One of the most common misconceptions about accidents that occur in the workplace, is that the presence of a pre-existing condition automatically precludes it from being an acceptable claim. However, under WorkSafeBC’s law and policy, this is not the case.
If there is a specific incident or series of incidents that occurred, and there is medical to support this, the board will typically accept the claim. Their rationale is that an aggravation of that pre-existing condition would not have occurred had the worker not been engaged in whatever activity they were doing at the time of the incident.
To offset the potential increase in claim costs that a pre-existing condition may cause, WorkSafeBC has developed policy that can relieve employers of a portion of the costs on eligible claims.
To determine eligibility for Relief of Cost on a Claim, there is a Four-Tiered Evaluation Process.
- There must be ten or more weeks of temporary total and/or temporary partial wage loss benefits paid to the worker.
- If the above criterion is met, the board will then ask a medical advisor three questions:
- Was there a pre-existing disease, condition, or disability and, if so, to what extent?
- Was the worker’s compensable disability enhanced because of a pre-existing disease, condition, or disability, if so, to what extent? If the answer is no, Relief of Cost will not be granted, as the pre-existing condition had to delay or prolong recovery.
- How severe was the incident that initiated the claim in question?
- The answers to the questions are then assessed based on the severity and categorized as minor, moderate, or major:
- Minor severity is expected to cause either no disability or a minor disability.
- Moderate severity is expected to cause a disability.
- Major severity is expected to cause serious disability or probably permanent disability.
- Based on the categories that each of the questions are assigned, the boards medical advisor will then use a matrix to assign a percentage of costs that will be relieved.
The Disability Management Institutes (DMI) WCB claims management team ensures that all individual claims are examined so that pre-existing conditions can be a factor but not the overarching decision maker of that claim. DMI also supports the employer in the above process by determining Relief of Cost eligibility.
In addition, errors and omissions from your workers compensation statements can cost thousands of dollars in premium increases, with the impact lasting for years. DMI helps organizations that are dealing with high workers compensation rates, do not have time to review their claims in detail themselves to ensure that their data is correct.
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DMI is committed to providing timely support & information to our clients. We have been working with employees and employers nationwide to provide comprehensive end-to-end solutions for their absence & disability management needs.