Initial entitlement decision procedure

Detailed business procedure

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1. Review all documents on file and gather initial information Review the information on the claim, get an understanding of the worker’s injury, their workplace environment and what they may need to assist them in their recovery. Determine what information may still be required to make the entitlement decision and anticipate questions that may arise during the initial conversations with the worker and employer (refer to step 2 for more details about this conversation). When reviewing the documents on file, consider if there is evidence to support: There is a worker and employer, as defined by the WC ActSee policy 06-01, Part II, Application 2 and Policy 06-01, Part II, Application 3. . Consider: Is the worker self-employed? If so, do they have personal coveragePolicy 06-02, Part II, Application 2. Is the worker a contractor/subcontractorPolicy 06-01, Part II, Application 4? There was an accident under the WC Act. To be compensable, an accident must arise out of employment and occur in the course of employmentPolicy 02-01, Part 1. An accident arises out of employment when it is caused by an employment hazardPolicy 02-01, Part II, Application 2. An accident occurs in the course of employment when it happens at a time and placePolicy 02-01, Part II, Application 2 consistent with the obligations and expectations of employment. There was an injuryPolicy 03-01, Part 1 and Part II, Application 1 that occurred as a result of the compensable accident. Injuries may be either physical or psychological and include disabling or potentially disabling conditions caused by an occupational disease. They may be the immediate result of an accident or develop over time. The type of injury or illness, and whether there is medical reporting confirming an injury and whether the injury could have reasonably been caused by the described accident. The date of the accidentFor progressive conditions/diseases, the date of accident is the earlier of: a) the first date the worker received medical treatment or b) the first day of earnings loss if the worker experienced lay-offs or loss of earnings capacity caused by the compensable condition.. The location of the accident. The permanent residence of the worker on the date of accident. If the worker has any previous claims and if the injury or illness is a pre-existing condition in the same part of body as their injury. This information helps determine if the accident had an impact on the pre-existing condition. The injury resulted in time off work. If there is possible third-party action. There is a Worker's Report of Injury or Occupational disease (C060) and Employer's Report of Injury or Occupational Disease (C040) on file. Determine if the worker has any previous claims for the same part of body as their injury to help determine if the accident had an impact on the previous injury. Some injury-specific or claim-specific exceptions or special circumstances may require further consideration to make a decision, such as if: The accident occurred outside of Alberta. The worker was injured in an accident that occurred in Alberta, but their permanent residence is in another province, The claim was not reported within 24 months of the accident or date of initial medical attention. The worker sustained: a dental injury a loss of hearing or another occupational disease a psychological injury a repetitive strain/progressive injury an eye injury damage to eyewear Refer to the Injury-specific initial entitlement decision and claim-specific circumstances sections for additional information.	Administrative tasks Review applicable forms: Worker report of injury or occupational disease (C060) Employer report of injury or occupational disease (C040) Supporting medical reporting Employer physical demands analysis (C545) Job description MVA request for information (CL020A) Automobile accident report (L054) If there are questions about the employment relationship between the worker and employer, or whether the employer has coverage, contact the Manager of Employer Account Services (EAS) for clarification. Send a file note (Employer Account) to the Claims Charging, Working Desk when the employer charging is not done, the claim needs to be charged to another account or industry, or the personal coverage amount is not showing on the eCO Claim Folder-Policy screen. If there is an indication that the accident has been caused by a third party, review the task list to confirm that there is a task for Legal Services to review for possible third-party recovery.
2. Contact the worker, employer and health care provider(s) Contact the worker, employer and health care provider, when required. In some instances, communication with other parties, such as a union representative, worker or employer representative(s) and/or family members may be required. Arrange an interpreter to assist with communication, if necessary. Worker: Contact the worker and explain that WCB has been notified that they were in an accident and clarify the decision maker's role in making a decision about their entitlement to compensation benefits. Discuss the following: How are they feeling and dealing with their injury? How and when their injury occurred and what they understand their diagnosis to be? If their employer identified concerns about the accident, attempt to gain any relevant information related to those concerns. Have they received any medical treatment or testing related to this injury so far? If so, who provided the treatment? Ask what treatment their health care provider has recommended and if they have any upcoming medical appointments/testing booked, as well as what their health care provider may have told them to expect during the recovery. If any diagnostic testing is required that is not yet booked or will take a while in the community, discuss whether the tests can be expedited the testing and how that would be done. Ask about their recovery and treatment goals? Confirm if they have returned to regular or modified duties and if so, the date they returned. If they have returned to modified duties, confirm what duties they are performing and if they have any concerns with modified duties. Ask if they are in contact with their employer? Encourage them to maintain that contact and relationship. If there are discrepancies in the reporting, clarify what the worker thinks about the discrepancy. If the medical reporting supports that the worker might have a pre-existing condition in the same part of body as their injury, clarify whether the worker had symptoms in that part of the body before their accident and/or received medical treatment for that same body part. When required also gather information about their employer and/or names and phone numbers of any witnesses to the accident. If it is unclear that the worker is a worker under the WC Act (Refer to the Key information section), obtain any information needed to make that decision. If they are self-employed confirm if they have personal coverage. If they have a unique employment situation (e.g., they are a subcontractor, student, pieceworker, owner/operator etc.,) gather additional relevant information about their situation. If not already on file, request they complete and sign a Worker's Report of Injury or Occupational Disease form (C060). Any additional assessments needed to make an entitlement decision (e.g., Return-to-Work Planning Meeting, ergonomic assessment) and why an assessment might be required and ask if they are willing to participate. Explain their responsibility to make reasonable, good faith, effortFor additional information see Section 89.1 of the Act and Policy 04-11, Part 1 and Part II, Application 1.s to cooperate in the return-to-work process. Discuss the plan for making an entitlement decision and outline the next steps, such as requesting medical information or referring for reviews and/or assessments. Explain when a decision is expected to be made and create a plan for maintaining contact with the worker (e.g., a phone call every two weeks). When the employer is not aware of the accident, advise the worker to contact the employer to report the accident. For additional details, refer to Section 32 of the Worker's Compensation Act. Employer: Explain that WCB has been notified that the worker was in an accident and clarify the decision maker's role in making a decision about the worker's entitlement to compensation benefits. Discuss the following: The accident and injury and clarify any information that is inconsistent or missing. Any concerns the employer noted on the Employer's Report of Injury or Occupational Disease (C040), if applicable, or determine whether the employer agrees that the accident occurred during a time and place consistent with employment as a result of a work hazard. Educate the employer about the nature of the worker’s injury and the important role that they play in the worker’s recovery. Ask if the worker has returned to regular or modified work and if so, when. If not, discuss what modified work is available for the worker, and whether they have offered modified work. If they have not already done so, request that they offer the modified work in writing. When the date of accident is between September 1, 2018, up to and including March 31, 2021, also explain their responsibility and obligation to provide modified and/or permanent employment. For additional information, Refer to Policy 04-05, Part 1 and Part II, Application 2. Explain their responsibility to make reasonable, good faith effortsFor additional information see section 89.1 of the Act and Policy 04-11, Part I and Part II, Application 1. to cooperate in the return-to-work process. If it is unclear if the worker is a Worker under the WC Act or the employer is an Employer under the WC Act, obtain any information necessary to make this determination. If there are discrepancies in the reporting (e.g. the worker's report of how the injury happened differs from the employer), clarify what the employer thinks about the discrepancy. Determine if the employer is facing any challenges while their worker is hurt and away from work. Encourage the employer to stay connected with their worker and keep their worker engaged in the workplace while they recover. Confirm earnings information as required. If not already on file, request they complete and sign an Employer's Report of Injury or Occupational Disease form (C040). Any additional assessments needed to make an entitlement decision (e.g., Return to Work Planning Meeting), why an assessment might be required and if they are willing to participate. Discuss the plan for making an entitlement decision and outline the next steps to make a decision. Explain when a decision is expected to be made and create a plan for maintaining contact with the employer until then (e.g., a phone call every two weeks with updates by email in between). Health Care Provider: Explain that WCB has been notified that the worker was in an accident and clarify the decision maker's role in making a decision about the worker's entitlement to compensation benefits. Discuss: Diagnosis and treatment recommendations. Any discrepancies in reporting between what the worker reported and what the health care provider reported. The worker’s fitness for work and opportunities for safe modified work. If they have recommended any diagnostic testing, explain that a copy of the requisition for the diagnostic test is required to expedite the test, when applicable. Request reporting, if required.	Administrative tasks If unable to reach the worker or employer by phone and additional information is required to make the initial entitlement decision, send the Request missing information letter (CL004A and/or the appropriate IN004 letter). Confirm who is authorized on the claim to ensure communication takes place with all necessary representatives. Follow the 9-4 Authorizations: worker and employer representatives procedure and ensure the appropriate consent form is received: Worker's authorization of a representative form (C622) Employer's authorization of a representative form (C966) If interpretation services are required Refer to the tools available on the EW>Business tools> Translation Services Refer to the Reporting the accident section for further information. Send the Request Medical Information (Physician, PT, Chiro) (SP006A) letter to request outstanding medical reports. Attach release of medical information form (C463) for out-of-province cases.
