WorkSafeBC Appeals Process | Gosal & Company

WorkSafeBC (WCB) Appeals Process

WorkSafeBC Matters

The following section will provide you with an overview of the WorkSafeBC claims process. In our experience, WorkSafeBC is a body that, for all intents and purposes, behaves like an insurance company. After over 30 years of handling WorkSafeBC claims, Mr. Gosal has found that WorkSafeBC’s goal is to minimize the number of claims accepted, minimize the nature and extent of claims accepted, and minimize the duration and amount of compensation entitlement.

Most people retain our services when they feel that they can no longer deal with the complexities of the appeal system and/or demands made by WorkSafeBC staff. Unfortunately, we see many people who come to us after their avenues of appeal have been exhausted. It is difficult (although not impossible) to help these people. Therefore, it is prudent to seek legal advice soon after the commencement of your WorkSafeBC claim, as we can advise you what to watch for and what to expect as your claim progresses.

The decision-making level: the Board

The Board provides workers with initial decisions on their claims. Wherever possible, the Board will deny compensation entitlement. You will interact with various decision-makers at this stage. Your Case Manager gathers the information required by the Board (usually in a passive manner) to adjudicate your claim. They decide which medical conditions are accepted under your claim and what type of compensation you are entitled to as a result. Often, calculating the actual amount of your award requires specialized knowledge. For this reason, your Case Manager may refer your claim to other WorkSafeBC departments.

The Wage Rate Unit determines the wage rate on your claim, which serves as the basis for calculating your monthly benefits. The Disability Awards Department determines the amount of your disability pension by reviewing medical evidence of your condition. If you require assistance in returning to work, a Vocational Rehabilitation Consultant may be assigned to formulate a return to work plan for you.

As you are dealing with an insurance company, you should be aware that the Board’s goal is to deny and minimize your entitlement under your claim.

The following is a list of terms to be aware of in Board decision letters:

Your “chronic pain” is accepted. Your file will be referred to Disability Awards for chronic pain. (This means that the WCB has quantified your disability as 2.5% out of 100% and that any and all objective signs of medical disability will be ignored.)
Your claim has been accepted for…
No other condition (temporary or permanent) is accepted.
No limitations or restrictions are accepted.
It is not anticipated that any permanent impairment will result.
Your file will not be referred to Disability Awards.
You have been deemed fit to return to work without restrictions.
Your condition has resolved.
You have a significant pre-existing condition. No aggravation of your pre-existing condition is accepted.
Your file has been reviewed by our Medical Advisor…I have accepted the Medical Advisor’s opinion…
There is no convincing evidence of…
I have accepted a temporary…
This condition is deemed to have resolved…

The above are just some examples of terms that should set off alarm bells, as these terms indicate that the Board is attempting to limit your compensation entitlement, and limit the parameters of your claim.

After a Board decision is issued, you have 90 days to file an appeal (a Request for Review) to the Review Division.

The initial level of appeal: the Review Division

The final level of appeal: the Workers’ Compensation Appeal Tribunal (“WCAT”)

Further options: WCAT Reconsiderations, Judicial Reviews

Our goal is to have WorkSafeBC recognize the full nature and extent of your objective impairment and to maximize your compensation entitlement.