time absent.2. All monies received by an employee by way of a compensation for loss of wages underthe said Act shall be paid to the Board, in return for which the Board shall pay theemployee the full amount of the employee's wages to which the employee would havebeen otherwise entitled but for the disability suffered or incurred.3. Compensation does not include a disability pension or other final settlement awardarising from such disability. Compensation means periodic payments during the period oftemporary disablement.4. During the period of paid leave for the disability, the Board shall continue to pay its shareof all benefits premiums and pension contributions.
Questions?
Types of Injuries Covered by WorkSafeBC
Personal Injuries • Wounds• Fractures• Concussions• Physiological changes caused by explosion• Sprains and strains• Damaged cartilage or ligaments• Dislocation of the bones at a joint• Burns caused by a single incident of a chemical spilled on the skin.
Personal Injury
• Compensation is paid where a personal injury or death arising out of and in the course of the employment is caused to a worker.
• “Personal injury” is defined as any physiological change resulting from some cause. It may result from a specific incident or a series of incidents occurring over a period of time.
Personal Injury Cont.
“Arising out of the employment”• The focus is on whether the worker’s employment was of
causative significance in the occurrence of the injury or death.
“In the course of the employment”• Refers to whether the injury or death happened at a time and
place and during an activity consistent with the employment.
Types of Injuries Covered by WorkSafeBC
Occupational Diseases• Poisoning by lead, mercury, arsenic, carbon monoxide, etc. • Infectious disease, Staphylococcus aureus, Salmonella organisms,
Hepatitis B virus• Pneumoconiosis, such as asbestosis or Silicosis• Cancer• Asthma• Upper respiratory infections • Tendinopathy• Radiation injury
Occupational Diseases
• Section 6 of the WCA provides that compensation is payable for occupational disease that is due to the nature of a worker’s employment.
• Section 7 provides that compensation is payable for a certain level of non-traumatic noise-induced hearing loss that results from a worker’s employment.
• Workers’ compensation does not extend to all diseases, rather only to those that are due to a worker’s employment. Determining the extent to which a worker’s employment had a role in producing the disease becomes a critical or central issue
Occupational Diseases
Occupational disease must be due to the nature of the employment
• E.g. infectious disease exposure: nurse infected by patient
• E.g. poisoning by lead: metal worker poisoned casting steel at a foundry
• E.g. Hand/wrist tendinopathy: clerical worker develops inflammation from keyboard work involving awkward motions and postures
Types of Injuries Covered by WorkSafeBC
Mental Disorders Section 5.1 of the WCA sets out that a worker may be entitled to compensation for a mental disorder that does not result from an injury. This is distinct from a worker’s entitlement under section 5(1) for psychological impairment that is a compensable consequence of an injury.
Mental Disorders Cont.
• Does the worker have a DSM diagnosed mental disorder?• Was there one or more events, or a stressor, or a cumulative
series of stressors?• Was the event “traumatic” or the work-related stressor
“significant”?• Causation• WCA Section 5.1(1)(c) Exclusions
Mental Disorders Cont.
Traumatic events
For the purposes of the policy, a “traumatic” event is an emotionally shocking event, which is generally unusual and distinct from the duties and interpersonal relations of a worker’s employment. However, this does not preclude a worker who, due to the nature of his or her occupation, is exposed to traumatic events as part of their work (e.g., emergency workers)*
*Rehabilitation Services & Claims Manual, Vol. II, Policy 13.00
Mental Disorders Cont. Work-related stressors:
A work-related stressor is considered “significant” when it is excessive in intensity and/or duration from what is experienced in the normal pressures or tensions of a worker’s employment.
Interpersonal conflicts between the worker and his or her supervisors, co-workers or customers are not generally considered significant unless the conflict results in behavior that is considered threatening or abusive*
*Rehabilitation Services & Claims Manual, Vol. II, Policy 13.00
Mental Disorders Cont.