3. Make any referrals that are needed Determine whether additional information is needed to make the entitlement decision. Expedite any diagnostic testing, if applicable upon receipt of the requisition. Some injuries may require additional diagnostic testing or medical referrals to accept the claim. For injury specific circumstances, refer to the sections on: Dental injury Fractures Hearing loss Occupational injury or disease Psychological injury Repetitive strain injury Consider whether a referral is needed for a(an): Medical opinion if there are questions about the worker's diagnosis or the relationship of the injury to the work accident, or if the medical reporting shows the worker might have a pre-existing condition in the same body part as their injury and whether an aggravation occurred. Entitlement investigation by the Investigation Unit when there is not enough information to determine if there was a work accident and attempts to gather information have been unsuccessful (e.g., to gather reporting from the worker, employer or witness statements). Medical assessment (e.g., Medical Status Exams, Independent Medical Exams, Comprehensive Psychological Assessment, etc.) to determine if the worker's current diagnosis and the relationship of the injury to the worker accident and/or to facilitate any diagnostic testing necessary to confirm the diagnosis. Work site assessment (e.g., Return-to-Work Planning Meeting, ergonomic assessment) to confirm job demands and assess the work set up. When a medical investigation (e.g., independent medical examination, referral to a specialist, etc.) is needed to determine whether the claim is compensable, consider whether the worker is eligible for benefits during the medical investigation. Refer to the 1-4 Benefits during a medical investigation procedure and go to the next step once the medical investigation is complete.	Administrative tasks Follow the appropriate procedure for how to make the referral and to determine what referral form/letter may be required: 4-1 Medical testing, referrals and program support 11-2 Internal consultant referrals Internal procedure 20.6: Investigation Unit referrals 1-4 Benefits during a medical investigation 1-6 Aggravation of a pre-existing condition
4. Make the initial entitlement decision Review all information on the file and determine if the claim is compensable, based on related policy and legislation. When: There is not enough information to make an entitlement decision and a medical investigation (e.g., independent medical examination, referral to a specialist) is not required, repeat steps 1 through 3 until there is enough information to make the decision. A decision cannot be made because the worker and/or employer could not be reached and information from them is needed to make a decision, send a letter explaining what information is required to make a decision, why a decision cannot be made and request contact from the worker and/or employer. The claim may be inactivated until the information is received. Note: If a decision can be made without contact, proceed with making the decision after making two attempts to contact the worker and/or employer. The medical evidence supports the worker has a pre-existing condition in the same part of body that was involved in the accident, and it is unclear whether the accident impacted the pre-existing condition, go to Procedure 1-6 Aggravation of a pre-existing condition decision to make a decision about whether the injury is an aggravation of a pre-existing condition. Return to this step once the decision has been made The claim may be accepted when all of the following are met: The weight of evidence supports that an accident arose out of and occurred in the course of employment, and The worker sustained an injury as a result of the accident, and The worker is a Worker under the WC Act, and The employer is an Employer under the WC Act. The claim is not accepted (may be denied) when any of the above criteria are not met. If denying the claim, go to Step 6.	Administrative tasks Complete/update the required eCO screens: Claim details - claim type and initial entitlement decision Injury details Treatment details (only required when surgery has occurred, or treatment has been denied) Return to work screen Employment screen Update the screens as new information is received on the claim. Ensure the date of accident is correct on the Claims Details tab. Refer to Policy 03-01, Part 1 for information on how to determine the date of accident for progressive injuries and occupational disease claims. Complete the Return-to-Work screen for time loss claims when the worker has returned to modified work. Authorize medical treatment by adding the Authorized Treatment line and complete the Benefit Details tab if required. Add or update the appropriate lines to authorize other expenses or benefits as required such as medications or travel. If contact with the worker and/or employer was unsuccessful after two attempts, consider making an entitlement decision when: There is no conflicting information about the accident. No concerns are identified on the Employer's Report of Injury or Occupational Disease (C040). There are no unusual circumstancesExample: the worker performing duties outside of the scope of their regular job.. It appears that the claim meets or does not meet Policy 02-01 criteria.
5. Set the rate for wage replacement and/or top up benefits and issue payment If the worker has not missed any time from work proceed to Step 6. If the worker has missed time from work set the compensation rate. Make every attempt to set the rate so the payment can be issued to the worker within 14 calendar days from the date the claim was registered or from the first date the worker missed time from work, whichever is later. Rates are based on the worker’s: Employment status (permanent, non-permanent, personal coverage, owner-operator, subcontractor) Date of hire and history with the employer for the past 12 months Shift cycle Hourly rate of pay Overtime, vacation pay and shift premiums Additional income from other employers, if applicable Refer complex rates to the Payment Unit for calculation. Refer to the 2-1 Rate Setting procedure for additional information on how to set a compensation rate. If the employer does not provide earnings information in a timely manner, set a provisional compensation rateA provisional rate is a temporary rate that is set to ensure benefits are paid in a timely manner. Once the worker's earnings are verified, using their T1 tax return, the rate is adjusted as required. using the information the worker submitted about their earnings. Once the rate is set, communicate with the worker and confirm how and when they would like to receive wage replacement benefits. If the employer continues to pay the worker wages/salary the wage replacement benefits may be paid on assignmentWhen an employer keeps a worker on pay while they are missing time from work, WCB issues benefits to the employer instead of the worker. See policy 04-09, Part II, Application 1. to the employer.	Administrative tasks Follow the 2-1 Rate setting procedure Refer to the WCB as first payer Resource Library document for more information.
6. Communicate the outcome/decision Call the worker and employer to communicate the decision and next steps. Clearly express the rationale used to reach the decision (citing policy, medical information on the file, any important background information). If the worker or employer disagrees with the decision, consider whether their concerns require further review. If not, explain why the decision is unchanged. When the claim is accepted and the worker has missed time from work, explain how their compensation rate was set and when payment will be issued. If they have any concerns with how their rate was set, ask them to submit any evidence they may have (e.g., paystubs, tax returns, etc.) or follow up with the employer about their concerns. When the claim is denied, discuss additional resources that may be available to the worker as they recover, such as Employment Insurance benefits, long-term sick leave through Canada Pension Plan or sick benefits through an employer plan. When appropriate, offer assistance from WCB’s Community Support Program, which can connect workers with various agencies and organizations across the province for additional support outside of the workers’ compensation system. Send the appropriate letter explaining the decision. When the claim is: Accepted, outline next steps (e.g., treatment, benefits, the compensation rate and how it was calculated), return-to-work-details and plans for follow-up conversations. Offer additional services if eligible. If wage replacement benefits will be paid, include the option to receive payment through direct deposit. Address any concerns identified by the worker or employer. Denied, clearly express the rationale used to reach the decision (citing policy, medical information on the file, any important background information, etc.). Outline additional resources that may be available to the worker as they recover.	Administrative tasks Document the discussion in a file note (Contact/Worker Contact/Employer Contact). Send the appropriate initial entitlement decision letter. Send initial entitlement decision denial letters to the worker only. The system will automatically send the date-of-accident employer or their representative another version of the letter. The community support referral form can be found on the internal Electronic Workplace.
7. Manage, transfer or inactivate the claim Manage: Action any next steps that were discussed with the worker and employer in the previous step (e.g., referral for a treatment program, RTWPM). Contact the worker every two weeks at minimum and the employer every six weeks at minimum. Contact the worker and employer as soon as the worker is able to return to either modified or regular work to assist with facilitating their return. Discuss the worker's progress with the worker and/or employer, evaluate their fitness for work and modified work opportunities. Discuss any changes that are needed to the plan based on new information. Issue the appropriate benefits and arrange additional services as required. Determine if the claim can be inactivated (e.g., once the worker is able to return to full duties and no longer requires treatment) or transferred if the worker is not able to progress to regular duties or the worker does not recover as anticipated. Transfer: Longer terms or complex claims may be transferred to another staff member (a case manager) for management. Other claims may be transferred to another staff member (a case assistant) for monitoring. Call the worker and employer. Ask how the worker is recovering and assess whether they require additional referrals or supports. Explain the reason for the transfer and discuss any related referrals, if applicable. Provide the worker and employer with the name and telephone number of their new contact and send a follow up letter. Confirm with the worker that they will hear from their new contact within five business days. Inactivate: If the worker did not miss any time from work, or has already returned to their regular job, the file can be inactivated (closed). Call the worker and employer to communicate the closure of the file and ensure all benefits have been paid. Let the worker know that their file can be re-opened at any time in the future if there are any concerns or additional information related to their claim. Consider if a permanent clinical impairment (PCI) is suspected, the impairment may be assessed based on the reporting on the claim file, or the worker may undergo a medical review with an independent medical examiner 24 months after the date of accident or most recent surgery.	Administrative tasks Follow the appropriate procedure: 3-1 Modified work 3-2 Collaborative care planning 4-1 Medical testing, referrals and program support If a new entitlement decision (e.g., to accept an additional diagnosis, to approve a new benefit or service) is made, add a file note (Entitlement Decision) and document the decision. Add a file note (Contact/Claimant or Employer or Modified Work/Employer or Claimant) documenting the discussions. Refer to the Disability Duration Guidelines or the fracture memo to determine if a PCI is anticipated for the accepted injury. Refer to the 6-1 Permanent Clinical Impairment procedure for more information If a claim requires transfer to a case manager: Complete a CM transfer file note. Refer to the WCB Made Easy, Adjudication Tip sheets, transferring claims for the file note template. Ensure all screens are up to date. If a claim requires transfer to a case assistant and: Complete the Claim Closure/CA Monitoring File note - Fit for Full Duties and advise the Case Assistant to monitor the claim for a period of 6 months following the worker's return to pre-accident work and to transfer the claim to a claim owner if there is a change in status (i.e., worker was laid off, terminated, etc.). If contact with the worker or employer was unsuccessful, send the CL054A letter to advise of the claim transfer. Once fitness for work has been determined, send the appropriate fit for work letter in the CL041 series. If the claim is concluded send a Care Plan Conclusion (CL041E) letter as required.

