Chapter Seven Workers Compensation-Books Pdf

CHAPTER SEVEN WORKERS COMPENSATION
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2 Timely Application Health Care 19, 3 Standard of Proof 20. 4 Survivor Benefits 20, VII SECTION 5 1 INJURY PSYCHOLOGICAL INJURIES 20. VIII SECTION 7 INJURY HEARING LOSS 21, IX CLAIM BENEFITS 21. A BENEFITS 21, B SHORT TERM AND LONG TERM WAGE RATES 22. 1 Recurrence or Deterioration and Wage Rates 23, C AVERAGE EARNINGS 23.
D TEMPORARY WAGE LOSS BENEFITS TWL 24, E HEALTH CARE BENEFITS 25. F INCOME CONTINUITY BENEFITS 25, G VOCATIONAL REHABILITATION BENEFITS 25. H PERMANENT DISABILITY PENSIONS 27, 1 Functional Impairment Method 28. 2 Projected Loss of Earnings Method 28, I BENEFITS AFTER AGE 65 29. J BENEFITS IN FATALITY CASES 29, K SUSPENSION OF BENEFITS 30.
L EMERGENCY ASSISTANCE 30, M RESOLVED PLATEAU DECISION LETTERS 30. 1 Has the Worker s Injury OccD Stabilized 31, 2 Plateau Date 31. 3 What Permanent Conditions are Accepted and what Conditions are Denied 32. 4 Accepted and Denied Conditions 32, 5 Missing Conditions 32. 6 Can the Worker Return to the Pre Injury Job Not Appealable 33. 7 If Not Referral to Vocational Rehabilitation VR 33. 8 Did the Worker Suffer an Exceptional Loss of Earnings 33. X APPEALS 33, A INTERNAL REVIEW WORKERS COMPENSATION REVIEW DIVISION 34. B APPEAL TO WORKERS COMPENSATION APPEAL TRIBUNAL WCAT 34. C ACCESS TO FILES 35, D APPEAL PROCEDURE WORKERS COMPENSATION REVIEW DIVISION 35.
E APPEAL PROCEDURE WORKERS COMPENSATION APPEAL TRIBUNAL 35. F CLARIFICATIONS CORRECTIONS MISSED ISSUE 36, G RECONSIDERATION OF WCAT DECISIONS 36. H JUDICIAL REVIEW JR 37, XI HEALTH AND SAFETY REGULATIONS 38. A A WORKER MAY REFUSE UNSAFE WORK 38, B PROHIBITION AGAINST DISCRIMINATORY ACTION 38. XII ASSESSMENTS OF EMPLOYERS 39, XIII THE WCB FAIR PRACTICES OFFICER 39. XIV LSLAP S ROLE AT THE INITIAL DECISION LEVEL 39, A LIMITED SCOPE RETAINERS 40.
XV APPENDIX INDEX 41, A LIST OF ABBREVIATIONS 42, B LIST OF CASES 42. C REFERRALS 43, D RESOURCES 44, 1 Print Resources 44. 2 Internet Resources 44, 3 Organizations 45, E CLAIMS PROCESS FLOW CHART 46. F CHECKLIST FOR WORKERS COMPENSATION INTERVIEWS 47. G CHECKLIST FOR REVIEW DIVISION APPEALS 48, H SAMPLE AUTHORIZATION BY WORKER OR DEPENDENT FORM 49. CHAPTER SEVEN WORKERS COMPENSATION, I INTRODUCTION.
