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Appealing a WCB Decision?
Appealing a WCB Decision?
Appeals Department Ken Anderson - Appeals Manager
Right to Appeal • Workers and employers have the right to
appeal any claim decision
• The intent is to provide an easily accessible and independent process of review – a second opinion
• There is no limitation period – an appeal can be launched at any time
Appeals Department • The Appeals Department is independent
• The appeal process is informal – it is not a court
proceeding and there is no trial or hearing
• Do not handle appeals on employer accounts (assessments) or on items exclusive to Board Tribunal
• Currently 9 Appeals Officers, two administrative
personnel and a Manager in the Appeals Department
Appeal Process Steps 1. Receive Appeal
2. Register Appeal
3. Assign Appeal
4. Review File
5. Write Decision
6. Review Decision
7. Send Decision
Appeal Process
• Appeal must be in writing • Submitted by e-mail, internet, mail, in person • Appeal submissions are date stamped
1. Receive Appeal
• Determine the appeal issue • Send letters to appellant confirming
registration of appeal • Send appeal for scanning to file
2. Register Appeal
Appeal Process
• Assign appeal to Appeals Officer • Based on First Come First Served basis
unless appeal is a priority (e.g. fatality) • Record date assigned and the Appeals Officer.
3. Assign Appeal
• Reconfirm appeal issue(s) • Review key documents • Obtain further information if needed • Conduct meetings if needed
4. Review File
Appeal Process
• Develop decision outline • Identify key facts and evidence • Develop issue statement. • Outline applicable legislation and policy • Make findings of fact and evidence • Write decision and confirm reasons • Provide closing directions and summary
5. Write Decision
Appeal Process
• Spell check and grammar edit • Check for possible errors by 2nd person read • Audit against Decision Audit Tool
6. Review Decision
• Send decision and letters to customers • Scan letters and decision to file • Send decision to Ops Team Leader
7. Send Decision
The Appeal Decision • Written decision using plain language
contains the following elements: 1. Issue - Description of the issue under appeal 2. Authority - Explanation of legislative and
policy 3. Relevant Information – Information used to
reach a conclusion and make the decision 4. Decision – Explanation of the grounds for the
decision, including why various arguments or positions were accepted or rejected
Natural Justice • Appeals Officers adhere to the following key
principles : • Act fairly and in good faith • Act without bias • Give party the opportunity to present their case • Give party the opportunity to refute statements
that may be prejudicial to their case • Ensure there is no abuse of power • Ensure the decision is made by the one who
considers the evidence
Decision Wait Times
• Target is to make a decision within 30 to 45 days of receipt of appeal
• Current 2016 average wait time is 22 days • Appeal reviews based on date of receipt -
first come, first served basis • Time to complete an appeal depends on
many factors - wait times have varied • 10 year historic average is 63.7 days
Appeal Statistics
• WCB receives about 30,000 injury claims each year that contain decisions
• On average about 1020 of these decisions are appealed each year
• In 2015 we received 1139 appeals requests (1070 in 2014)
• Comparable numbers in Man, NS, NFLD
Board Appeal Tribunal
Employers/Workers Shelley Rayner – Hubick, WCB
Rules of Natural Justice
• Act fairly and in good faith • Act without bias • Give each party an opportunity to state
their case • Give each party an opportunity to know
the case they must respond to • Ensure that the decision is made by
those who hear the evidence
Appeal
• What decision is being appealed? • Why do you disagree? • What resolution do you want?