Injury-specific initial entitlement decision

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Dental injury

Administrative tasks

Send the initial dental assessment request (SP001A) to the dental treatment provider.

Complete the MC Review – Dental/Ophthalmology Referral form (FM551Q) from the eCO Create Referral screen. Include additional information or questions not on the form, if needed.

Send the appropriate decision letter:

Dental treatment approved (SP001B)
Dental treatment not approved (SP001C)

Update the eCO Dental treatment line with the appropriate benefit, decision, as required.

Fractures

Administrative tasks

Enter the correct fracture injury code on the injury details screen in eCO and click the "Calculate Best Practice" button to calculate and display the best practice date and assist with determining an initial estimated return-to -work date to enter on the return- to- work screen.

Once the fracture diagnosis is confirmed, the Medical Services department will automatically arrange for a medical consultant to complete a fracture memo (a referral is not required). If the medical consultant identifies a different best practice date than the one displayed in eCO, they will update the best practice date in eCO.

Occupational Noise-Induced Hearing loss

Administrative tasks

Send the hearing loss package [PDF, 0.62MB]

Hearing information form (C042)
Worker's employment record form (C131)
Employer’s information questionnaire (C139)
Hearing loss medical release form (C583)

If the worker has been employed through a union, a letter from the union can provide a history of employment.

Send a dizziness/balance questionnaire to the worker if dizziness/balance problems are reported (traumatic injury) in consultation with the worker.

Occupational illness or disease entitlement

Administrative tasks

There are no administrative tasks for this section.

Psychological Injuries

Psychological or psychiatric injuries at work can happen suddenly, due to a traumatic situation, or can develop over time. They can also develop in response to being injured at work or undergoing treatment for a work-related injury. A claim can be accepted just for a psychiatric or psychological injury, or a psychiatric or psychological injury may be accepted in addition to physical injuries.

To accept a claim for a psychiatric or psychological injury, there must be a confirmed psychological or psychiatric diagnosis as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) currently in use by WCB (Refer to Policy 03-01, Part II, Addendum A).

