WorkSafeBC answers your most commonly asked questions

Q: How do I know if my patient’s claim has been accepted?
A: Your patient will often know immediately if his or her claim has been accepted. WorkSafeBC accepts approximately 91% of submitted claims, and, on average, workers receive wage-loss benefits within 3 months of the date of disability. In certain circumstances, WorkSafeBC will require additional information regarding the injury either from the employer or from you—as the worker’s physician. The more serious injuries are directed immediately to a case manager from the date of injury. All workers, along with their physician and employer representatives, are informed of claim decisions in writing. 

Workers can also view claim decisions in real time by logging into their online WorkSafeBC account at online.worksafebc.com/wcb.SCON.web/preauth/signup1.aspx.

Q: How does my patient receive claim updates?
A: Claim updates take place in the following ways:
•    The worker and the case manager speak to each other over the phone throughout an accepted claim of 1 week or more in duration. This involves a two-way exchange that is pertinent to each phase of the worker’s recovery. The case manager generally closes these discussions by outlining the time frame associated with the next steps of the claim. He or she attaches a corresponding memo on the claim, which is then available for review on the worker’s online account.

•    The worker’s case manager will make formal decisions on matters such as reopening a worker’s claim or the development of secondary conditions by following the same process. The worker—along with the attending physician and employer representative—will also receive these subsequent decisions in writing.

•    The worker and case manager will communicate with each other in face-to-face meetings. On occasion, the worker and one or several of the worker’s team members will arrange these meetings. Some examples of where such interactions would take place include an active rehabilitation program in the community, an occupational assessment or vocational rehabilitation meeting in an employer setting, or a meeting at a WorkSafeBC office with the case manager and medical advisor.

Q: May I register for online access to my patient’s claim?
A: No, you won’t have online access, since the worker is considered the designated representative on file. However, your patient-worker can share access to his or her claim by logging into that account in the presence of others. Alternatively, workers can grant formal access to individuals of their choice using Form 63M4—WorkSafeBC Authorization of Representative.

Q: Is there one place where I can find all the forms?
A: Yes, you can access all the WorkSafeBC forms online. Go to worksafebc.com, click on the Forms tab, and then click on Health Care Providers. Once you’re there, scroll down the list of health care providers and click the appropriate selection (worksafebc.com/forms). 

Q: If my patient’s claim is denied, why do I not receive a copy of the rationale?
A: Under the Freedom of Information and Protection of Privacy Act, WorkSafeBC cannot share information about workers with others in the absence of prior written consent. However, your patient is free to share claim decision information as he or she sees fit.

Q: What resources are available to help injured workers navigate through a claim?
A: A worker’s case manager is the first and preferred point of contact for all claim-related questions. Case managers routinely assist workers with concerns throughout their recovery. Service coordinators are also available to assist workers with specific claim-related questions. Often, the case manager and service coordinator work in tandem to support workers throughout their claim process.

For workers who do not belong to a union and would like to review or appeal their claim, workers’ advisors are available to assist. Their services are offered free of charge to all claimants via the Government of British Columbia Ministry of Labour and Workers’ Advisers Office at www.labour.gov.bc.ca/wab.

If you would like more information on the claims process, call a medical advisor in your nearest WorkSafeBC office.
—Deanna Tripodi, MD

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This article is the opinion of WorkSafeBC and has not been peer reviewed by the BCMJ Editorial Board.