When a claim is filed with the WCB, the medical information received from health care providers is reviewed alongside information provided by the injured worker and employer to determine the worker's entitlement to benefits.
In the decision-making process, the WCB takes into consideration whether:
- There is a reasonable relationship between the condition/injury and the workplace.
- The incident is of sufficient severity to result in the reported symptoms.
- Non-occupational factors have contributed to the condition.
- There is a documented need for time off work as a result of the condition/injury.
- The medical information is evidence-based and consistent with medical literature.
A worker may choose to receive initial treatment from a hospital emergency department, a walk-in clinic, a family doctor, or another direct access provider. If subsequent treatment and care is required, this should be provided by a health care provider who is familiar with the worker’s health whenever possible
If clarification or additional medical information is required to make a decision on a claim, the WCB may contact the health care providers treating the worker. If the claim is accepted, the worker may be eligible for benefits and services. If time off work is required, the return to work process will begin.
An injured worker's entitlement to health care benefits may include, but is not limited to:
- Medical, surgical, and dental aid.
- Hospital and nursing services.
- Chiropractic services provided by a registered chiropractor.
- Physiotherapy services provided by a licensed physiotherapist.
- X-ray and other diagnostics.
- Drugs, dressings, appliances, and apparatuses.
More information about WCB claims can be found in the WCB's claims policies.
Return to Work
If an injury or illness prevents a worker from performing regular job duties, the WCB will collaborate with the worker, the employer, and you, the health care provider, to develop a timely and safe return to work plan.
Health care providers play a vital role in the return to work process by providing functional abilities and recovery timelines. These are used in developing return to work plans. A return to work plan can include:
- Modified or alternate work which may or may not be part of the pre-injury duties.
- Gradual building of hours or duties through an ease back program.
- Work conditioning to build strength and stamina.
More information can also be found in the return to work FAQs for workers and employers, and the WCB's return to work policies.
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