Questions guide our thinking and our thinking guides our actions. Which is why forgetting to ask 3 crucial questions BEFORE you appeal a WCB claim will often result in a poor outcome for you.
Most of us will jump right into the appeal when we don’t agree with something or are worried about our WCB premiums.
Appeals need structure and a game plan. How you put together this game plan is by using the questions in this article.
It doesn’t matter where you are in Canada.
If you’re dealing with WCB Alberta, Worksafe BC, or WSIB Ontario these question NEED to be used before you appeal a WCB claim.
Before I get to the questions, lets look at what happens prior to the actual appeal.
How We Used to Appeal a WCB claim.
You were involved in a WCB Claim and there was a decision that you wanted. Depending on what side of the claim you were on, it was either to have an issue accepted or denied on the claim.
In my experience, people will submit the documents they have to and right away tell the WCB Claims Manager they want to appeal the issue. BEFORE the claim manager had a chance to appeal the claim.
This is going too fast.
If you have a disagreement on the file, then focus on gathering the evidence you need to persuade WCB to see things your way.
Studies have shown that when humans are under stress or angry, they don’t think properly. This results in poor decision making or tunnel vision.
What’s tunnel vision?
It’s when you focus on what you want to happen, that you forget the evidence to support your position.
Often this is appealing a claim “out of principle” as opposed to basing the argument on facts and evidence.
This will cloud your judgment and prevent you from presenting a strong case to WCB.
How to Appeal a WCB Claim Better?
It starts with the evidence you collect in your investigation. The better the evidence, the better the decision you will get.
When you have the evidence, organize it in a way that makes it easier for the WCB to follow your line of thinking.
It may be important to have a conversation with WCB and discuss what you’re submitting and why so they understand your perspective.
Then you wait.
Before You Appeal a WCB Claim
You’ve submitted your evidence and had your discussions with WCB.
You want to appeal the claim because you don’t agree with it.
The first question you want to ask is:
“What is the decision that you’ve made on the file?“
Does this sound ridiculous?
You’d be surprised how many people launch into an appeal BEFORE WCB has made a decision. This is a waste of time for you and for WCB.
I always want to make sure a decision is made.
Often the WCB will send a letter telling you the decision is made. This letter will tell you what this means for the worker and the employer involved in the claim.
Why is This Question Important?
It’s important because you are clarifying the exact decision that was made on the WCB claim.
People will appeal an issue on the WCB claim that has nothing to do with the decision.
These same people spend time pointing to evidence that relates to a different issue.
This is why…
When you clarify the decision from WCB, you’re making sure that you’re all talking about the same issue.
This 1 minute video discusses Question #1.
Once you’ve clarified the decision, you can move on to the next question.
Before You Appeal a WCB claim
This question will direct you to the parts of the WCB claim that the WCB used to make their decision.
That question is:
What is the evidence you looked at, to make your decision?
This is a huge question to ask after a WCB decision is made.
Because when you understand how a decision was made, you will know what evidence they used to make their decision.
There have been many times where I realized a decision was made because the WCB didn’t consider a specific piece of evidence.
It could have been a:
- witness statement,
- doctor report,
- or any other type of evidence that I thought was important.
In some cases, the WCB may have had other evidence I was not aware of. These things could be reports or evidence sent in by the worker.
They could have had an MRI that I wasn’t aware of or a witness that supports their position.
When you ask WCB what evidence did they look at, you’re trying to identify and confirm:
- What you know
- What you don’t know
- What’s missing
- What’s the truth
This 1 minute video discusses Question #2.
Before You Appeal a WCB claim
Without the answer to this question, you may as well go home. It’s that important.
While the previous two questions help get things started, it’s this question that will give you the keys to getting the outcome you want.
That question is:
What was your rationale for making this decision?
What you’re asking the WCB claim manager is what are their reasons for making this decision?
You know what evidence they looked at, but WHY did they look at THAT evidence.
You’re also getting their interpretation of the evidence. What was different about their interpretation from how you saw it?
Sometimes that’s the difference in an appeal.
You’re also going to get them to explain how this evidence relates to the WCB policy.
Why is being familiar with policy important?
WCB Alberta just saw changes to their policies in Bill 47 that could affect how those companies working in Alberta manage and appeal WCB claims.
For more on this check out our article:
10 Things Alberta Business Needs to Know About WCB
WCB cannot make decisions without relating them to policy because the policy is the rules to use when deciding on claims.
They tell everyone involved in the claim what allows a WCB case manager to accept or deny an issue or benefit.
Check out the 2 minute video that talks about Question #3.
What Can I Do With the Answers to These Three Questions?
Once you have the answers to these questions, you will start your appeal.
Let’s quickly recap what the answers gave you:
- You Confirmed a Decision is Made
- You Know Exactly What the Decision Is
- You’re Able To See The Evidence WCB Considered When Making Their Decision
- The Reasons They Made Their Decision Which Will Guide You In Your Appeal.
Next you want to prepare for your letter. What do I mean by letter?
Normally WCB Appeals are done in writing.
You want to take this information that you have and put them in a letter that explains to the WCB decision maker:
- Your position
- Your evidence
- Argument for what you want
To find out more on How To Write A WCB Appeal Letter check out the article.
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 the 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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