WCB presumes that a confirmed psychological or psychiatric injury arose out of and occurred in the course of employment in the following circumstances, unless there is evidence to the contrary, when:

For accidents on or after Dec 10, 2012: A first responder (as defined in section 24.2 of the WC Act) has been diagnosed with post-traumatic stress disorder (PTSD) or a worsening of pre-existing PTSD. First responders include firefighters, police officers, peace officers (sheriffs only), and paramedics (including emergency medical responders (EMRs), primary care paramedics and advanced care paramedics).
For accidents/incidents that occur on or after April 1, 2018, this presumption also applies to correctional officers and emergency dispatchers.
For all decisions made on or after April 1, 2018, this presumptive coverage is not limited to PTSD. It also includes other psychological/psychiatric conditions that develop after a confirmed exposure to a traumatic event at work.
For accidents on or after April 1, 2018, up to and including December 31, 2020, there is a confirmed exposure to a traumatic event at work.

For any circumstances and time frames not specified above, WCB will accept a confirmed psychological/psychiatric injury when there is a link between the psychological/psychiatric diagnosis and the work accident/incident(s) or the injury/subsequent treatment. This includes:

A traumatic event at work; it must be confirmed that the psychological/psychiatric injury was caused, at least in part, by the traumatic event/situation at work. This is called a traumatic onset psychological injury.
An accumulation of work stressors over time or a stressor that exists over time; it must be confirmed that the stressor(s) is the predominant (main) cause of the psychiatric/psychological injury. This is called a chronic onset psychological injury.
An extreme emotional reaction to being injured and/or undergoing treatment for that injury; it must be confirmed that the psychological/psychiatric injury was caused, at least in part, by the injury or treatment.

An event is considered to be traumatic when it involves direct personal experience of an event or directly witnessing an event that is sudden/unexpected, frightening or shocking, has a specific time and place and involves actual or threatened death or serious injury to oneself or others or threat to one’s physical integrity. All of these criteria must be met for the event to be considered traumatic.

For decisions made between April 1, 2018, to December 31, 2020, a traumatic event can also include workload or work-related interpersonal incidents that are excessive and unusual in comparison to the pressures and tensions experienced in normal employment.

For accidents on or after January 1, interpersonal relations between a worker and coworkers, management, or customers may be traumatic when they result in behaviours that are aggressive, threatening or abusive. Excessive workload alone would not be considered traumatic, but WCB considers whether this may have resulted in a chronic onset psychological injury.

Making an entitlement decision

Review the information on file to determine if there is evidence that the worker experienced a traumatic incident at work or an accumulation of stressors over time at work, or if they are experiencing an extreme emotional reaction to their injury or treatment.

Also review whether there is a confirmed psychiatric or psychological diagnosis made by a physician (including psychiatrists) or psychologist using the criteria of the DSM that is currently in use by WCB.

Contact the worker and the employer to obtain information about the traumatic incident or workplace stressors, or their reaction to their injury/treatment. Ask questions to get an understanding of the worker’s injuries, how they’re coping and progressing and any initial or ongoing medical treatment they have received.

If a decision to accept the claim or injury cannot be made immediately and the worker advises they are not yet receiving any treatment, offer up to five sessions of psychological counselling so they can receive support until the review is complete. Refer to the 4-3 Psychological Counselling procedure.

If the information is unclear or there is no confirmed DSM diagnosis, contact the worker’s physician or psychologist using the appropriate letter to obtain additional information or clarification.

If appropriate, send the appliable psychological injury fact sheets to the worker and/or employer to provide them more information.

When additional information is required to make a decision on acceptance or the injury, obtain an opinion from a medical consultant or psychological consultant or consider referrals for additional investigation(s) such as a Psychological Injury (PI) assessment, a Comprehensive Psychological Assessment (CPA) or an Independent Medical Examination (IME – psychiatric). Refer to the 4-1 Medical testing, referrals and program support procedure for more information on making a referral.

Additional information may be needed to make the initial entitlement decision, such as interviews with other interested parties or witness statements. Request assistance from the Investigation unit to help gather the information if there are difficulties with obtaining it.

Administrative tasks

Send the applicable letter or fact sheet:

Request medical - physician (SP006A)
Psychological report request (SP021D)
Request med-psychiatrist (SP006H)
Chronic psych intro (CL026B)
DSM confirmation physician (SP026J)
DSM confirmation psychologist (SP026K)
Bullying and harassment in the workplace worker fact sheet [PDF, 0.07MB]
Presumptive coverage for traumatic psychological injuries worker fact sheet [PDF, 0.07MB]
Psychological injuries as a result of stressors that occurred over time at work (chronic onset) worker fact sheet [PDF, 0.06MB]
Psychological injuries as a result of traumatic event(s) at work worker fact sheet [PDF, 0.06MB]
Psychological injuries—frequently asked questions worker fact sheet [PDF, 0.07MB]
Bullying and harassment in the workplace employer fact sheet [PDF, 0.07MB]
Presumptive coverage for traumatic psychological injuries employer fact sheet [PDF, 0.07MB]
Psychological injuries as a result of stressors that occurred over time at work (chronic onset) employer fact sheet [PDF, 0.06MB]
Psychological injuries from traumatic event(s) at work employer fact sheet [PDF, 0.06MB]
Support your employee as they recover from a psychological injury employer fact sheet [PDF, 0.06MB][JC1]

It is common for the following diagnoses to be caused by a traumatic event:

Acute stress disorder
Post-traumatic stress disorder (PTSD)
Adjustment disorder with depressed mood
Adjustment disorder with anxiety
Adjustment disorder with mixed anxiety and depressed mood
Adjustment disorder with disturbance of conduct
Adjustment disorder with disturbance of emotions and conduct
Specific phobias related to the traumatic event (for example, a fear of heights after a fall from a significant height or a fear of driving after being involved in a major motor vehicle accident).

Once a decision is made send the appropriate decision letter:

Psych IED accept (CL041H)
Psych IED deny (CL026G)

Follow the appropriate procedure:

Progressive injuries/ repetitive strain injuries

Contact the worker and employer and discuss whether the worker had to perform a specific task over time that led to the injury. Ask additional questions related to the worker’s job duties as they relate to the part of body that was injured:

Describe the typical tasks performed each day. Ask:
- How long does it take to complete each task? How many times per day do they perform them?
- What are the typical movements required to complete those tasks (such as twisting, lifting or reaching)?
Describe the work environment. For example, if they do a lot of standing, is it on a concrete floor and, if so, do they use an anti-fatigue mat?
How long has this been their typical workday or the physical demands of the job?
Have there been any recent changes to their hours, the length of their shift, overtime hours, the length of time they need to perform specific tasks, their workload, etc.?
Have there been any recent changes to their workstation or ergonomics?Do they think their work-station is set up in a way that allows them to perform their job duties without injury?
Do they rest between tasks?
When do they have their scheduled breaks and do they take them?
When did they first notice symptom(s) and have they become worse? What were they doing at the time?
Are there any other factors that may have contributed to their injury? Do they do anything outside of work that involves repetitive activity?

Also consider:

Whether the worker has previous injuries or pre-existing conditions.
Whether the injury is known to be caused by specific movements and whether the worker was required to perform those specific movements in their job.
Information about the worker’s job and industry.
The medical provider’s opinion.
Whether a Return-to-Work Planning Meeting is needed to help confirm the nature of the job demands and whether they are repetitive in nature
Whether an ergonomic assessment is needed to confirm whether the workstation might have contributed to the injury

If a Return-to-Work Planning Meeting or ergonomic assessment is needed to confirm job demands/the setup of the workstation, make a referral for the applicable assessment.

