Problems with WorkSafeBC ? : 6 Steps to Appeal a Workers’ Compensation Decision

Rhonda works for a medical supplies company. One day she is carrying a tray of materials to her workstation when she slips on some water a co-worker had spilled on the floor. She falls hard on her back and is in immediate pain. Her WorkSafeBC claim is initially accepted, but after weeks of therapy she’s still in chronic pain. One day WorkSafeBC requests a medical examination by one of their staff physicians. Two weeks later, Rhonda gets a letter stating that there are “no objective medical findings” and that her WorkSafeBC benefits are being discontinued.

As an employment lawyer, I have heard many heartbreaking stories from injured workers just like this one. These are stories from people that have suffered a workplace injury or loss and are either being denied the benefits they so desperately need or are being forced to return to work before their bodies are ready. For many people, it seems as though there are holes in the safety net created to assist injured workers, and too many people are falling through.

Fortunately, there are some remedies for workers to contest unfair decisions. The process is long and difficult, but  resources are available to help workers along the way. If you are a worker that has been denied WorkSafeBC benefits, there are 6 steps you should take to have your appeal heard.

1) Note the deadline for a response

If you receive a WorkSafeBC decision you are unsatisfied with, you will generally have 3 months to contest and to request a review. Note the date of the letter, and circle on your calendar when your response must be received by WorkSafeBC. Don’t miss this date! In deciding whether to review a case manager’s decision, the first thing that a reviewing officer will verify is the limitation period.

2) Request your WorkSafeBC file

WorkSafeBC has significant information on all claimants. This will include completed forms, the payment history, medical opinions and even a telephone log from case managers receiving questions on your file. You are entitled to a copy of your complete file. Request it and make sure that the information contained in it is accurate and complete. Also, search your file for opinions or information that supports your claim and bring this to WorkSafeBC’s attention.

3) Start gathering medical information

Often, WorkSafeBC will deny a claim for a “lack of objective medical information”. Generally, a person’s subjective reports of pain will not be enough if there is no additional medical documentation confirming a health problem. If WorkSafeBC is claiming that there is not sufficient information, ask your health care providers for support. Talk to your family physician to review the opinion of WorkSafeBC’s staff doctor and ask for their comments. Ask your physiotherapist, your massage therapist or your chiropractor to prepare an opinion on your progress and submit it to WorkSafeBC. If you need to consult a specialist, ask for a referral and let WorkSafeBC know.

4) Get assistance

Before you file your request for review, get help. The Workers’ Compensation Act and its supporting policies are very complex, and your appeal may deal with complicated questions of law. Fortunately, support can come from a number of sources, including a union representative, a workers’ adviser, a friend or family , or an employment lawyer knowledgeable in WorkSafeBC law and regulations. Whatever you decide, make sure you ask for help and get the support you need.

5) Request a Review

The first step in the appeal process is to request a review. In this step, WorkSafeBC will assign the file to a reviewing officer for reconsideration. The job of the reviewing officer is to provide a second look at the file to make sure that the original decision was appropriate. In conducting the review, the officer can consider written arguments and new evidence. I strongly encourage workers to provide thorough, well thought out arguments supported by evidence in the WorkSafeBC file and new evidence when requesting a review.

6) File an Appeal with WCAT

If the worker is unsatisfied with the result of the review, they can request an appeal to the Workers’ Compensation Appeals Tribunal (WCAT). WCAT hearings can be heard in person or through written submissions. In an oral hearing, the worker will be present with a representative and will be provided the opportunity to present the panel member with evidence and arguments that support their claim. The employer may also be present at the hearing and will also be provided the opportunity to present evidence.

Injured workers fighting WorkSafeBC for benefits are in a very difficult position. Not only are they dealing with the pain and real limitations of their injuries, but they are forced into a prolonged battle for the benefits they rightfully feel entitled to. In addition to these stresses can be complications in their relationship with their employer and the indignity of financial hardship.

WorkSafeBC appeals should be treated with the seriousness the situation deserves. Injured workers should always seek assistance. Workers’ Advisers provide free information and representation, while employment lawyers are highly trained legal advocates with developed skills in oral presentation, written argument and legal interpretation. For more information on WorkSafeBC, consult our Employee Resources page.

David M. Brown,

Doak Shirreff LLP

dbrown@doakshirreff.com