Medical Review Panel
• Fact Sheet – Medical Review Panel (under worker’s appeal on website)
Process changes
• Issue focused summaries to reduce preparation time
• Appeal Commissioner – temporary term • New issues handled separately • Centralized electronic booking • Hearing days increased • Daily hearing slots increased • Reduced notice for Tribunal • Limitations on rescheduling hearings • Flexible time limits for hearings
Stats
2015 2014 2013 2012 2011
Appeals received
273 266 275 270 190
Appeals accepted
152 95 148 116 121
Appeals denied
168 102 81 103 102
TOTAL DECIDED
320 197 229 219 223
Appeals withdraw
22 25 10 13 15
Appeals Pending
173 240 217 158 111
Dana Stutsky Fair Practices Officer
WCB
April 25, 2016
Fair Practices Office
Overview
What is a Fair Practices Officer? What the office can do – Role, Mandate
and Authority What the office cannot do Standards of Practice Fairness & Communication
A Corporate Ombudsman
Report directly to the Board of Directors, through the Chair
Independent of WCB Operations Access to all files, documents and staff Confidential Impartial / Neutral Powers of recommendation only
Confidential-Impartial-Neutral
Distinct from the rest of the WCB Maintain a position of confidentiality,
impartiality and neutrality Arms length relationship Separate space within the WCB building and
complaint tracking system Separate toll free phone, fax, email Annual Report (see website:
www.wcbsask.com)
Customer Access
Confidential access for workers, employers and others through: • Telephone (majority) • Fax • Email • Written correspondence • WCB website • Available to meet as required
Customer Access
Referral Network established with: • Office of the Workers’ Advocate • Provincial Ombudsman • MLA’s / Constituency Assistants • Brochures • WCB website • Information Tables
Role and Mandate
Receive, investigate and resolve complaints about unfair practices in all areas of service delivery
Identify complaint trends, policy matters and systemic issues
Make recommendations for improvement
Authority of FPO
Delays in adjudication, communication, referrals or payments Conduct of staff Verbal and written communication Implementation of appeal findings Revenue and employer accounts Benefit payments Misapplication of policy
Outside of Mandate
Conduct or a decision of the Board Appeal Tribunal Changes to the Act or its Regulations An issue under appeal Issues being handled by the Office of the
Workers’ Advocate, unless requested by Advocate Internal Human Resources issues An alleged illegal or fraudulent act
Standards of Practice
A. Independence Independent of WCB operations Report directly to the Board of Directors
through the Chair Sole discretion over what actions to take Can initiate own investigation or systemic
investigations
Standards of Practice
B. Neutrality and Impartiality Moral duty of impartiality, cannot act as an
individual’s advocate or representative Approach issues with an open mind and treat all
parties with respect Consider the interests of all individuals Recommendations for remedial actions, based
upon findings of an investigation Develop a range of options to resolve problems
Standards of Practice
C. Confidentiality Communication is privileged and confidential No identifying information provided unless
recommendation being made No information entered on any WCB claim or
employer file FPO database accessible only to FPO staff
Standards of Practice
D. Informality and Other Standards Process is informal – listen, receive
information, discuss options, seek solutions Recommendations are not binding FPO does not replace existing appeal
procedures Identify trends, issues of systemic concern
and make recommendations to resolve
It’s Not Fair
Communication
Can we help YOU?
Phone: Toll free: 1-888-787-8651 Regina: 306-787-8651 Fax: Toll free: 1-866-787-6751 Email: [email protected] Snail mail: 200 - 1881 Scarth Street Regina SK S4P 4L1
Office of the Workers’ Advocate (OWA)
Denise Klotz Director Office of the Workers’ Advocate
Mandate
• Section 161 of the Workers’ Compensation Act
• OWA may assist any worker or dependent in respect to a claim being advanced for compensation
• OWA may decline to provide services • OWA may examine all WCB records of the
WCB individuals utilizing our office
Principles of Advocacy
• Always act in best interests of client
• Prepare the best case possible
• Be knowledgeable
• Respect client’s right to privacy & confidentiality
• Ensure client’s support and permission for
action taken
• Do not create false expectations
Advice and Assistance • Provide independent information and
advice to injured workers on their WCB claims
• Facilitate progression and timely resolution of a claim
Representation • Represent and/or assist workers or dependents at all appeal levels;
• Initial Review • Appeals Department • Board Appeal Tribunal • Medical Review Panel
OWA Success • Appeals • Monetary awards • People
Contact Information Phone 1-877-787-2456 in Regina 787-2456 Fax: (306) 787-0249 E-mail: [email protected] Mailing address: Office of the Workers’ Advocate 1870 Albert Street REGINA, SK S4P 4W1
Questions?
