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- Claims basics
- Claims information for workers
- Benefits
- Claims information for employers
- Review and appeal
Claims basics
What is a work-related injury or disease?
A work-related injury or disease is one that arises out of and in the course of employment or is due to the nature of employment.
To be covered by WorkSafeBC a worker must have been working when hurt, and the injury must have been caused by something to do with the job in order to be covered by WorkSafeBC.
For a disease, this means that the disease contracted must be caused by the work or the work environment in order to be covered by WorkSafeBC.
How is a claim processed?
After WorkSafeBC receives reports from
- the injured worker
- the employer and
- the attending doctor
a WorkSafeBC staff member processes the claim to determine if the injury or disease was work-related.
What types of claims are there?
There are three types of claims:
No time lost – health care claim only- The worker has returned to work without losing time from work beyond the day of injury.
- WorkSafeBC covers medical costs; the employer pays the worker for the day the accident occurred.
- The claim is initially handled in the WorkSafeBC call centre by client service representatives (up to three weeks).
- Claims more than three weeks are transferred to the entitlement unit, where entitlement officers adjudicate and facilitate return to work.
- Claims involving workers with non-traumatic activity-related soft tissue injury, catastrophic injury, severe brain injury, or a psychological injury are transferred directly to a case manager.
- For claims more than four to six weeks, or where it is expected there may be problems returning to work, the claim is transferred to a case manager for ongoing management.
What is a claim number?
When a claim is made with WorkSafeBC, a claim number is assigned. With this number, the worker, the employer, and the health care provider can check the status of a claim online to find out if the claim has been accepted.
What happens if the injury occurs out of province?
If you are working outside of British Columbia and you normally live and work in B.C. and your employer is based in B.C., you will usually be covered by WorkSafeBC.
If you're not covered by WorkSafeBC, contact the workers' compensation board of the province in which you were injured. In some cases, you may be eligible for workers' compensation in B.C. and another province. In that case you have three months from the date of your injury to decide from which board you intend to claim compensation.
What happens if I'm moving to another province while still getting payment from WorkSafeBC?
Let the WorkSafeBC staff member handling your case know, and provide your address and phone number. Your benefits will not change unless the move delays your recovery and return to work. Note that WorkSafeBC will only pay health care costs up to the amount allowed in B.C.
Claims information for workers
What should I do if I'm injured at work?
- Report it to your employer immediately.
- Seek medical attention for your injury. If you need an ambulance or transportation from your workplace to your doctor's office or the hospital, your employer is required to pay those costs. Be sure to tell your doctor your injury is work related.
- Report your injury to WorkSafeBC as soon as possible. If you miss work as a result of your injury, please call our Teleclaim Contact Centre. If a WorkSafeBC staff member asks you to complete a Worker's incident and injury report or an Application for Compensation and Report of Injury or Occupational Disease (Form 6) at any time, it is important that you do so and submit it as soon as possible.
- It is against the law for an employer to tell you to not report an injury or disease, or even try to talk you out of reporting it to WorkSafeBC.
How do I start a claim?
Report your injury to your employer, your doctor, and WorkSafeBC. You will then receive a claim number and a personal access number from WorkSafeBC so you can view information about your claim.
How do I view information on my claim?
You can view information about your claim, including WorkSafeBC correspondence, decisions on your claim, payment information, return-to-work dates, and more. You'll need the claim number and your personal access number.
When can I return to work?
You can return to work as soon as you, your doctor, and WorkSafeBC feel you are able.
You may be able to start working part time, or at reduced activity levels, or even at another task if you are not able to return to full duties immediately.
Who is on my claim's WorkSafeBC team?
Client service representatives answer questions and make entitlement decisions on claims, and manage straightforward claims with up to three weeks of time loss.
Entitlement officers make decisions on straightforward and complex cases, and manage straightforward claims involving up to four weeks of time loss.
Service expediters support the entitlement officer and arrange work conditioning referrals.
Case managers provide ongoing management of complex claims that are in receipt of wage loss for periods of greater than four weeks.
Team assistants provide support to the case manager.
What if I move during the course of my claim?
If your name or address changes over the course of a claim, please complete and submit a Change of address, name, or contact information (#25w112) form to WorkSafeBC.
Benefits
What types of benefits are provided?
When a worker's claim is accepted, they begin receiving benefits from WorkSafeBC. The type and duration of the benefits depend on the nature of the injury and the work.
When do benefits begin?
WorkSafeBC benefits begin immediately:
- The employer is responsible for a worker's wages on the day of injury.
- Wage-loss benefits from WorkSafeBC start the first scheduled shift lost after the day of a work-related injury or disease.
- Health care costs are covered on the day of injury.
When do benefits stop?
Workers receive wage-loss benefits until the case manager concludes they are able to return to work or have recovered from the injury. If an employer can provide light or modified duties, and the doctor agrees it's safe for the worker to do them, they can return to work to those duties.
When can benefits be suspended?
WorkSafeBC benefits can be suspended if:
- The worker does not attend or does not co-operate in a medical examination or program arranged by WorkSafeBC
- The worker participates in any activity that might delay recovery
- The worker refuses treatment recommended by WorkSafeBC
- The claim is fraudulent
Claims information for employers
As an employer, what do I need to do when a worker is injured?
If a worker is injured on the job your responsibilities include:
- Transporting the injured worker to the nearest location where medical treatment can be obtained and paying for the transportation.
- Reporting the incident/injury to the WorkSafeBC within three business days of the injury's occurrence or within three business days of you or your representative becoming aware of the injury. View benefits of submitting your report online. (PDF 146kb)
- Submitting an Incident and Injury Report (Form 7) online or completing and sending the Employer's Report of Injury or Occupational Disease (PDF 81kb) to WorkSafeBC.
- You must report fatalities and serious injuries immediately to our Prevention Emergency Line at 604 276-3301 in the Lower Mainland or toll-free 1 888 621-7233.
If the worker misses work time as a result of his or her injury, ensure that he or she calls Teleclaim as soon as possible to report the injury to WorkSafeBC. Otherwise, ensure that he or she completes and submits a Worker's incident and injury report or an Application for Compensation and Report of Injury or Occupational Disease (Form 6) to WorkSafeBC.
What happens if I don't report a worker's injury?
Failure to report an injury or coercing a worker not to report an injury is an offence against the Act and can result in fines.
You're not usually required to report to WorkSafeBC if the worker does not lose time from work and does not seek medical attention. However, some accidents and incidents do need to be reported regardless of injuries.
How do I check the status of my worker's claim?
If you are an employer or health care provider you can view the status of a claim, but not wage-loss payment information, using online claim status.
Review and appeal
What do I do if I disagree with a decision made by WorkSafeBC on my claim?
If you disagree with a WorkSafeBC decision, you can have request to have it reviewed.
The Claims Review and Appeal Guide for Workers and Dependants (PDF 360kb) provides detailed information on how workers and dependants can request a review and file an appeal and the Claims Review and Appeal Guide for Employers (PDF 96kb) provides detailed information on how employers with claims concerns can request a review and file an appeal.