If a worker has been injured while on the job, the worker’s claim for compensation and the doctor’s medical report are first reviewed by a WCB Benefit Administrator or an Adjudicator. They determine if the worker’s claim is covered under the Workers’ Compensation Act. They also determine the level and extent of benefits that the worker may receive. Later in the claim, other types of decisions may be made by a Case Manager.
The Internal Appeals Process
If, at any stage in a claim, a worker or an employer does not agree with a decision that the WCB has made on a claim, they may file an appeal of that decision. The appeal process is intended to ensure that any decision the WCB makes is correct according to the Workers’ Compensation Act, and the policies of the Workers’ Compensation Board. All appeals on WCB claims are reviewed by the WCB’s Internal Appeals Department.
NOTE: If an appeal of a WCB decision is not filed within 30 days of receiving that decision, workers and employers are no longer able to appeal that decision. This decision then becomes the final decision of the Workers’ Compensation Board.
How to Appeal a Decision on a Claim
Both workers and employers can appeal decisions on their claims. These include decisions about whether a claim is accepted, the type, length, and amount of earnings-loss compensation or health-care benefits, and the worker’s eligibility for vocational rehabilitation services or the payment of permanent impairment benefits.
If a worker receives a decision from the WCB that they do not agree with and wish to appeal, they must complete a Notice of Appeal to Hearing Officer form and send it to the Internal Appeals Department of the WCB. A Notice of Appeal form is included with all WCB decisions. If you do not have a Notice of Appeal form, you may get one by contacting the WCB.
The Notice of Appeal and any other information in support of the appeal must be received within 30 days of being notified of the original decision. The Notice of Appeal form should specifically list the date of the original WCB decision that you are appealing and the error in that decision. The appeal process is not intended to go over the whole claim again, but to review specific errors or oversights. Therefore, the worker or employer filing the appeal must identify a specific error in the original decision in order to file an appeal.
How an Appeal Works
Once the Notice of Appeal is received by the Internal Appeals Department, the claim will be assigned to a Hearing Officer. A Hearing Officer is a specialist in workers’ compensation law and policy, and has experience in workers’ compensation matters.
The Internal Appeals Department will review the Notice of Appeal form, and based on the information provided there and the issue(s) on appeal, decide whether to conduct a paper review or an oral hearing.
In a paper review, the Hearing Officer reviews any new information submitted by the worker as well as any information on the file that relates to the issue on appeal. In an oral hearing, the worker, the Hearing Officer and any other parties who are connected with the appeal meet in an informal setting and discuss the issues of the appeal and any new information.
After the paper review or oral hearing has been conducted the Hearing Officer will send out a written decision which is the final decision of the Workers’ Compensation Board.
If an employer wishes to assist in an appeal made by a worker, or if the employer is appealing a WCB claim decision on their own, the employer may request a copy of the relevant information from a worker’s claim file. There is a small fee for this service.
Employer’s Appeal of an Assessment Decision
Employers may also appeal a decision made by the WCB Assessment Services Department with respect to their assessment rate, classification or any penalties. The procedure for appealing an Assessment decision is the same as that outlined in the How to appeal a decision on a claim section of this brochure.
The same 30-day deadline for filing an appeal applies, and a Hearing Officer will conduct either a paper review or an oral hearing and issue a decision. This decision is then the final decision of the Workers’ Compensation Board.
Staff at the Workers’ Compensation Board will be able to answer any question you may have about appealing a WCB decision. Workers may also be entitled to legal advice and representation through the Workers’ Advisers Program at no charge. Workers’ Advisers are appointed and paid for by the Provincial Department of Labour and are able to assist workers in filing an appeal or handling their claim. The Workers’ Advisers Program may be reached at 902 424 5050 in Halifax, or toll free at 1 800 774 4712.
If new information about a claim or assessment becomes available after a decision has been made, it should be sent directly to the staff member who made the original decision. The staff member will then review their decision, based on the new information provided, without the file having to go through the internal appeals process.
If you have received a final decision from the WCB on a claim or assessment matter, and you then receive new information that may affect the decision, you may also be entitled to have your decision reviewed.
However, in this situation the new information must be truly new evidence. That means it must be evidence which is different from that which is already on file and cannot be a new argument based on the same evidence. It must also be evidence which could not have been presented by the worker or the employer at the time the final decision was made. A final decision of the WCB is a decision of a WCB staff member which was not appealed to a Hearing Officer or a decision of a Hearing Officer.
Submitting the Notice of Appeal Form
The Notice of Appeal to Hearing Officer should be sent to the WCB’s Internal Appeals Department. It should be mailed, or faxed to the following address:
Internal Appeals Department
Workers’ Compensation Board of Nova Scotia
PO Box 1150 Halifax, NS B3J 2Y2
Halifax local: 902 491 8800 Toll free: 1 800 870 3331 Fax: 902 491 8801
The Workers’ Compensation Appeals Tribunal (WCAT)
If a worker or an employer does not agree with a decision of a Hearing Officer, that decision may be appealed to the Workers’ Compensation Appeals Tribunal (WCAT). The WCAT is an independent agency that hears appeals of WCB final decisions. The Workers’ Compensation Appeals Tribunal will report to the Minister of Justice, and is separate from the WCB. An appeal to WCAT must be filed within 30 days of being notified of the Hearing Officer’s decision.
For more information about the Workers’ Compensation Appeals Tribunal, please contact their offices at 902 424 2250 in Halifax, or toll-free at 1 800 274 8281.