WCA Section 5.1(1)(c) Exclusions:
is not caused by a decision of the worker’s employer relating to the worker’s employment, including a decision to change the work to be performed or the working conditions, to discipline the worker or to terminate the worker’s employment.
Compensable Consequences
• Once it is established that an injury arose out of and in the course of the worker’s employment, the question arises as to what consequences of that injury are compensable.
• See: Rehabilitation Services & Claims Manual Vol. II Policy Item #22.00; 22.10; 22.20.; 22.30; 22.40
Compensable Consequences Cont.
Looking at the matter broadly and from a "common sense" point of view, the Board considers whether the compensable injury, or the worker’s condition resulting from the compensable injury, was of causative significance in the further injury, increased disablement, disease, or death. If the compensable injury, or the worker’s condition resulting from the compensable injury, was of causative significance in the further injury, increased disablement, disease, or death, then the further injury, increased disablement, disease, or death is sufficiently connected to the compensable injury so that it forms an inseparable part of the compensable injury and is therefore also compensable.See: Rehabilitation Services & Claims Manual Vol. II Policy Item #22.00; 22.10; 22.20.; 22.30; 22.40
Other Compensable Events
• Accident – Section 5(4) Presumption*
• Pre-existing conditions or diseases**
• Replace or repair workers' artificial appliances, eyeglasses, dentures and hearing aids damaged or broken at work***
• See: Rehabilitation Services & Claims Manual Vol. II Policy Item: *14.20; **16.00, 16.10; ***23.00; 23.10; 23.20;
Questions?
Module 2
I. Wage RatesII. Board-sponsored treatment [OR1 & OR2; HIATS; PMP]III. Permanent Partial Disability IV. Vocational Rehabilitation V. Loss of Earnings VI. Appeals Process VII. Case study: Teacher participation in extra curricular activities
Wage Rate
The Board must determine the amount of average earnings and theearning capacity of a worker with reference to the worker’s averageearnings and earning capacity at the time of the worker’s injury.
Maximum wage rate, 2019: $84,800 gross annual income
RSCM Vol. 11, Policy Item 64.00; Workers Compensation Act, s. 33.00
Wage Rate Cont.
• Short term (or initial) wage rate: first 10 weeks of the claim
• General rule for calculating the short term wage rate: the worker’s average weekly earnings at the time of injury, assuming earnings not variable; if variable, up to previous 3 months.
• Used to calculate the weekly temporary wage loss (paid at 90% net earnings).
Wage Rate Cont.
• Long term wage rate: Applied after the first 10 weeks • General rule for calculating the long term wage rate: the worker’s
earnings for the 12-month period immediately preceding the date of injury.
• Used to calculate the weekly temporary wage loss (paid at 90% net earnings) AND
• The permanent partial disability (PPD) award , paid monthly
Board-sponsored Treatment
• Approved by a case manager, usually the claim owner
• On recommendation of the worker’s physician, a specialist, Board Medical Advisor (MA) or other Board-sponsored physician
• A CM will usually request an opinion from an MA before approving Board-sponsored rehabilitation
Board-sponsored Treatment
Compensable Consequences of Treatment• Where a worker is undergoing treatment for a compensable
injury, the place of treatment is analogous to a place of employment. A further injury, increased disablement, disease, or death arising at the place of treatment is compensable provided it is consistent with the worker being at the place of treatment for the purpose of treatment and does not result from activities of a personal nature.
• Does not include home exercises• RSCM Vol. II, Policy Item 22.00 (c)
Board-sponsored Treatment
Refusal of treatmentThe Board may require a worker who applies for or is in receipt ofcompensation to be medically examined at a place reasonablyconvenient for the worker. If the worker fails to attend for the examination or obstructs the medical examiner, the worker's right to compensation is suspended until the examination has taken place, and no compensation is payable during the period of suspension.
