CASE PLAN INFO

HOW TO READ AND UNDERSTAND CASE PLAN LETTERS

Case plan letters are what you receive when there's a decision made on your claim. They will list the applicable policies used. All decisions made on a claim are required to follow WCB policy. This is not always the case! Policy is similar to the WCB Act in that it is law. The laws within WCB's policies and legislation are no different than all the others. They Must Be Followed!

You will notice many of the paragraphs on these letters will say the same things on each one you receive. The letters are merely templates that the case manager fills in with their decision and policy quotes. Read through these letters with a fine tooth comb. Open WCB policies and look up the ones stated on your letter. If you do not understand what the policy is saying, try googling the words. You can also open up dictionary.com. This site has become my best friend and you don’t need to be intelligent to understand these.      

The letter states that if you do not understand the policies used to base their decision, you can call them or their supervisor and have them explain it to you. Don't even bother with that, you will just get told what you want to hear or some patronizing response.  

The letter will quote policy and immediately after state....."My decision was based on the above policy". This is very important and will be the policy applied in a future appeal if needed. You can find info about appeals under the 'More' tab at top of this page.

UNDERSTANDING CLAIM PROCESSES

After your claim is accepted you will receive a letter in the mail. The assigned adjudicator will likely contact you by phone.  Every claim that lasts more than 6 weeks after the DOA (date of accident), is transferred from an adjudicator to a case manager. Once this happens, each claim is assigned a team of managers, doctors and medical consultants. The management team is comprised of a case manager, a supervisor, a manager and a director. You are entitled to know each one of their full names. (Very important)! You can obtain this info by calling the contact centre at 780-498-3999, press 1, then 3. In Calgary at 403-517-6000. You can also ask your case manager but they may not tell you. The entire claim process will be further explained throughout the different stages on this site.

It is very important to know that if you quit your job. If it's discovered your accident was the result of serious or wilful misconduct, you are may not be entitled to compensation. This is stated in policy. https://www.wcb.ab.ca/assets/pdfs/public/policy/manual/printable_pdfs/0201_1.pdf

POLICY & LEGISLATION

WCB's policy is about 900 pages. You will not be required to learn it all. Most claims fall under the Claimant & Health Care Services section. Policy is written to be intimidating and patronizing! Once you learn what each section means and how it relates to your claim, you will see how easy it is to understand and follow. We are all still learning these!  

https://www.wcb.ab.ca/about-wcb/policy-manual/claimant-and-health-care-services-policies/  

WCB is governed by the Worker’s Compensation Act, referred to as WCA 2000. These are the laws surrounding the WCB that need to be followed. For example, if a person files a false claim, the ACT has a section that gives WCB the power to charge them.  The policy is considered to be attached and the sections within it are treated similar.  

http://www.qp.alberta.ca/1266.cfm?page=w15.cfm&leg_type=Acts&isbncln=9780779783540

Sec. 151.1 of the WCA 2000 states it is illegal to provide false or misleading info to the Board (WCB) Sec 126 of the Criminal Code of Canada states it is illegal to "Disobey an Act"....contravening sections of any legislation is disobeying an act!

Communication with WCB

I cannot stress enough how important it is to document all communications you have with any department of WCB! From my personal experiences and other claimant’s stories, I have learned to keep communications with them in a form that is documented. Using emails is the best way but as I have stated previously, some refuse to respond.  

All WCB employees are provided with an email account. This email address will always be in a form of their (first name) dot (last name) @ wcb.ab.ca. In my personal experiences with WCB, I discovered that including the managers in my emails, helped alleviate problems I was having with my case manager.  

When you want to speak to your case manager in Edmonton, phone the contact centre at 780-498-3999 then press 1, then 3. In Calgary call 403-517-6000. Toll free number is 1-866-922-9221. Fax: 780-427-5863 (Edmonton) Fax: 403-517-6201 (Calgary) Fax: 1-800-661-1993 (Alberta).

The reason for this is all calls and emails are documented on your file within what is called a ‘File Note Summary’. This is the first set of documents when you receive a copy of your claim file. Case managers are required to respond to you within one business day. They don’t always follow that. I myself stopped speaking to my case manager on the phone due to the lies about the conversation noted in a letter that is sent out immediately after. If you are being treated poorly by your case manager, send an email of the details to their bosses and include the date and time.  

When you document calls or emails in a journal (which you should do), pay attention to the all person’s names on the other end and write that down, as well as the time of the call. When you receive a confirmation email from the contact centre, it contains the initials of the person that opened it and scanned it to file right beside where it came from and will be in brackets.