This chapter covers basic legislation policy and procedures associated with appeals under Workers Compensation. Act RSBC l996 c 492 WCA, The WCA is a provincial statute creating a regulatory body called the Workers Compensation Board of B C. Since 2003 this body works under the name of WorkSafe B C and is referred to as the Board or WCB in. this section The Board has exclusive jurisdiction over compensation to injured workers for workplace injuries. amongst other duties The Board s origins are perhaps more interesting than its current form suggests. Some of the earliest forms of workers compensation started with pirates in the pre Revolutionary Americas A. pirate who lost an eye was entitled to 100 pieces of eight roughly one year s pay 1 With the industrial. revolution more evolved workers compensation schemes followed in Europe and eventually spread back to. North America where they are now mandatory across Canada and the United States. Today s workers compensation schemes including BC s are based on the historic trade off employers fund a. no fault insurance scheme for injured workers to compensate them and assist in their medical treatment. vocational rehabilitation retraining and in pension for a disability In return workers give up their right to. legal action against their employer for work related injuries and occupational diseases WCA s 10 Ideally this. approach offers several benefits It takes workplace injury claims out of the courts reducing clutter for them. and cost and delay for the workers It gives greater certainty of coverage to workers and streamlines the. compensation process Finally like any insurance scheme it spreads losses amongst employers and eliminates. the concern about ruinous claims Unfortunately reality often falls short of these ideals and especially in light. of changes since 2002 injured workers often require help and even representation. Aside from compensation The Board s other duties consist of. Regulation of Occupational Health and Safety OH S In BC the Board is responsible for. workplace health and safety regulations investigations and enforcement as set out in Part III of the. WCA and in the Occupational Health Safety Regulation While most enforcement orders and penalties. are against employers for safety violations orders may also be issued against workers Under the. WCA workers are entitled to refuse unsafe work and to be protected from retaliation for reporting. unsafe work practices, Employer Assessments The WCA grants specific powers to the Board to set rates and collect. assessments from employers to create an Accident Fund The Accident Fund must be sufficient to. finance the compensation system and each employer is assessed annually based on a complex formula. see below The WCA requires the Board to operate a fully funded system. A Scope of This Section, This section advises workers and their representatives on the overall structure and basic procedures of. the Board and its appeal body the Workers Compensation Appeals Tribunal WCAT It is intended. to assist in working on cases and appeals arising from Board decisions made under the WCA The. vast majority of appeals involve Board decisions denying injured and disabled workers particular. compensation benefits This is not surprising given that current Board policies are often complex and. that about 100 000 compensation claims are filed by injured workers every year with about half of. these claims involving a serious injury or disability. Christopher J Boggs Workers Compensation History The Great Tradeoff online 2015 Academy of Insurance. http www insurancejournal com blogs academy journal. Therefore the primary focus of this material is on compensation matters which may be at issue in. appeals Assessment and OH S issues are addressed briefly at the end of the chapter The. Appendices provide information for referrals community resources and helpful links for finding law. and policy In particular the WCA requires the Board through its Accident Fund to support the. Employers Advisors and Workers Advisors who can provide employers and workers with free legal. assistance However the extent of the assistance provided by these Advisors changes from time to. time and between locations, II GOVERNING LEGISLATION AND RESOURCES. A Legislation, The Workers Compensation Act WCA is the legislation which creates and governs the Board In.
2002 and 2003 the WCA was substantially amended and the key transition date is June 30 2002. Workers who were injured before or on June 30 2002 with a few exceptions have the former WCA. apply to their claims whereas workers who were injured after this date are under the amended or. The new WCA revised sections 99 and 250 of the Act to make Board policy binding on all Board. decision makers and appeal bodies i e Review Division and WCAT The courts have since. determined that the effect of these provisions is to give Board policy a legal status equivalent to. subordinate legislation see below, The WCA amendments also changed the appeal structure for Board decisions Since March 1 2003. there are two levels of appeal for most Board decisions. i an internal review at the Review Division RD and. ii an external de novo appeal at WCAT which is an independent tribunal. In 2004 the Administrative Tribunals Act SBC 2004 c 45 ATA came into effect The ATA. applies to all administrative tribunals in B C including WCAT The ATA sets out certain procedural. requirements for WCAT and also sets a 60 day time limit for filing a judicial review from a WCAT. decision The ATA does not apply to Claim or Review Division decisions. OH S matters are primarily dealt with through the OH S Regulation although there is also a. Prevention Manual, Citations for the WCA key amendments and other relevant legislation are attached in the Appendix. All legislation and Board policies are available on the Board website at www worksafebc com. Applicable ATA provisions and their effect on WCAT procedures are also incorporated in WCAT s. Manual of Rules Policy and Procedures MRPP available on the WCAT website at www wcat bc ca. B Binding Policy for Compensation Claims and Appeals RSCM II. Section 99 of the WCA requires the Board to apply any applicable Board policy which has been. passed by the Board of Directors This means that published Board policy is binding on all Board. decision makers including the Review Division a similar provision s 250 makes Board policy. binding on WCAT, Section 99 of the WCA also states that all decisions shall be given according to the merits and justice. of the case and where there is a doubt as to any issue and the disputed possibilities are evenly. balanced the issue shall be resolved in accordance with that possibility which is favourable to the. worker This means that in WCB cases there is a unique standard of proof the as likely as not. standard This is less than the balance of probabilities more likely than not and properly applied. should favour compensation for the injured worker, In practice Board policy confines or attempts to confine the nature of relevant evidence and. provides the framework for how evidence is to be assessed and weighed Therefore in appeals it is. important to identify the correct applicable Board policy whether or not it is identified in the initial. Board decision, Compensation policy is set out in the Rehabilitation Services and Claims Manual Volume II.
