The claims process
When there's been a work-related injury or illness, as a worker, you can help speed your recovery by staying at work and doing modified duties where possible. Medical literature shows that staying at work is one of the most important factors for overall health.
We have a basic process for most claims. These are the steps for workers:
File a claim
Once we receive an Application for Compensation Benefits we gather information from you, the employer and the health care provider. We can usually provide a decision on a claim within an average of 14 days. Some claims may take more time. We consider each claim on an individual basis.
Receive benefits and services for accepted claims
Once a claim is accepted, we let you know about the benefits and services you will receive. The services help you recover and safely resume usual job duties.
You are entitled to receive health care assistance in the form of services, devices or equipment that provide relief from the injuries, as approved by us. This may include, but is not limited to, health care services, hospital expenses, medication and aids to independent living.
If we determine you require treatment in another province, we will pay for travel costs to attend.
If you are unable to work or participate in modified work duties as a result of the work-related injury, you are entitled to loss of earnings benefits.
If you are eligible, you will be entitled to loss of earnings benefits. We will pay loss of earnings benefits based on your average earnings at the time of the injury. Benefits are calculated based on 75 percent of your gross average, up to the maximum annual earnings. Loss of earnings benefits for lower income workers are calculated at 100 percent of your gross average earnings at the time of injury.
Loss of earnings benefits are not taxed. However, you must report your benefits to the Canada Revenue Agency. We’ll issue you a statement of benefits paid on a T5 form every year in February.
You may also be entitled to compensation for a permanent impairment as a result of your work-related injury. These benefits will be explained to you by your case manager.
Recovery and return to work
We share with you the goal of getting you back to your pre-injury duties at work. All of our assistance supports the strong medical connection between recovery and work. See our Return-to-Work Guide for Employers.
It's important to follow up with your health care providers, and with us, if your condition doesn’t resolve or you are concerned you may miss time from work.
You must actively seek to recover. Return-to-work services work with you towards the goal of resuming function and activities as soon as it is safe and possible for you to do so. A case management team (you, your case manager, your employer and health care providers) will work collaboratively with you to get you back to work as soon and safely as possible to prevent long-term disability. Case management involves early intervention, ongoing communication and a team approach.
Every worker must take reasonable steps to reduce or eliminate any impairment and loss of earnings that results from a work-related injury.
Your health care providers (such as psychiatrists, psychologists, physiotherapists, chiropractors) must be licensed and have an agreement with us before we approve them. While you’re receiving compensation, you may not unreasonably change your health care providers.
Disagreement with decisions
If you are not satisfied or disagree with a decision made about your injury or claim, you have the right to request a reconsideration.
You have 12 months from the date of the decision to file a request for a reconsideration. See Reconsiderations and appeals.
A worker, a dependent of a deceased worker or an employer may appeal a reconsideration decision that was made respecting a claim for compensation to the Appeal Tribunal, an independent tribunal formerly known as Workers’ Compensation Appeal Tribunal (WCAT) in writing within one year of the date of the reconsideration decision.
See the Workers’ Compensation Appeal Tribunal website for further information on how to appeal.
Access to claim file information
All workers, or dependents of deceased workers are entitled to a copy of all information that is contained on the claim file, other than privileged information upon written request.
The board may grant access of information including personal information, it considers relevant to an employer who is a party to a reconsideration or appeal of a decision on a claim for compensation.
For access requests, please submit a Request for Disclosure form. Once the disclosure is prepared, you may come down to our offices and view the file under supervision. Or we can provide a copy. There is no charge for the first copy. After that, we charge a photocopying fee of $0.25 per page or $50 to copy the file.