Workers Compensation Act, Section 57(1)
Board-sponsored Treatment
Control and Direction of Treatment• Health care furnished or provided to injured workers is at all
times subject to the direction, supervision, and control of the Board.
• If there are reasonable choices of treatment, or reasonable differences of opinion among the medical profession with regard to the preferable treatment, or choices to be made that depend on personal preferences, the matter should be regarded as one of patient choice.
Board-sponsored Treatment
Cost
• If there is a substantial difference in costs of equally effective health care options, the Board normally authorizes the option that is expected to be the least costly.
• Generally, the Board does not pay for health care that is new, non-standard or not generally accepted by the Board, unless prior approval has been obtained.
Board-sponsored Treatment
Types of Treatment 1. Occupational Rehabilitation 1• Work with physical therapists and kinesiologists to develop
customized plans for a worker's safe and lasting return to work.2. Occupational Rehabilitation 2• The OR 2 program includes occupational and physical therapists,
kinesiologists, physicians and psychologists or counsellors. Service providers develop an individualized treatment plan to address the specific needs of each worker in the program.
Board-sponsored Treatment
Types of Treatment 3. Head Injury Assessment & Treatment Services When people have a work-related concussion or mild brain injury, may refer them to the network of Head Injury Assessment and Treatment Services (HIATS) providers.4. Pain and Medication Management ProgramInjured workers who have complex pain issues may be referred to the Pain and Medication Management Program team (or an outside provider). It includes physical therapists, occupational therapists, psychologists, physicians, and pharmacists.
Board-sponsored Treatment – Other
Amputee Multidisciplinary ProgramActivity Related Soft Tissue Disorder ServicesCommunity Brain Injury ServicesCommunity Occupational Therapy ServicesExpedited Surgical Facilities ServicesHand Therapy ProgramHearing Aid ServicesHome Care Services
Home IV/Wound Care Services Health AuthorityMedical Supply ServicesMental Health TreatmentResidential Care ServicesReturn to Work Support ServicesShort Term Care FacilitiesSocial Work – Outreach and Transition Services
Board-sponsored Treatment
Assessments• Expedited Medical Imaging Services• Functional Capacity Evaluation• MARP Assessment Service• Permanent Functional Impairment• Psychology & Neuropsychology Assessments
Questions?
Permanent Partial Disability
• An injury or disease that is considered permanently disabling by WorkSafeBC
• A condition will be deemed to have plateaued or become stable where there is little potential for improvement or where any potential changes are in keeping with the normal fluctuations in the condition which can be expected with that kind of disability.
• No expectations of significant changes in the next 12 months. • Worker with a PPD is referred to Disability Awards for assessment
Permanent Partial Disability
• Temporary wage loss ends (it may continue if eligible for vocational rehabilitation services); and the permanent disability award is immediately assessed
• Permanent physical injuries assessed by a medical doctor at a permanent functional impairment (PFIE) exam
• Permanent psychological injuries assessed by a psychologist at a psychological assessment
Permanent Partial Disability
Examples: “temporary”: sprain/strain, contusion, concussion
“permanent”: chronic pain, post-concussive syndrome, mild neurocognitive disorder, vestibular disorder
Both: psychological conditions, tears to ligaments, fractures, aggravation of pre-existing osteoarthritis
Permanent Partial Disability
How WorkSafeBC Arrives at an Impairment Rating Based on “Loss of Function” • The Disability award officer calculates PPD for physical injury and
disease based on a PFIE assessment; by applying the Permanent Disability Evaluation Schedule (PDES) found in Appendix 4 of the RSCMVol. II ; or alternative guide for unscheduled awards.
• The Disability award officer calculates PPD for psychological injury based on an assessment by the Psychological Disability Awards Committee (PDAC); by applying the Permanent Disability Evaluation Schedule (PDES) found in Appendix 4 of the RSCM Vol. II
Permanent Partial Disability
• The level of impairment is measured using the “loss of function” method to arrive at a percentage of total disability.