When it is not clear whether the repetitive strain injury/progressive injury was caused by work duties/workplace ergonomics, make a referral for a medical consultant to provide an opinion.

Administrative tasks

Ensure physical demands analysis (C545) and job description forms are on file.

If additional information is still required after contacting the worker/employer, send:

Follow the 4-1 Medical Testing, Referrals and Program Support

For additional information on computer-related RSIs, refer to the causation scenarios in WCB made easy

Accident resulted in damage to eyeglasses/contact lenses but no injury

Under section 79 of the WC Act, when eyeglasses that are lost, damaged, or destroyed as a result of an accident, WCB pays for the cost of replacement or repair. An accident does not need to result in an injury for a worker to be entitled to the replacement or repair of eyeglasses or contact lenses, provided the damage occurred as a result of a work-related accident. To determine whether damage to other personal belongings will be replaced or repaired, refer to Policy 03-01, Part II, Application 8, question 4 for a list of circumstances in which damage to eyeglasses/contact lenses would be considered to be a result of a work-related accident.

A claim for eyeglasses damaged in the course of employment is adjudicated in the same manner as other claims. A worker may submit a claim to replace or repair eyewear damaged during the course of employment when there is no personal injury claim.

When the damage is to:

The frame, normally WCB covers the replacement of the frame, but not the lenses. An exception may be made if the lenses cannot be fitted into the new frame. WCB will not approve a medical fee in this case.
One lens only, WCB normally replaces only that lens with a lens of the same type, style, and prescription but will not approve payment for a medical fee, new frame, or second lens. An eye exam is covered only if the prescription is not available and cannot be identified from the broken lens. If the subsequent eye exam indicates the worker has a new prescription for the unbroken lens, WCB will replace both lenses.
Both lenses are broken (and the frame may or may not be broken), WCB provides for an eye exam and a new (full) pair of eyeglasses.
Contact lenses, WCB will pay for the replacement of the contact lens that was damaged.

Workers who choose to obtain insurance on their eyeglasses or contact lenses are responsible for payment of the premiums.

When communicating a decision (in step 6) to accept the eyewear damage, clearly explain the eyewear coverage that is approved (e.g., eye examination, eyeglass replacement, frame replacement, one lens replacement, contact lens replacement, etc.) and limitations of the coverage (e.g., coverage is limited to a one-time only replacement). Request that they submit receipts for eyewear, if not already on file.

When the worker's eyewear damage is not accepted, they are not eligible for reimbursement. Recommend they submit a claim through their personal insurance.

Payment of eyewear based on receipts

Review the receipts for payment and ensure the eyewear is consistent with the entitlement accepted. Refer to the benefits authorized on the Benefit Details screen for the Eyeglasses line.

If the receipt(s) does not provide an itemized list of the total costs, contact the supplier to obtain a list of the items purchased and the services provided.

If the total replacement or repair cost appear unreasonable or excessive, discuss with the supervisor. If the cost exceeds the decision maker's authority, obtain approval from the supervisor.

Payment is issued to the worker or to the optometrist providing the claim is accepted. WCB has an agreement with the Alberta Optometric Association, that the WCB will pay the optometrists' usual and customary fee but will not issue payment for report fees. Payment for the eye exam is issued by Medical Aid Unit. Refer to Policy 03-01 - Application 8 - Personal Belongings.

Administrative tasks

Direct the worker to complete the Damaged eyeglasses Non-Personal Injury (C697) form when their eyewear is damaged during the course of their employment but there is no personal injury. A Worker's Report of Accident (C060) form is not required.

Send the Reimbursement of Receipts – Eyewear (CL005C) form to gather information about the damaged eyewear.

Follow the Internal consultant referral procedure.

The Claims Processing (CAPs) team adjudicates claims for damaged eyewear with no personal injury. When there is a personal injury and the claim does not meet the criterial to transfer to adjudication, the claim is processed. This means a decision will be made on the damaged eyewear and the physical injury will be processed in the related eCO claim screens (for example, no time loss, laceration, with eyewear damage).

Add the Eyeglasses line and updateUpdating the Benefit Details screen will allow the Medical Aid team to issue the payment without generating an exception approval task. the Benefit Details screen with the decision and coverage details.

Receipts are required for eyewear. Workers can submit the receipt using the myWCB mobile app or by email, mail or fax of scanned or photographed original receipts.

Send the Eyeglasses (CL006G) letter when there is no physical injury, and the eyewear is accepted or partially accepted.

In all other cases, send the appropriate decision letter based on the claim circumstances to accept or not accept the physical injury and/or eyewear.

The Medical Aid team issues payment for the expenses related to the eye injury and/or eyewear.

Send receipts received directly, to the claim file for processing. Update the Benefit Details screen, if needed.

If the total replacement cost exceeds the levels of authority, send a file note (Entitlement/Line) to the supervisor with recommendations about whether or not to accept the additional cost. Attach the file note to the Eyeglasses line.

Accident resulted in damage to eyeglasses/contact lenses with an eye injury

Gather information from worker, employer and treatment provider as outlined in step 2.

Determine if an ophthalmology consultant review is required. Ensure all medical reporting regarding the injury has been received before making the referral.

The referral may include questions such as:

Is there a relationship between the work accident and the eye injury?
If further treatment is anticipated, what type of treatment is recommended?
Whether the appliances, contact lenses, glasses, medications, etc., recommended by the worker’s treatment provider are appropriate.
The anticipated prognosis (e.g., is permanent vision loss anticipated?)

Make and communicate the decision.

Review the consultant's response and any additional information added to the claim and determine whether the eye injury is compensable (accepted), or not compensable (denied/inactive) as outlined in Step 4.

When communicating a decision (in step 6) to accept the claim, clearly explain any eyewear coverage that is available (e.g., eye examination, eye treatment, eyeglasses, frames, one lens, etc.) and any limitations on the coverage (e.g., how often will WCB approve payment for eye exams, replacement of eyeglasses, etc.). Request that they submit receipts for eyewear, if not already on file.

Eyeglass coverage when the worker sustains an eye injury

Coverage for eyewear continues until the disability ends.

Eyeglass coverage when the worker did not wear glasses before the injury

When a worker sustains injury to:

both eyes, approve complete eyeglasses (frames and lenses) or contact lenses for as long as they need to wear eyeglasses/lenses due to their injury.
one eye (excluding complete vison loss/blindness) approve complete eyeglasses (frames and lenses) or contact lenses until the vision in the worker's uninjured eye worsens to the point that the uninjured eye requires a new lens. Once that occurs, they are only covered for lenses for the injured eye. The frames and lenses for the uninjured eye are not covered because it is an expense the worker would have incurred had they not been injured.

Eyeglass coverage when the worker wore glasses before the injury

When the worker sustains an injury to:

both eyes, approve complete eyeglasses (frames and lenses) or contact lenses for as long as they need to wear eyeglasses/lenses due to their injury.
one eye (not including complete vision loss (blindness)), approve lenses for the injured eye lens only. The frames and the lens for the uninjured eye are not covered because it is an expense the worker would have incurred had they not been injured.

Note: When the lens for the injured eye cannot fit into the worker's existing frames, the cost to replace the frames will be covered on a one-time basis.

