How the WCB Makes a Claim Decision

A claim is created after you report an injury or illness that happened at your workplace to the WCB. It consists of information provided by you, the worker and the worker’s healthcare provider.

When an injury is reported, an adjudicator may be assigned to manage the claim. The adjudicator is responsible for deciding if the claim meets the criteria to be accepted or not. In some cases, the adjudicator may first need to decide if the worker is covered by the WCB.

At this stage, all of the information in the claim is reviewed by the adjudicator. The adjudicator’s decision is based on details related to the injury.

If there is any information missing or if there are any inconsistencies the adjudicator will follow up with you, the worker or the worker’s healthcare provider. This process is usually done over the phone. 

Once the claim is reviewed, the adjudicator will decide to accept it or not. For a claim to be accepted, it has to meet the key criteria outlined in The Workers Compensation Act and Regulations (the Act). The main criteria is that the injury or illness is related to the worker’s duties or workplace.

As an employer, you have the right to know the decision on a claim of an injured worker. Most claims with the WCB are accepted and the way you will be notified of the outcome depends on the result.

1. If the claim is accepted and there is wage loss for the worker, you will be notified.

2. If the claim is accepted and the worker needs medical aid, you will be notified by a Claim Transaction Statement. The Claim Transaction Statement is sent to you on a monthly basis if you have active claims with workers who are receiving benefits from the WCB. It gives you an overview of the costs involved with a worker’s claim. 

3. If a claim is rejected or disallowed, you will receive a letter. 

Learn more about Claim Transaction Statements.

Many incidents reported to the WCB are no time loss claims. This means that although the employee was affected by an injury or illness in the workplace, they can keep working without losing time after the day that the injury happened. 

You will not receive a notification when a no time loss claim is accepted. If you would like to confirm whether a no time loss claim was accepted, you can call the WCB.