• The whole body is 100% • Therefore someone total permanently disabled is 100% disabled; PPD is a
fraction of 100%, e.g. 4.56% total disability; • Psychological PPD is awarded in increments of 5% total disability;
• Mild: 5-25%• Moderate 30-70%• Extreme: 70%+
Vocational Rehabilitation
GoalsThe goals of vocational rehabilitation are:• For workers with a temporary partial disability, the goal is to assist injured
workers in their efforts to return to work in a suitable occupation and maximize short-term earning capacity up to the pre-injury wage rate. This goal reflects the wording of section 30 of the Act, which refers to an assessment of what a worker is earning or is capable of earning in a suitable occupation.
• For workers entitled to a permanent partial disability award, the goal is to assist injured workers in their efforts to return to work in a suitable occupation and maximize long-term earning capacity up to the pre-injury wage rate.
See: RSCM Vol. II Policy Item 85.00
Vocational Rehabilitation
Services Provided• counselling;• vocational assessment and planning;• job readiness/skill development;• placement assistance;• residual employability assessment; and• assessment of a worker’s need or continued need for rehabilitation and healthcare services and supports, where a worker’s permanent total disability will continue past retirement age.
Vocational RehabilitationEligibility1. Temporary partial disabilityVocational rehabilitation services may be made available to a worker who is no longer considered to be “totally” disabled from working in the preinjury occupation. The worker is considered capable of returning to a suitable occupation but may require vocational rehabilitation assistance to maximize short-term earning capacity.2. Permanent partial disabilityVocational rehabilitation services may be provided where a worker’s temporary disability has ceased and his or her medical condition has stabilized. Workers may be returning to their pre-injury occupation or may have to return to the workforce in another suitable occupation and maximize long term earning capacity to the pre-injury wage rate
Vocational Rehabilitation• Phase 1: All efforts will be made to help the worker return to the same job
with the same employer.• Phase 2: Where the worker cannot return to the same job, the employer will
be encouraged to accommodate job modification or alternate in-service placement.
• Phase 3: Where the employer is unable to accommodate the worker in any capacity, vocational exploration will progress to suitable occupational options in the same or in a related industrial sector
• Phase 4: Where the worker is unable to return to alternate employment in the same or related industry, vocational exploration will progress to suitable occupational opportunities in all industries using existing skill set/aptitude
• Phase 5: Where existing skills are insufficient to restore the worker to suitable employment, the development of new occupational skills will be considered
Loss of Earnings • Discretionary provision that establishes rules for compensating a worker for
a permanent partial disability in exceptional circumstances
• This test requires that the Board determine whether the combined effect of a worker’s occupation at the time of injury and a worker’s disability resulting from the injury is so exceptional that an amount determined using loss of function does not appropriately compensate the worker for the injury.
• The disability resulting from the work injury makes it unlikely that a worker can continue in the occupation at the time of injury or adapt to another suitable occupation, without incurring a significant loss of earnings.
See: RSCM Vol. II Policy Item 40.00
Questions?
Appeals Process
• Every compensation decision of WorkSafeBC must apply a policy from the Rehabilitation Services and Claims Manual (RSCM) Vol. II (for injuries occurring on or after June 30, 2002).
• To resolve disagreements over financial and health care entitlements, an administrative tribunal system is established under the WCA with two levels of appeal. Lower appeal, the Review Division, and final level of appeal, the Workers Compensation Appeal Tribunal (WCAT)
• A WorkSafeBC claimant or their representative has the right to appeal most decisions of WorkSafeBC respecting entitlement to financial and health care benefits within the prescribed statutory time limits.
