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Is a WCB Claim Ever Officially Closed?

Posted in: Claims Costs,Workplace | Posted by Rebecca Ingram on November 4, 2015

Have you ever wondered if a WCB claim ever officially closed?

Once a worker has recovered from an injury and has returned to their full duties, the WCB will often send out a closure letter that outlines the injury accepted, the treatment and services provided, the return to work details and indicates that the claim will now be considered inactive.

But what happens if a worker develops problems after their claim has been considered inactive?

Unlike private insurance claims, where there are specific time limits enforced in which you can claim benefits, the WCB will always consider any new information that is submitted. Interested parties will be notified of the new action on a claim and invited to provide any additional information for consideration.

If, after review of the submission, it is determined that the information is relevant to the accepted work related injury and requires action, the claim will be reopened.

The WCB considers every situation on its own merit to determine if the new information has a direct connection to or an impact on the claim in question. A review does not guarantee that a claim will be reopened but if warranted the WCB will approve further treatment and/or benefits.

Claims can be reopened if a work-related injury flares up and no intervening cause for the flare up can be identified.  Degenerative conditions like osteoarthritis and lung diseases can impact a workers health, sometimes many years after they have effectively recovered from their original injury, requiring additional medical treatment and/or benefits. Claims can also be reopened for the assessment or reassessment of a permanent clinical impairment (PCI).

These are the more common scenarios and although claim re-openings are relatively rare, they can be costly to employers.

If the reopening occurs within three years of the date of accident, the costs associated with the claim reopening are charged to the employer of record and can affect their premium rate directly. If the reopening occurs beyond the three year cost accumulation window, costs will impact the industry that the employer belongs to.

Following the determination, the WCB will send out a letter to all interested parties advising of their decision and provide the rationale if the claim is to be reopened. Employers should ensure that they understand why claim is being reopened and what the potential impact the decision may have on their WCB premiums.

As with any decision made by the WCB, there is a 12 month period to request a review or submit an appeal.

If you would like further information about WCB claim re-openings or assistance with appealing a decision to re-open a WCB claim, you can contact us directly at BCL.Calgary@bclconsulting.caBCL.Edmonton@bclconsulting.ca, by phone, at 1-844-377-9545 or you can connect with us on FacebookTwitter, or LinkedIn.

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