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WorkSafe BC Accident and Injury Reimbursement Agreement

Tuesday, September 18, 2018
Insurance Basics, How to make a claim

WorkSafe BC Accident and Injury Reimbursement Agreement

Why the Reimbursement Agreement is Necessary:

All Pacific Blue Cross Plans contain an exclusion that prohibits us from paying claims that are related to any workplace-related illnesses or injuries.

WorkSafe benefits are available to most employees in British Columbia who have suffered injury or illness while at work. WorkSafe is a provincial agency overseeing a no-fault insurance system for the workplace, with a legislated mandate to:

  • Rehabilitate workers who are injured, and provide timely return to work; and
  • Provide fair compensation to replace workers’ loss of wages while recovering from injuries.

Because benefits relating to these injuries or illnesses are excluded on your PBC plan, you must make a claim to WorkSafe to have your workplace-related expenses paid with respect to extended health benefits and wage loss.

We recognize that these claims can take a long time to settle. We do not want your recovery to be delayed because you are waiting for payment from WorkSafe BC.

Our solution has been to build a provision into all PBC plans that allows us to advance funds for claims that would have been eligible expenses if they were not part of a workplace accident.

Part of this contract provision to advance funds is the Reimbursement Agreement. For us to be permitted to advance funds for eligible expenses, we must have a completed and signed Reimbursement Agreement in place.

These advanced funds must be reimbursed to us for the full amount claimed, regardless of the amount and terms of any settlement received.

What You Can Expect:

  • You may notice that your eClaims access has been suspended. This is temporary as we await the signed Reimbursement Agreement, and it will be reinstated at that time.
    • Until this is reinstated, you must submit your non-workplace injury/illness related claims by paper.
  • When you make claims with our Extended Health Claims form, or when you make claims online, you must identify the claims that are related to your workplace injury or illness. There is a check box for you to tick.
    • Claims that are not related to your workplace incident can be submitted and will be processed as usual
  • While WorkSafe is adjudicating your claim – either initially or on appeal, we will continue to advance funds for your eligible claims as you submit them.
  • Worksafe will only approve payment for expenses that they deem necessary as part of your treatment plan with them.
    • It is important to remember that all claims for these workplace incidents are excluded from your PBC plan. If you incur costs that WorkSafe does not deem part of your necessary treatment plan, and PBC has advanced funds to pay for these expenses, you will be required to pay us back.
    • If you feel your current treatment plan is not working, you can return to WorkSafe so that they can make adjustments for you. WorkSafe does not cover any expenses for services that you elect to use that are outside of your treatment plan.
  • From time to time, you may receive communications from our Finance Recoveries team asking about your progress with WorkSafe BC. Our intention is to assist you and/or your lawyer if applicable, in fulfilling your obligation to reimburse the plan.
  • At any time, you or your legal representative, if applicable, may contact our Finance Recoveries department regarding the amounts that we have advanced for your auto injury related expenses.
  • When WorkSafe approves your claim or your appeal, the workplace injury related amounts that we have advanced will become due, in accordance with the terms in the Reimbursement Agreement.
  • If WorkSafe denies your claim, and you do not appeal, we will not seek reimbursement for the funds that we have advanced.

Future Claims:

Claims arising from workplace illnesses or injuries are excluded from your plan. In the future, if you are still experiencing symptoms of your related injuries, you must apply to reopen your WorkSafe claim.

While you are awaiting a new decision, we will advance payment for your claims, however we would need you to sign a new Reimbursement Agreement for repayment for any additional eligible expenses that we may advance.

Any Questions:

Our Customer Service Representatives are available for your calls from Monday to Friday from 8:00 am to 4:30 pm. Alternately, you can drop by our customer service centre at 4250 Canada Way, Burnaby between the hours of 8:30am and 4:00pm, Monday through Friday. We are here to help.

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