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.
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). At this stage, you will be able to discuss the decision with a supervisor who will try to work 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, will be mailed.
Appeals Commission
Once you have received the results of the DRDRB review and 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 request a representative, free of charge, from the Office of the Appeals Advisor (OAA).
As an employer, you can use resources of the WCB’s Employer Appeal Consulting service. However, WCB account managers are not employer advocates and will not act on your behalf in claim management or the appeals process. However, employer consultants and claims management experts can provide complete representation and assistance in dealing with all matters pertaining to workers compensation.