RSCM II The current RSCM II is available at www worksafebc com under the Law and Policy. tab followed by the Compensation Policies link under Claims Rehabilitation On the sidebar. there are tabs for both RSCM Volumes I and II Volume I applies to claims initiated before June 30. 2002 RSCM I and Volume II applicable to any claims initiated after June 30 2002. The RSCM II has eighteen chapters Each chapter focuses on a particular entitlement issue or benefit. and contains the policies relating to that issue Each policy is numbered and dated and is typically 1 3. pages long The RSCM II index also available through the RSCM II link is very helpful for locating. any relevant chapter and policy, Board policies change frequently Each new version of a policy is passed by the Board of Directors. and is published with both a specific effective date and a determination as to whether or not the. changes apply to appeals This information is set out at the end of each policy Each new Board. policy is incorporated into the electronic version of the RSCM II available on the Board website. When handling an appeal students should determine the relevant applicable policy especially for old. claims and should also review the electronic version of newer policy to ensure that it is still current. The Board website also contains all the former or archived policy manuals so that any relevant. policy is accessible even for old claims, If a particular Board decision quotes part of a policy it is good practice to read the whole policy and. also to look at the surrounding policies to understand the full framework for that type of benefit. Also although a particular policy may be quoted in a decision the decision maker may or may not. have applied the right policy It is best to assess the worker s issue and determine whether or not. alternative policies may be the correct applicable policies. Lastly Board policy must be consistent with the WCA If someone considers that a Board policy is. inconsistent with the WCA they are entitled to challenge that policy in a WCAT appeal in which it is. relevant If the WCAT panel agrees that the policy is not supported by the WCA the panel will refer. the matter to the WCAT Chair if the Chair agrees they will refer the policy to the WCB s Board of. Directors for ultimate determination and possible policy change s 251 WCA. C Non Binding Practices, Both WCB and WCAT also provide useful interpretive guides that combine policy important. decisions and best practices WCB issues Practice Directives PD that advise on many particularly. complex issues such as chronic pain mental disorders and overpayments These are accessible. through the Law and Policy tab at www worksafebc com under the title Compensation Practice. Directives and Reference Guides WCAT s guidelines are published in the MRPP discussed above. These publications can be extremely useful and are worth exploring although neither are binding on. their respective bodies, D Arguing Medical Evidence. As in any legal arena at all stages of the Workers Compensation process it is vital to support claims. with evidence Often this can be especially challenging when dealing with medical issues for many. reasons for example these issues require specialized knowledge they often do not lend themselves to. certainty even for professionals and most injured workers have limited time and money to spend. collecting evidence Conversely WCB has salaried Board Medical Advisors BMA and WCAT is. presumed to be an expert in all matters over which it has exclusive jurisdiction Fraser Health. Authority v Workers Compensation Appeal Tribunal 2014 BCCA 499 Fraser Health Nevertheless WCB. and WCAT are not presumed to have medical or scientific expertise and as such they are not. permitted to ignore uncontradicted expert advice Page v British Columbia Workers Compensation Appeal. CHAPTER SEVEN WORKERS COMPENSATION I INTRODUCTION This chapter covers basic legislation North America where they are now mandatory across Canada and the United States Today s workers compensation schemes including BC s are based on the historic trade off employers fund a no fault insurance scheme for injured workers to compensate them and assist in their medical treatment

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