How the WCB Manages Benefits and Claims

If the adjudicator accepts the claim, your worker can expect to receive their benefits according to the type of injury and the time loss they experienced.

In general, we try to reach a decision and pay the worker within 14 days of the incident. However, there are injuries and illnesses that are more complex and therefore may take more time for a decision. We need to receive all the information from you as soon as possible so we can pay your worker as quickly as possible. 

WCB coverage pays for lost wages from the job where the incident occurred and for other jobs the worker may have, but can’t work due to their injury. If your worker receives wage loss benefits related to another job they hold, cost relief is applied to keep these costs from affecting your WCB rate and premium

WCB coverage may pay for the following when someone is hurt at work:

• medical aid treatments like physiotherapy, prescriptions or hospital care (some treatments will need to be pre-approved before medical aid is provided)
• Permanent Partial Impairment Award
• fatality and spousal dependent benefits.

Permanent Partial Impairment Award 

If a worker sustains a work-related injury or illness and, as a result, a body part does not function the same way as it did before, that worker may be entitled to a Permanent Partial Impairment Award (PPI) in addition to other WCB benefits. 

Download the Permanent Partial Impairment Award Fact Sheet

You have the right to the following information about your worker’s claim:

• the claim decision 
• the worker’s restrictions and abilities set by their healthcare provider or the WCB
• the amount paid to the worker by the WCB while the worker is recovering 
• healthcare or Permanent Partial Impairment (PPI) costs
• these are listed on your monthly Claim Transaction Statement.

Due to privacy laws, we cannot give you any information about the worker’s diagnosis, other medical information or the kind of medical treatment they receive for their injury.

If you are appealing the claim decision, you may request a copy of the worker's claim file. After you submit an appeal for a claim decision, the Review Office will decide whether you can receive a copy of the worker's file.

Learn more about appealing a claim. 

Claims are transferred from an adjudicator to a case manager for two main reasons:

• The worker’s wage loss will be longer than eight weeks. 
• The worker’s recovery is expected to last longer than 14 weeks.

You will receive a letter if your worker's claim gets moved from short-term claims to case management. The case manager's name and contact information will be included in the letter.

A claim might be transferred to case management if:

• pre-accident employment is uncertain or unavailable for the worker 
• there is no clear diagnosis after four weeks of the worker’s treatment.

In some situations, claims are transferred to case management right away. This happens when:

• the worker’s injury is severe or results in a fatality
• the worker is showing signs of mental or emotional distress
• the WCB and the worker’s healthcare provider disagree on a decision
• there are challenges within the Return to Work plan that the WCB is helping to resolve.