Appeals Process• You must file a Request for Review of a WorkSafeBC decision with the
Review Division within 90 days of the decision date*, otherwise you lose your right to appeal**
• You must file a Notice of Appeal of a Review decision with WCAT within 30 days of the decision date*, otherwise you lose your right to appeal**
• Decisions of WCAT are final and binding, with few exceptions; may be reconsidered in limited circumstances or subject to judicial review in limited circumstances (e.g. see Fraser Health Authority decision (2014 BCCA 499)).
• *With the 8-day mailing rule, the deadline is extended to 98 days & 38 days, respectively. • **Leave to file late may be granted if special circumstances exist and an injustice would otherwise
result
Appeals Process
Appeals Process
• The Review Division is part of WorkSafeBC, but it is separate from the operational divisions of WorkSafeBC.
• The purpose of the Review Division is to review WorkSafeBCdecisions.
• Review Division decisions are made by Review Officers. • The Review Division will only change a WorkSafeBC decision in
the following circumstances: - the original decision is inconsistent with the law and WorkSafeBC policies; - the evidence has not been properly weighed; or, - there is significant new evidence that supports a change in the original decision.
Appeals Process
The Review Division and WCAT only have jurisdiction to consider appeals of the issues in the decision letter (usually explicit, but sometimes can be implied).
Appeals Process
• At Review Division, the outcome may be: • To confirm a decision (or deny the appeal): confirm WorkSafeBC’s
decision on that issue • To refer back a decision: Insufficient evidence available, refer the
decision make to WorkSafeBC for further investigations and a new decision
• To vary a decision: Change WorkSafeBC’s original decision, due to persuasive new evidence or a re-weighing of the existing evidence
Appeals Process
If the worker is reviewing the WorkSafeBC decision: • A confirm/deny is usually a negative result, and the issue(s) will
be appealed to WCAT
• A refer back is usually a positive result, as WorkSafeBC must investigate the issue(s) in more depth and issue a new decision (cannot appeal a refer back to WCAT)
• A vary is usually the best result, as the Review Officer has agreed to direct WorkSafeBC to change its original decision on an issue(s)
Appeals Process
WCAT
• WCAT is the final level of appeal in the workers' compensation system of British Columbia and is independent of WorkSafeBC
• WCAT hears appeals from most Review Division decisions. Some Review Division decisions are not appealable to WCAT, such as vocational rehabilitation decisions
Appeals Process
• WCAT will hear the appeals of review decisions that were confirm/deny or vary on one or more issues.
• The employer or the worker may initiate the appeal • WCAT appeals may proceed by written submission or oral hearing • WCAT may refer a matter back to WorkSafeBC for a new decision
and suspend the appeal, but will re-activate the appeal once the new decision is rendered.
• WCAT may confirm/deny or vary the Review Division. • Decisions are final, binding and conclusive.
After the Appeal
After the Review Officer has referred back or varied a decision, or the WCAT Vice-Chair has varied a Review decision:
• The appeal goes back to WorkSafeBC for implementation. • An appeals case manager or appeals VR must implement the decision(s)
of the Review Officer or Vice-Chair by completing the necessary investigations
• A new decision letter must then be issued • The new decision may be reviewed in some circumstances.
Links • WCB Advocate webpage (with presentations) • https://bctf.ca/HealthAndSafety.aspx?id=4318• Workers’ Compensation Review: https://engage.gov.bc.ca/workerscompensationreview/• BCTF Workers’ Compensation Review Position Paper• https://engage.gov.bc.ca/app/uploads/sites/482/2019/07/SUB-0083-Teri-Mooring-BCTF-written-
submission.pdf• Workers Compensation Act• http://www.bclaws.ca/civix/document/id/complete/statreg/96492_00• Rehabilitation Services and Claims Manual Vol. II• https://www.worksafebc.com/en/law-policy/claims-rehabilitation/compensation-policies/rehab-
claims-volumeii• Teachers' Participation in Extra-Employment Activities• https://www.worksafebc.com/en/resources/law-policy/compensation-practice-
directives/teachers-participation-extra-employment-activities?lang=en
