While a decision is being made on a claim, your Client Care Navigator can help connect you with community resources. And, they can help both you and your employer discuss safe options for staying connected to work and working safely through this time. 

At this point, depending on the situation, a Return-to-Work Specialist may contact the worker and employer before a claim decision is made to begin discussing a return-to-work plan, accommodations, or transitional work. It is important to note that working while you recover does not impact your entitlement to a claim.

A WCB Eligibility Specialist will contact the worker and employer to discuss the claim. They are specially trained to decide if psychological injury claims are eligible for WCB benefits under the Workers’ Compensation Act. 

The eligibility specialist may ask the worker and employer:

• A detailed description of the events that led to the injury
• A timeline of the events
• Any internal safety or HR reports or processes relevant to your injury
• Information about your job description and job demands
• Any documented complaints or investigation reports from the employer, police, or OH&S regarding your injury
• A worker’s job description or agreement

In some cases, the Eligibility Specialist may also need to talk to others who have relevant information as part of the process, such as coworkers or others who may be involved.

Additional Information Gathering 

Sometimes, depending on the circumstances of the injury, specialized service providers may be used to help gather more information about the claim. If the services of 3rd Party WCB Claim Investigators are required, the decision can take a little longer.

We know it may be difficult to share the details about what happened in your workplace, however, the Eligibility Specialist will need to hear these details in order to make a decision on the claim. In addition to the types of information they will seek from you and your employer, they will ask you about any treatment you are receiving for the Injury. A psychological assessment might be requested if one hasn’t already been provided. 

If an assessment is required, the WCB will connect you with a registered psychologist or psychiatrist and pay for this service. The health care provider will contact you to set up an appointment for the assessment. These can be done in person or virtually. 

Most often, within three weeks of the claim being opened, both the worker and employer will hear from WCB with a decision on the claim. During this conversation, you will both receive a detailed explanation of how the decision was made. Both the worker and employer will receive a detailed written decision as a follow-up.

My Claim is Approved. What Happens Next? 

If your claim is approved, a WCB Case Manager will contact you within 1 day of the decision. They will become the new main point of contact throughout the treatment, recovery, and return-to-work process.

The Case Manager will work with the worker, employer, and healthcare provider throughout treatment and safe recovery at work. 

My Claim is Not Approved. What Can I Do? 

As part of the discussion about the claim decision, the Client Care Navigator will discuss options and possible resources for care. They can also explain the next steps if you wish to appeal the decision. 

You will receive a full written decision for your records. 

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