The WCB Appeals Process

Posted in: Claims Costs,Workplace | Posted by Rebecca Ingram on October 29, 2015

The WCB has just made a decision on a claim and as a worker or as an employer, you are not in agreement with the decision that was made – what can you do?

The WCB has a number of different levels of appeal and use a collaborative review process as a way to resolve issues in a timely manner, here is a look into the WCB appeals process:

Contact the Decision Maker

The first step is to contact the WCB and discuss your concerns with the person who made the decision. They will be able to explain the rationale and considerations that went into making the decision. If you have any additional or new information that may have an impact on the decision, this is the time to provide it.

Complete a Request for Review Form

Following that discussion, if you still have concerns, you can request a formal review of the decision by completing and submitting “Request for Review” form (G40). Once your Request for Review has been received and reviewed, you will contacted by a WCB client services supervisor who will try to work with you towards a possible resolution.

Contact by a Review Specialist

If an acceptable resolution was not reached, the WCB will forward your request to the Dispute Resolution and Decision Review Board (DRDRB) for their consideration. You will be assigned and contacted by a review specialist to make sure that they understand your specific issues and concerns plus determine your understanding of the initial decision, prior to reviewing the claim file.

DRDRB Review

After discussing the issue with you and determining the best approach to resolve the dispute, the specialist will review the claim file and make a determination to uphold or overturn the original decision. The results of the review, including the rationale used to arrive at the conclusions, written report will be made available.

Appeals Commission

Once you have received the results of the DRDRB review, if you are still not satisfied with the results, you have one year, from the date of the decision, to the issue to the take your issue to the final level of appeal, the Appeals Commission (AC). The AC is a government entity that reports directly to the Ministry of Jobs, Skills, Training and Labour and is completely separate from the Workers’ Compensation Board.

Time Limits

As an employer or an injured worker, you have 12 months from the time a decision was made to initiate a request for review of that decision. You also have 12 months from the time the DRDRB renders its decision to appeal the decision to the Appeals Commission. If you are late in submitting your request, you can submit a written request for an extension of the time period, however each case is judged on its own merit taking into consideration for the delay.

Using Representation

The appeals process can be confusing and complex, if you wish, you may acquire representation at any point throughout the review process. By providing a representative with written consent, they will be authorized to obtain the WCB claim file and interact with the WCB on your behalf.

As an injured worker, if you choose a lawyer or advocate as your representative, you are responsible for their fees. Alternatively, you can get assistance, free of charge, from the Advisor Office for Alberta’s Worker Compensation and ask for a Worker Advisor.

As an employer, you can use resources of the Fair Practices Office – Employer Appeals Advisor Branch or Employer Appeals Consulting (EAC). However, FPO and EAC employer appeals advisors are not employer advocates and will not act on your behalf in regards to claim management or the appeals process. The service is focused on resolving issues by collaborating with WCB Customer Service Department. When a resolution possible, the advisor will provide a letter outlining the issue(s), facts and policies necessary to prepare a formal written appeal submission.

On the other hand, independent employer consultants and claims management experts can provide complete representation and assistance in dealing with all matters pertaining to workers compensation.

If you are interested in further information on the WCB appeals process or would like help with the appeal of a WCB decision, you can contact us directly during business hours through our chat feature or by phone at 1-844-377-9545. You can reach us by email at  [email protected] or [email protected]  and you can connect with us on FacebookTwitter, or LinkedIn.

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