Is a WCB Claim Ever Officially Closed?
Your employee has been injured at work, they’ve received treatment, they’ve recovered, they’ve successfully returned to work and the Workers’ Compensation Board (WCB) has inactivated their claim but is that claim really closed?
Once a worker has recovered from an injury and has returned to their full duties or has reached a medical plateau and is working at their maximum potential, the WCB Alberta sends a letter to the injured worker and their employer outlining what injuries were accepted, the treatment or services provided and the return to work details. The letter also advises that the claim will now be considered inactive.
But what happens if a worker develops problems related to their work-related injury after their claim has been inactivated?
Unlike private insurance claims, where there are defined time limits in which you can claim benefits, the WCB will always review any new information that is submitted. It does not guarantee that the claim will be reopened but it does initiate an investigation into the issue and all interested parties are notified.
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 or injury in question. Following the investigation, if it is determined that the new information is relevant to the accepted work-related injury and requires action, the claim will be reopened. If the results of the investigation do not support a connection to the work-related injury, the claim remains inactive.
Why would a claim be reopened?
There are a number of reasons that a claim may be reopened including but not limited to:
- Flare-ups or recurrence of a work-related injury with no intervening cause for the new symptoms.
- Degenerative conditions like osteoarthritis that may develop from a work-related injury and require attention.
- Progressive conditions like hearing loss or lung disease such as asbestosis, that require medical treatment sometimes many years after the original injury.
- Assessment or reassessment of a Permanent Clinical Impairment (PCI) where there is lingering disablement from a work-related injury that has not previously been considered.
Will a claim reopening affect my WCB premiums?
Possibly. In Alberta, if the reopening occurs within a three-year window in relation to the date of the 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 the employer belongs to.
Although other provinces also use a three-year window of claims for rate setting purposes, the costs associated with the claims in that window will continue to accumulate without limit and become part of their premium rate calculation, as it does in Saskatchewan.
Once the investigation is complete and an entitlement determination has been made, the WCB should send out a decision letter to all interested parties, including their rationale if the claim is to be reopened. It is important that employers understand why the claim is being reopened and what the potential impact the decision may have on their WCB premiums.
Can a reopening investigation still impact my premium rate even if the reopening is denied?
Yes. If the reopening is denied because the investigation does not support that the worker’s ongoing issues are related to their work injury, then all costs associated with the investigation should be relieved from the employer’s account. This is particularly important if the claim costs continue to accumulate and will be used for rate-setting purposes. Cost removal should be automatic however, it is often overlooked and the onus lies with the employer to ensure claim costs are accurate.
Can a reopening decision be appealed?
Yes. Any decision made by the WCB is open to appeal however the time limit to submit an appeal differs from province to province. In Saskatchewan and Manitoba there is no time limit at all to appeal WCB decisions, whereas in Alberta there is a 12-month window and in British Columbia it’s even more restrictive at 90 days from the date a decision was made.
Although claim reopenings are relatively rare, they can be costly for employers and therefore should be monitored closely until a decision is made and the claim is inactivated again.
If you would like further information about WCB claim reopenings or assistance with appealing a decision to reopen a WCB claim, you can use our live chat feature during business hours, email us at [email protected] or at [email protected], contact us directly at 1-844-377-9545 or you can always connect with us on our Facebook page, through our Twitter account, on our LinkedIn profile.