Eyeglass coverage for compensable blindness in one eye

When a worker has a loss of vision (blindness) in one eye, approve complete eyeglasses (frames and lenses) to alleviate the effects of the disability and to improve and protect the vision in the uninjured eye.

Costs covered

Refer to policy 03-01, Part II, Application 8 for more information

Eye examinations and treatment

The cost of routine eye examinations, including when there is no change in the prescription, is covered every two to three years. More frequent examinations may be considered when medical evidence supports a need.

Frames, Lenses, and Contacts

The purchase of frames, lenses, and contacts is dependent on the conditions of the worker's injury as outlined in the above sections.

Frames: covered up to a maximum of $200.00 and replacements are approved every 4 years.
Lenses: covered up to the full cost of the basic or prescribed lens and replacements are approved whenever there is a change in vision acuity.The clarity or sharpness of vision when measured at a distance of 20 feet.
If a worker wants to purchase frames that cost more than $200 they may do so and use the $200 towards the purchase of those frames.
Contacts: are covered up to a maximum of $200.00 and replacements are available as often as required, based on the medical need and recommendations.

Note: Request two estimates when the cost of the frames and/or lenses appear excessive.

Prescription Safety Glasses

Prescription safety glasses may be provided to protect the worker's uninjured eye if required for work and the employer does not provide safety glasses.

Ensure the worker is aware that safety lens material (polycarbonate) is designed not to fracture but may scratch easily. More expensive high refraction lenses may not follow the standards set by Canadian Standards Association.

For the purchase of non-prescription safety glasses required as a part of a re-employment plan, follow the 7-9 Tools and equipment procedure.

Prescription Sunglasses

Prescription sunglasses are approved if there is medical documentation confirming the compensable injury causes light sensitivity or sunglasses are needed for another reason (e.g., psychological barrier due to the loss of an eye).

When the need for sunglasses is due to a psychological barrier, they are provided on a one-time basis.

Administrative tasks

Follow the Internal consultant referral procedure.

Add the Eyeglasses lineUpdating the Benefits Details screen will allow the Medical Aid team to issue payment without generating an exception approval task.” and update the Benefit Details screen with the decision and coverage details.

Receipts are required for eyewear. Workers can submit the receipt using the myWCB mobile app or by email, mail or fax of scanned or photographed original receipts.

Send the appropriate decision letter based on the claim circumstances to accept or not accept the physical injury and/or eyewear.

The Medical Aid team issues payment for the expenses related to the eye injury and/or eyewear.

Send receipts received directly to the claim file for processing. Update the Benefit Details screen, if needed.

If the total replacement cost exceeds the levels of authority, send a file note (Entitlement/Line) to the supervisor with recommendations about whether or not to accept the additional cost. Attach the file note to the Eyeglasses line.

