It’s important to understand the basics of the WCB claims process. There are generally four types of claims. Of course, while many claims follow a similar process, all workplace injuries are unique.
- Injuries resulting in NO Time Loss
- Injuries resulting in Time Loss with Return to Work with NO Permanent Earnings Loss
- Injuries resulting in Time Loss with Return to Work with Partial Earnings Loss
- Injuries resulting in Time Loss with NO Return to Work and FULL Earnings Loss
Step 1: Report an Injury
When an injury occurs, the best thing for you is to get things back to the way they were before the injury. But before that can happen there are few things that need to be taken care of first:
- Report your injury to your employer immediately - If possible see your supervisor, first aid attendant or company nurse before you leave work.
- Seek immediate health care - Ask your doctor or health care provider to complete forms provided by your employer and to send a report to the WCB immediately. Ask if you are cleared to return to work in regular or transitional duties.
- Fill out a WCB Injury Report Form - Work with your employer to learn why the injury happened, and prevent it from happening again. Fill out the form with your supervisor and ensure your employer reports the injury to the WCB immediately.
- If you must be off work due to your injury, work with your employer, health care provider, and the WCB to return to work as soon as you are able. Of course, not every injury will prohibit you from working entirely - it may be possible for you to return to transitional duties while recovering from your injury.
- Work is healthy. Return to work as soon as you are functionally able to, and work toward minimizing your earnings loss.
- Report any injury to or incident to your employer right away, regardless if it requires medical attention or time off work. Your report creates an official record that can be referred to if there are any complications later.
- Time is of the essence! Delays in receiving reports can delay claim decisions.
- If you have any questions regarding reporting an injury you can contact the Integrated Service Center (1-800-870-3331 or 491-8999) and an Integrated Service Associate can assist you.
Step 2: WCB Receives Form(s)
Typically, the claims process begins once the WCB receives an injury report from an employer, or the appropriate form from your healthcare provider – a doctor’s report, chiropractic report, hospital report, physiotherapist report, or occupational disease report.
It's very important to notify your healthcare provider if your reason for visiting them is related to something that happened at work.
Once the WCB receives an accident report or appropriate health care provider form indicating that an injury has occurred, your claim is registered with the WCB and a claim number is assigned.
Step 3: Claims Process
Case Worker is Assigned
A WCB benefits administrator determines the complexity of the claim based on the injury severity and expected service needs. The claim is then assigned to the appropriate case worker. There are three levels of case management at the WCB:
- Low complexity claims – Usually involve only a visit to a health care provider or very short amount of time off work.
- Medium complexity claims – Tend to be sprains and strains and are expected to be resolved within 4-6 weeks.
- High complexity claims – More serious injury or injuries with complicating factors that require extensive support and services.
Sometimes a claim is handled by all three types of case workers. This may occur if the WCB receives additional information indicating that a higher level of service is needed.
Depending on the type of injury and how long you have to be off work, a Return-to-Work Assistant may be assigned to help support the case worker. The Return-to-Work Assistant can help with your claim by answering questions you or your service providers might have, facilitating communication with all involved parties, and maintain contact with employer for payroll information/injury information as required.
Step 4: A Decision is Made
The case worker assigned to the claim gathers all information and supporting documentation from you, your employer, and the health care providers. The WCB uses that information to decide about the claim’s acceptance and benefits level.
WCB decisions may be appealed. More information about the appeals process can be found in appealing a decision.
Step 5: Develop a Return-To-Work Plan
In most cases, workplace injury is minor, and you may not miss any time from work at all, other than to receive the first aid and medical attention that you need.
But, all too often, it is more serious.
When this type of more serious injury occurs and you do lose time from your regular job, staying connected and continuing to work, whenever possible, is a very important factor in your recovery.
If you are losing time from work, your case worker will begin coordinating medical evaluations for building an effective return-to-work plan for you.
Based on the medical diagnosis, the case worker can identify the usual treatment plan, expected recovery and typical return-to-work timelines. However, your health care providers are responsible for the treatment plan.
The case worker’s role is to ensure you receive services that will help you recover and safely return to your job.
The case worker will contact your employer to discuss options for transitional duties – job tasks that match your current physical ability until you’re able to return to your original job. Transitional duties promote recovery by allowing you to perform valuable work and stay connected to your workplace.
Once transitional duties and a return-to-work plan are established, your employer is encouraged to stay in contact with your case worker to monitor your progress, all in an effort to help you fully recover and safely return to your job.