For employers

Stage 2: Claim classification

After reporting, your worker's injury will be classified and a decision will be made regarding the status of the claim.

Types of claims

WCB-Alberta registers your worker's claim as one of the following:

1. lost-time claim
2. no-time-lost claim
3. interjurisdictional claim

Lost-time claim

Your worker's claim will be assigned to an adjudicator who makes the initial benefit decisions. If they need additional rehabilitation support to return to work, the claim may be transferred from an adjudicator to a case manager.

No-time-lost claim

If your worker did not miss work past the day of injury, a claim process team will monitor medical treatment.

Interjurisdictional claim

If a worker is injured in a province that they work in, but are not a resident of, they can choose to have their claim started in the province of employment or their home province.

For example, a worker that lives in British Columbia, but gets injured on the job while working in Alberta can have his/her claim initiated in B.C. if they prefer. If so, the workers' compensation board in B.C. can request reimbursement costs from WCB-Alberta.

---

Go to Stage 3: Claim decision

Stage 3: Claim decision

Depending on the information submitted to WCB, the status of your worker's claim may be:

• accepted
• not accepted
• pending (a decision has not been made yet)
• processed (a claim has been registered and medical costs are being paid, but the claim has not been reviewed for a decision)
• medical investigation (further medical assessments are required before a decision can be made)

Claim accepted:

Once the claim is accepted, an adjudicator will contact your worker to discuss the benefits they are entitled to, along with other services that can help them return to work.

Each claim is unique. Some claims require more support and ongoing communication than others. If that's the case, the adjudicator may transfer your worker's claim to a case manager, who will work closely with the both of you to determine the return-to-work options that are best suited to them.

Claim not accepted (denied):

The adjudicator may reject your worker's claim if any of the following is true:

• The injury did not arise out of employment.
• The diagnosis is for a condition not caused by work.
• There is not enough information in his/her file to support that an injury or illness occurred.
• The claim was not filed within 24 months of his/her injury.
• If as an employer, you are not required to have workers' compensation coverage and did not purchase this for your worker.

If you would like to request a copy of your worker's claim file, find out how to do so here.

As an employer, you can question any decision made on a claim for one of your workers. As decisions are made, you will receive a copy of decision letters and it is important you read these carefully to understand the decisions and the rationale.

We are committed to making claim decisions that are fair. It is important to us that you understand the decisions that affect your workers, your workplace and your account.

See Reviews and appeals to learn more about this process and the help that is available to you.

---

Go to Stage 4: Treatment and recovery

Stage 4: Treatment and recovery

A healthy recovery is one of the most important parts of successfully returning to work. To help your injured worker get there, we have a wide range of rehabilitation services available to them.

Just like your employees, each claim is unique. We review each one individually to determine the benefits and services that are best suited to that individual. We place a strong focus on rehabilitation that will get your worker back to his/her pre-accident job.

---

Go to Stage 5: Return to work

Stage 5: Return to work

Our priority is to help injured workers get back on the job safely—but we don't do this alone. The entire claims process is made better when we can collaborate with you and your worker, and health care providers to make it happen.

Creating a plan

Once your worker's claim is approved, we develop a case plan with them and you, their employer. A case plan lists clear return-to-work goals and how we will work together to achieve those goals. The case plan has distinct phases through which a claim typically progresses:

1. Entitlement determined: WCB confirms claim acceptance.
2. Case plan defined: Together we determine appropriate treatment and return-to-work options.
3. Fitness to work determined: We define the standards required for your worker's safe return to work.
4. Return-to-work status confirmed: We follow up to make sure your worker has returned to safe and appropriate work.
5. Case plan conclusion: Determination of long-term WCB benefits and services, if appropriate.

Returning to work

You and your injured worker are expected to work together towards a return to the same job or an alternative job after a workplace accident, unless it impacts your ability to run your business. This is called undue hardship. To claim undue hardship, you will be required to complete an employer claim of undue hardship form. We will work with you to determine if undue hardship applies.

Ready to return

Your case manager will work with your injured worker to determine when they are able to return to work, based on progress reports from the worker, his/her doctor and other health care providers. If medical information suggests your worker is ready to return to the pre-accident job, we will confirm the return-to-work date with you.

Likely to return

If medical information suggests your worker will likely return to the pre-accident job, but has temporary restrictions, modified work will be discussed with you as a way to enable a safe and timely return to work for your employee.

Modified work is a change in job duties that you can arrange that allows your worker to return to work while recovering, providing them with an opportunity to remain active and continue contributing to your workplace. Working while recovering keeps injured workers connected to their jobs and colleagues and helps them maintain normalcy in their lives.

If you'd like to learn more about return to work options and how to start planning, see Return to work.