Claim-specific circumstances

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Delayed worker reporting of the accident (Section 26) Section 32(2) of the WC Act indicates that a worker must give notice of the accident to their employer and WCB as soon as possible after the accident. In addition, Section 26 of the WC Act indicates that workers must report their accident to WCB within 24 months of the date of the accident or the date the worker becomes aware of the accident. When a worker delays reporting and it has been: 24 months or less since the date of accident, determine why the worker delayed reporting their accident and whether this impacts the entitlement decision. For example, a trucker who sustains a back strain during a road trip may delay reporting the injury until they return to the shop. Consequently, medical treatment is postponed until they can visit their family doctor. Such a delay in reporting is likely reasonable and is unlikely to impact the entitlement decision. More than 24 months since the date of accident, the claim may still be reviewed for entitlement if: There are reasonable and justifiable groundsReview Policy 01-05 Part II, Application 1, Question 6 for examples of reasonable and justifiable grounds. for the delay, or The claim is a just claim A "just claim" means evidence exists that supports claim acceptance. It's probable that the available evidence supports the claim is compensable, in accordance with the WCA, and all statutory and policy criteria. When evaluating if it is a just claim, the decision is determining probablity of acceptance, rather than making an initial entitlement decision.and should be allowed despite the failure to report within24 months. Determine why the worker did not report their accident within 24-months and gather information about the accident (as outlined in step 2). If contact is unsuccessful, send the worker a letter requesting the information. Explain the claim will remain active for 30 days, and then will be inactivated until the information is received. Once received, evaluate all of the information and decide if the 24-month time limit can be waived (extended). Obtain approval from the supervisor for the decision to extend or not extend the time limit. Communicate the decision to extend or not extend the time limit in writing and include how the worker met one of the requirements or didn’t meet either requirement. If the time limit was waived, proceed with making the entitlement decision.	Administrative tasks Send the appropriate request for information letter (CL050 series). Provide a time frame for the worker to submit their information. Generally, this is 30 days from the date of the letter. Send a file note to the supervisor (Entitlement) outlining the decision and reasons for extending or not extending the 24-month time limit. Send the Section 26 Extended/Approved (CL019H) or Section 26 Not Extended/Denied (CL019G) letter. When the Cl019H letter is sent, the decision maker must send a separate letter explaining the initial entitlement decision.
Out-of-province workers injured while working in Alberta When a worker is injured in Alberta but resides in another province, they may be eligible for coverage under the WC Act. They may also be entitled to claim compensation in the jurisdiction where they reside. This depends on whether: Their employer performs business and/or operations in the province where the worker lives at the time of their accident. Whether the worker was hired to work solely in Alberta or if they were hired to work both within Alberta and outside of Alberta. Their employer has an account with the other Board in the province where the worker resided at the time of the accident. The worker has a right to elect (choose) to claim compensation in that jurisdiction (as determined by the board in the other jurisdiction) Contact the employer to determine if they performed (or planned to perform) any business and/or operations in the province where the worker resided at the time of the accident, whether they have an account with that board and whether the worker was hired solely in Alberta. Employer does not have business or operations in the province where the worker resided at the time of the accident or the worker was hired solely in Alberta. If the employer confirms they did not perform any business and/or operations in the province where the worker resided at the time of accident, the worker does not have the right to elect in another province. Ask the employer to complete the Employer confirmation of interjurisdictional accounts form, confirming they did not perform any business and/or have any operations in the province at the time of the accident. Verbal confirmation may also be accepted if the employer does not complete the form. If the employer confirms they had an account in the other province at the time of the accident, but they hired the worker solely to work in Alberta, an Employer confirmation of Interjurisdictional accounts form is not required. Employer has business or operations in the province where the worker resided at the time of the accident If the employer confirms they performed business and/or operations in the province where the worker resided at the time of accident and have an account with that jurisdiction, contact the worker to discuss their right to elect to claim compensation in Alberta and in other jurisdictions. Ensure the worker understands their options and answer any questions they may have. If the worker elects to claim compensation in Alberta, send the Right to elect letter with an Election to claim under the AB WCB (C1040) form to the worker and request they complete the form and return it within 14 days. Return to the main procedure to continue the claim entitlement investigation but do not make a final initial entitlement decision or release any benefits until the signed Election to claim under the AB WCB (C1040) form is received. When the signed form is received, notify the other board that the worker is claiming compensation in Alberta. If the worker elects to claim compensation with the other board, obtain the worker’s verbal or signed authorization to release claim information to the other board. Communicate the decision and send the letter to the worker and employer.	Administrative tasks Confirm whether the worker is a resident of Alberta at the time of the accident. Consider what address the worker provides on their tax assessment or the address on government issued identification. Some claims for federal government employees who reside in the Yukon, Northwest Territories, or Nunavut are administered by WCB Alberta. Employer confirmation of Interjurisdictional accounts form (C1137) Document the employer’s verbal confirmation on the claim. It must include the information that is required on the Employer confirmation of Interjurisdictional accounts form including that they do not have business and/or operations in the worker’s province of residency. The Right to elect letter (CL058A) requests the worker complete, sign and return to the Election to claim under AB WCB (C1040) form to the WCB-Alberta. Election to claim under the AB WCB form (AB accident - out-of-province resident) (C1040) Note: The right to elect form (C169 or C1040) can be completed electronically through the WCB worker's app. Send the “Was incident reported to other board letter” (GE001B) to notify the other Board the worker chose to elect in Alberta. Send the Out-of-province Permission letter (CL025B) to obtain the worker’s written authorization, if verbal authorization is not provided. Once authorization is received, send the Worker elected to claim with other board letter (GE001C). Do not release claim information to the other Board until authorization is received. If Section 28 is denied send the CL058B Right to Elect- Section 28 denial letter. When the worker was paid benefits from both Boards, discuss with the IJA team (Team M1) Send the Request Medical Information (Physician, PT, Chiro) – Out-of-P (SP006E) letter to request outstanding medical reporting from out-of-province providers.
Alberta residents/employees injured while working outside of Alberta Workers injured in an accident that occurred outside of Alberta may be entitled to claim compensation either in the jurisdiction where the accident occurred or in Alberta. If the conditions outlined in Section 28 of the Workers’ Compensation Act and Policy 06-01 Part II, Application 5 – Coverage Outside of Alberta are met. Talk to the worker and the employer to determine if the worker meets all of the following conditions to claim compensation in Alberta under the WC Act: The worker was a resident of Alberta at the time of the accident or if not, their usual place of employment was in Alberta and their work outside of Alberta was a continuation of that employment with the same employer and, The nature of the employment required the worker to perform work both inside and outside of Alberta. The worker’s employment outside of Alberta lasted less than twelve continuous months. Note: An employer may apply to have all or any of these conditions waived in which case the worker may still be able to claim compensation in Alberta. If the employer indicates they applied to have any of these conditions waived prior to the date of accident, follow up with Employer Services to confirm if any of these conditions were waived. If the worker does not meet these criteria, they are not entitled to claim compensation in Alberta. However, they may be eligible to claim compensation in the province where the accident occurred. Discuss the outcome of the review with the worker. If they are entitled to claim compensation in Alberta, explain they must decide where they would prefer to claim compensation. If they are considering claiming compensation with another jurisdiction, suggest they contact the board in the other jurisdiction to ensure the other jurisdiction will provide coverage. Worker elects (chooses) to claim compensation in Alberta Send the “Right to elect” letter and the “Election to claim under the AB WCA” form to the worker and request they complete it within 14 days. Proceed with the decision-making process to determine if the worker has an acceptable claim for compensation but do not make a final initial entitlement decision or release any benefits until the signed "Election to claim under the AB WCA” form is received. When the signed "Election to claim under the AB WCA” form is received, notify the other provincial board that the worker is claiming compensation in Alberta, to ensure that the worker does not receive compensation from more than one jurisdiction for the same accident. Worker is not eligible to elect or has chosen not to elect to claim compensation in Alberta Obtain the worker’s verbal or signed authorization to release claim information to the other Board. Once the authorization is received, send the appropriate letter based on the claim circumstances and a copy of the claim documents and file notes to the other Board. Proceed with the decision-making process to determine if the worker has an acceptable claim for compensation.	Administrative tasks To assist in determining if the worker is a resident of Alberta, consider what address they provide on their tax assessment and/or government-issued identification. To find out if the employer has a waiver in place at the time of accident, send a file note to the Mailbox.ESProcess1@WCB.AB.CA. Additional information on Section 28 is available in the internal Procedure Resource Library. The Right to elect (CL058A) letter requests the worker complete, sign and return to the Election to claim under the AB WCA (out-of-province accident) (C169) form to the WCB. Election to claim under the AB WCA (out-of-province accident)(C169) Note: The right to elect form (C169 or C1040) can be completed electronically through the WCB worker's app. Send the Out-of-province permission letter (CL025B) to obtain the worker’s written authorization, if verbal authorization is not provided. Once authorization is received, send the appropriate letter and copy of the claim information to the other board: Worker elected to claim with other board (GE001C) Worker is not eligible to claim with Alberta Board (GE001D) When the worker was paid benefits from both Boards, discuss with the Interjurisdictional (IJA) team (Team M1).

Supporting Information

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Reporting the accident

Recording and reporting accidents is a joint responsibility of workers, employers and physicians.

Policy 01-05, Part I: Recording and Reporting Accidents, along with its associated applications, provides direction on recording and reporting of accidents. Policy 01-05, Part II: Recording and Reporting Chart presents an overview of the obligations for each involved party.

Employer's Report of Injury or Occupational Disease (C040)

Employers must report accidents to WCB as soon as possible if the accident results in the worker being disabled or the worker is likely to be disabled beyond the day of the accident. Injuries can be reported to WCB through WCB online services or submitting the completed C040 via fax.

When a decision maker is reviewing a claim without a C040 form, contact the employer identified in the other reportsWorker's Report of Injury or Occupational Disease (C060) or the Physician's Report form. to confirm:

The worker was working for that company on the date of the accident. If not, contact the worker to confirm the name and contact information of their employer.
If so:
- Whether the employer is aware of the accident, if so, gather details of the accident and rate setting information.
- Determine if the employer has any concerns about the accident/injury.

Request that the employer completes the C040 form. Answer any questions the employer might have regarding the completion of the form.

Note: A completed C040 form and/or signature on the form is not required to make an entitlement decision when the employer does not submit the completed form within a reasonable timeframe.

Employer declines to submit an Employer's Report of Injury or Occupational Disease (C040)

Should an employer decline to fill out an Employer's Report of Injury or Occupational Disease, or if they do not have knowledge of the incident, or suggest the claim be rejected, confirm their concerns and gather as much detail as possible.

Advise the employer that their concerns will be investigated. Request they complete the C040 form and identify their concerns on the form. Explain they are required by law to report accidents and that a penalty may be applied to their account if they do not.

If, following the discussion, the employer does not submit the C040 form and/or they do not provide earnings information or, if the decision maker is informed of allegations that the employer is not reporting or is underreporting work-related accidents consider making a referral to:

The Industry Support team, to educate the employer on their reporting duties and to promote cooperation in submitting the required information.
The Premium Audit team, to conduct an audit of the employer's records to confirm earnings information or when there is a concern that the employer is not reporting or is underreporting work-related accidents.
The Investigation unit, to aid in obtaining the missing information.

Proceed with the investigation of their concerns and the decision-making process while awaiting the completed C040 form. If an entitlement decision can be made before receiving the C040 form, communicate the decision both verbally and in writing to the employer. Additionally, in the decision letter, provide the dates of all requests, both verbal and written, for the employer to complete the C040 form.

