The other day a frustrated Safety Director asked me: How do I appeal a WCB claim? What is it that you do that’s different from other people? How do I even get started?
Appealing claims is the most popular topic I get asked about. It usually starts because a client calls wanting to appeal a claim. They are worried how it will affect their company and their premiums.
For some safety clients, they’re concerned about:
How their “Total Recordable Injury Frequency” (TRIF) will be affected by a claim.
If your company is currently dealing with a claim you want assistance with, then get in touch with us by clicking here.
How Does This Work?
As I am going to show you in this quick two-minute video below, I begin by focusing my attention on WCB and what they will use to accept or deny a claim.
Early in my career I realized that regardless of which province you’re working in, the WCB/WSIB/Worksafe uses the same 3 criteria for accepting a WCB claim.
Think of it as a mathematical formula.
1 + 1 + 1 = 3
My experience was: if I could prove to WCB that any one of the 3 parts didn’t exist, the formula wouldn’t work.
Which means WCB would have to deny the claim.
This was HUGE because when I explain this to safety professionals, they realized you can:
- Focus your investigation appropriately
- Avoid Distractions and chasing after evidence that won’t help you
- Come up with a list of questions to help you interview witnesses more effectively
- Put a solid argument together based on facts
- Present a persuasive argument to WCB
- Defend your position with solid facts
Right away you get a feeling of control because you know what WCB must see. This guides you on how you’re going to go about proving this.
In addition, if you can’t find evidence to support your appeal, then you can move forward knowing why you can’t appeal.
A proactive response would be to put steps so these gaps don’t exist in the future.
If you do have an appeal, then you need to send your appeal in writing. To find out: How To Write A WCB Appeal Letter click the link.
You can also check out our online appeal course: How to effectively appeal a Workers Compensation (WCB) claim and win!
What is the WCB Appeal Formula?
Start by watching this quick 2 minute video for an explanation.
As you saw in the video WCB looks for:
- Was the worker in the course of employment?
- Was an employment hazard present?
- Are the workers symptoms related to the event they say happened because of work.
To get the claim denied, you must show one of these elements doesn’t meet WCB policy. Do this effectively, and you will stop losing appeals to deny a WCB claim.
While each WCB uses the same criteria in their formula, their definitions can differ slightly.
Meaning, what is considered in the course of employment in one province…may not be the same in another.
To find out what the definitions are for your province, you can go to the WCB policy OR ask a WCB representative.
If WCB already made a decision on the claim, and you want to appeal the decision, then you want to start with:
This article will give you 3 questions that will help guide you through your investigations to appeal WCB claims. You will notice how it relates back to the formula we’ve been discussing.
Lastly, if it is clear that the evidence proves that all 3 elements are present. Then focus your attention on managing the claim and controlling claims costs.
Understanding when to walk away from an appeal is just as valuable. It will have a huge impact in reducing your WCB premiums.
How Can WCBconsulting.ca Help You?
We specialize in providing WCB online training to companies and safety professionals or anyone interested in understanding how to manage and appeal WCB claims in a simplified and easy way.
It focuses on the principles of WCB and how you can use them to control a claim and the costs associated with the claim.
Regardless of your:
- position in the company
- province you work in, the online courses will guide you every step of the way.
This allows you to have access 24/7 to videos, articles, and information to handle any WCB related issue from your phone or desktop. It is literally information at your fingertips.
For more information check out our COURSES PAGE to browse our selection of courses.
In addition, for those clients that prefer to have us manage their claims, we offer WCB claims management and WCB appeals representation.
Simply CONTACT US with any questions and we’d be happy to help.
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