Three-part Series: Four Useful Tips for Managing your WCB Claim

Part two of our three-part series is about providing you with helpful tips on managing your WCB claim. Below, we introduce four tips that will help you make the most out of your case manager. If your claim is accepted, you’ll be assigned a person who will make most of the decisions about your compensation.  In most provinces and territories, including BC, they’re called “case managers.”  The case manager is in charge of making a lot of decisions on your file as you move forward, including whether to approve healthcare requests or wage loss benefits, and whether you qualify for long-term disability benefits.

 

Make the most out of your case manager

The workers compensation system can be a frustrating process.  Workers often don’t know what they’re owed under the law, or what the next step in the process will be.

Case managers aren’t just there to make decisions. They’re there to tell you why they are making those decisions, and help ensure you understand that.  What’s more, every decision your case manager makes about your benefits has to follow the law and policy.

You should do your best to know what rules are being applied to your claim, and why you are being given or denied benefits based on those rules. Ask your case manager to tell you what rules they are following. If it’s a big decision, you should get the decision in writing. Happily, in BC, the big decisions are usually communicated by a letter. That said, the reasons in the letters can vary from very detailed to no reasoning at all – so again, it’s important to follow-up with your case manager quickly if you don’t understand a decision.

If you don’t understand a decision, or are unclear about the rules they’re applying, those rules – law and policy and practice directions – are available online.  WorkSafeBC’s compensation policy manual, called the Rehabilitation and Benefits Manual Volume II, is online.  Practice Directives, which give decision-makers some guidance on specific issues, are also on the WorkSafeBC website.

 

Follow-up with your case manager

The reality is that case managers will not always follow-up with you as quickly as they could.  Case managers are responsible for dozens and dozens of files at once.  A case manager may be especially busy one week, or off on vacation, or covering for someone else and have additional work.

If you want your claim to move forward as quickly as possible, it’s important that you ask your case manager every step of the way how long they can expect the next step to take. They won’t always be able to guarantee that something will happen by a certain date, but always ask for an estimate. And if they don’t get back to you by that date, follow-up with them.

 

Make your case manager’s job easy

It’s easy for frustrated workers caught in the process to demand things from their case managers, or even be rude or aggressive on the phone.  This is not a good approach.

One of the best ways to help ensure your claim is handled as quickly as it can is to make the case manager’s job as easy as possible. Be polite. Have your questions ready when you call.  Remember – your case manager has a lot of files they’re working on, so, on your file, if you can refer them over the phone to reports or letters by date, all the better.

To be clear: case managers are professionals, and a big part of that responsibility is making the right decisions to ensure workers are provided with the benefits owed to them under law and policy.  This won’t change whether the case manager likes you or not.  But, everything else equal, you have a much better chance of getting a phone call returned faster if you’re polite and helpful instead of angry. It’s human nature.

 

Ask for the healthcare you think you need, and attend your medical appointments

Healthcare benefits are some of the most valuable benefits you can get from workers compensation.  You have access to all sorts of referrals. From my experience, workers often get treatment faster than folks who have to get treatments or referrals on their own.

Because of this, it’s really important that you ask your medical professionals about what you need to get better – and then ask your case manager for the healthcare you and your medical professionals say you need.

Every request to your case manager is a separate decision for them to make, and is appealable if he or she says “no.”

An important part of managing your claim is always making your medical appointments.   If your medical practitioner recommends a treatment, make sure that your case manager knows and ask them when they will make a decision on whether that treatment is approved. And again – always follow-up!

Don’t miss out on the last part of our series. Tune in next week to learn about appealing decisions on your claim.