If the employer fails to provide earnings or employment information, establish a provisionalThe provisional rate is a temporary rate that is set to ensure benefits are paid in a timely manner. Once the worker's earnings are verified using their T1 tax return, the rate is adjusted, if necessary. compensation rate using the reported information from the worker. Refer to the 2-1 Rate setting procedure.

Employer requests help to complete the Employer's Report of Accident or Occupational Disease (C040) form

In the rare event that an employer requires help to complete the C040 form, a WCB staff member may provide assistance either over the phone or in person. It is crucial to confirm that the employer agrees with all the information entered by the WCB staff member before they sign the form.

If assistance was provided by phone, a copy of the completed C040 form may be emailed or faxed to the employer for their signature, which they must then return to WCB. The accompanying fax cover sheet, or letter should verify the date of the telephone conversation with the employer and ask the employer to inform WCB within one week should there be any discrepancies on the form.

Worker's Report of Accident or Occupational Disease (C-060)

Workers must report accidents to their employer as soon as possible (under Section 32 of the WC Act), and to WCB if the accident results in the worker being disabled, or they are likely to be disabled beyond the day of the accident. Injuries can be reported to WCB through WCB online services or by submitting the completed C060 form via fax or email.

The C060 form requires the worker's signature. By signing the Declaration and Consent section, the worker confirms the statements made on the form are true and grants WCB permission to gather information relevant to determining entitlement on the claim.

When reviewing a claim without a completed C060 form, it is crucial to obtain a signed copy of the C060 form. Contact the worker listed on other reporting to confirm:

The specifics of the accident (when, where and how it occurred) and their earnings information,
The employer's name and address, and whether the employer was informed of the accident. If not, inform the worker that it is a legal requirementSection 32 of the Workers' Compensation Act. that they report the accident to their employer.
Why they didn't report their accident to WCB and/or their employer.
The names, job titles and contact number of any witnesses to the accident.
The names and dates of all medical appointments, including treatment and tests.

If attempts to contact the worker fail, mail a letter to the worker requesting that they complete the C060 form. Include the details about the accident from as noted on the claim.

Proceed with the decision-making process while awaiting the completed C060 form. If an entitlement decision can be made before receiving the C060 form, communicate the decision both verbally and in writing to the worker. Additionally, in the decision letter, detail the dates of all requests, both verbal and written, for the employer to complete the C060 form.

Worker declines to submit a Worker's Report of Injury or Occupational Disease (C060)

Should a worker decline to fill out a C060 form, gather as much detail as possible about their concerns and offer suggestions to resolve their concerns (e.g., offer assistance to complete the form, determine if they are worried about their job security if they report the accident, etc.). Explain that, because WCB has been informed of the accident/injury from other parties/reporting, they are now obligated to make an entitlement decision, if possible, even if they decide not to submit the C060 form or cooperate further.

Proceed with the decision-making process while awaiting the completed C060 form. If an entitlement decision can be made before receiving the C060 form, communicate the decision both verbally and in writing to the worker. Additionally, in the decision letter, detail the dates of all requests, both verbal and written, for the employer to complete the C060 form.

Delay in the worker submitting a Worker's Report of Injury or Occupational Disease (C060)

If the reporting delay exceeds 24 consecutive months, refer to the Delayed worker reporting section. For shorter delays, follow this information.

Reach out to the worker listed on the Employer's Report of Accident (C040) or the Physician's Report to verify:

The cause of the delay in reporting the accident details
The names, job titles, and contact numbers of any witnesses to the accident
The reason for the delay in obtaining medical treatment,
The names and dates of all medical consultations, including treatment and tests.

If attempts to contact the worker fail, mail a letter to the worker with the accident details as noted in the file. Ask for an explanation for the delay in reporting the accident or seeking medical attention. Assess the claim for entitlement while waiting for the worker's response. Sometimes, the information in the claim might be sufficient to explain the reason for the delay.

If the information provided by the worker is reasonable, continue with determining the entitlement of the claim.

For instance, a trucker who sustains a back strain during a road trip may delay reporting the injury until they return to the shop. Consequently, medical treatment is postponed until they can visit their family doctor. Such a delay in reporting could be considered reasonable.

Worker requests help completing the Worker's Report of Injury or Occupational Disease (C060)

Should a worker's injuries prevent them from filling out the C060 form, they may have another person complete the form on their behalf. Once they are able to sign the C060 form, provide them with a copy of the C060 so they may sign and return it.

In the rare event that a worker requires help in filling out the C060 from a WCB staff member may provide assistance either over the phone or in person. It is crucial to confirm that the worker agrees with all the information entered by the WCB staff member before they sign the C060 form.

If assistance was provided by phone, a copy of the completed C060 form may be emailed or faxed to the worker for their signature which they must then return to the WCB. The accompanying fax cover sheet, or letter should verify the date of the telephone conversation with the worker and ask the worker to inform WCB within one week should there be any discrepancies on the form.

Administrative tasks

Document the discussion with the employer in a file note (Employer/claimant).

Send the Accident - Request for Missing Reports (IN004A) letter, detailing the specifics of the accident and requesting the completion of the Employer's Report of Accident or Occupational Disease (C040).

Send a letter to the employer and/or worker notifying them of the decision. Include the dates when requests were made or letters were sent asking them to submit a completed Employer's Report of Accident (C040) form of the Worker's Report of accident (C060).

Send the Request for Missing Info (CL004A) letter, detailing the specifics of the accident and requesting the completion of the Employer's Report of Accident or Occupational Disease (C040).

Document the discussion with the worker or employer in a file note (Contact/claimant/employer). Indicate if assistance was provided with completing the C060 or C040.

Third party claim actions

Administrative tasks

Send a task (Legal) to the Legal -Third Party, Team Desk. Use the role code of Consultant - Legal.

Do not complete or clear the "Screen for Third Party Recovery" task. It will be completed or cleared by Legal Services.

The Denial Letter (CL101C) provides a summary statement that clarifies the entitlement decision for motor vehicle or third-party accident claims without injury. Legal Services requires confirmation that the worker is covered under the Act, and it is crucial that this information is included in the denial letter.

Compatibility Warning

WCB Procedures

Initial entitlement decision

Procedure summary

Detailed business procedure

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Injury-specific initial entitlement decision

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Payment of eyewear based on receipts

Administrative tasks

Eyeglass coverage when the worker sustains an eye injury

Costs covered

Administrative tasks

Claim-specific circumstances

Administrative tasks

Administrative tasks

Administrative tasks

Supporting Information

Employer's Report of Injury or Occupational Disease (C040)

Employer declines to submit an Employer's Report of Injury or Occupational Disease (C040)

Employer requests help to complete the Employer's Report of Accident or Occupational Disease (C040) form

Worker's Report of Accident or Occupational Disease (C-060)

Worker declines to submit a Worker's Report of Injury or Occupational Disease (C060)

Delay in the worker submitting a Worker's Report of Injury or Occupational Disease (C060)

Worker requests help completing the Worker's Report of Injury or Occupational Disease (C060)

Administrative tasks

Administrative tasks

Supporting references

Policies

Procedures

Related links

Workers’ Compensation Act

General Regulation

Related Legislation

Procedure history