The Importance of Understanding How to Effectively Appeal a WCB Claim - Anthony Butkovic
“That is so #$%@#* stupid!” exclaimed my client.
If you’ve been in Alberta this winter, you’d know we’ve had some awesome freeze / thaw action going on. This is where during the day temperatures are higher melting the snow and then temperatures drop causing this melt to turn into ice. This results in a slipping hazard that is tough to control.
Three weeks ago my client….let’s call him bobby…saw the risk of injury and decided to provide spikes to his employees to make sure they reduced the likelihood of a slip and fall injury.
Bobby tells me the idea came when he saw one of his drivers start slipping on ice and doing what he could only describe as “the Charleston dance” before regaining composure and not actually falling.
(For the record, I actually had to youtube the Charleston Dance to know what he was talking about.)
A week ago, one of Bobby’s drivers did end up slipping and falling.
Even though he:
· Provided the necessary spikes
· Did a toolbox talk stressing the importance of wearing spikes in the parking lot
· Had the employees sign off acknowledging they agree to wear the spikes when in the parking lot
I’ll save you the details, but today WCB called bobby to advise they were accepting the claim. Right away bobby jumped on the phone and called me. The first thing out of his mouth was not “good morning.”
Instead, Bobby rather enthusiastically proclaimed: “That is so #$%@#* stupid!”
Bobby wanted to understand how WCB could accept the claim when he took the initiative and provided the necessary equipment to prevent injuries…educated his staff…and still…because of their own negligence caused the accident.
After calming bobby down, I had to tell him the truth.
I explained that WCB is NO FAULT INSURANCE.
Bobby very eloquently said: “What the hell does that mean?”
“To put it bluntly bobby, WCB pays for stupid” I said.
Then for the first time ever, I got to use a line from my favorite movie Forrest Gump. “A stupid is as stupid does, and WCB will pay for it regardless of it’s the worker’s fault or the employer’s fault for the injury.”
Bobby was dead set to appeal the claim on the basis that the worker was negligent by not wearing their spikes and that is what caused the injury to happen.
While Bobby has a point and it’s completely understandable why he felt this way…unfortunately I knew he would lose.
Here are a few reasons Bobby would lose his appeal:
1. As I mentioned WCB is no fault insurance. Moving past this point we go to #2.
2. The worker was in a parking lot at a time and place that was consistent with their job duties.
3. The ice in the parking lot is a hazard that if not for the worker’s employment would not have caused an injury.
4. The symptoms that the worker claimed were consistent with a slip and fall injury.
Naturally, the next question is: What’s bobby to do?
Bobby needs to focus his efforts on managing the claim to reduce claims costs. He may not like it…in fact I know he doesn’t, but the way the WCB system is structured, Bobby has little choice or risk higher premiums in the future and a disgruntled worker.
Remember: You can do everything right as a company and still be at risk for a WCB claim like our friend Bobby.
I have seen many companies that would decide against managing this claim but focus on the appeal and spend time and money collecting evidence and building an argument.
In the meantime, the worker is at home collecting a cheque from WCB putting costs against your account increasing YOUR premiums for years to come.
Like the great Kenny Rogers sang in the The Gambler:
“You gotta know when to hold’em”
“Know when to fold’em”
“Know when to walk away”
Bobby needs to walk away from the appeal and manage this claim.
While it may feel like a loss, when you understand the rules of the game you realize that doing it this way is still a win under the circumstances.
Bobby will end up winning because he:
1. Understood that an appeal wouldn’t get the result he wanted, but managing the claim would be the next closest thing.
2. By taking care of the worker as opposed to picking a fight in a losing battle, Bobby improved the relationship with his employee.
3. The worker felt like a valued member of the company and in discussion over modified duties gave feedback on how the company could do things a little differently during the delivery process that Bobby calculated would save them thousands in the future.
An unexpected outcome for Bobby.
What’s the moral of the story?
When you don’t understand the rules of the game, you can often end up making decisions that will cost you more than you ever thought.
Not every WCB claim results in a warm and fuzzy outcome like this one.
Some do get contentious and need to be fought. Understanding the WCB system allows you to pick your battles wisely, so that you not only save money, but you retain good people in your company even when things seem “#$%@#* stupid!”
To learn more about the WCB system and when you should appeal or manage a claim, check out our online course:
HOW TO EFFECTIVELY APPEAL A WORKERS COMPENSATION (WCB) CLAIM…and win!
Have a scenario you’d like to see me do an article on?
Perhaps comments about the article?
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If you are interested to learn more about how to appeal a WCB claim, check out our training:
How to Effectively Appeal a Workers Compensation Claim (WCB)
For additional inquiries on WCB claims management, please email Anthonyb@wcbconsulting.ca or connect with Anthony on LinkedIn.
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I hope you have a safe day!