Summary Matrix - Compensation Services and Adjudication

Transcription

1 Compensation Services, Adjudication and Appeals Compensation Services and Adjudication Page 1 ALBERTA SASK MANITOBA ONTARIO Compensation Services Readjustment Short-term rate After 24 months TTD, adjusted for cost of living Wage loss benefit adjusted annually for cost of living (CPI) Reviewed after 12 weeks to determine more accurate net average earnings basis. May be reviewed at any time if board believes there has been a change in circumstances. General annual adjustment for cost of living 24 month variable review and then again at 72 months or five years. Worker under obligation to inform board of change in condition or circumstance Long-term rate Reviewed during initial 36 month period of payment to take into account changes in level of disability and earnings impairment; annual adjustment for cost of living Earnings replacement adjusted annually for cost of living. Permanent impairment may be adjusted at request of claimant May be reviewed at any time if board believes there has been a change in circumstances. General annual adjustment for cost of living. Permanent impairment only adjusted at request of claimant At five years final review and benefit rate set; no further readjustment Topping-up No prohibition No prohibition Topping up prohibited; will reduce compensation benefit by amount provided to worker by other sources No prohibition Factors in calculating rate Just earnings (based on taxable income and T-4) Just earnings (based on taxable income and T-4) Just earnings (based on taxable income and T-4), except for permanent impairment which is reduced by 2% for each year claimant over 45 to a maximum reduction of 40% Just earnings (based on taxable income and T-4), except for permanent impairment which is reduced/increased by set amount for each year claimant over/under 45 to a set maximum Deeming Deeming used to calculate wage loss rate; applied when worker reached medical and vocational plateau; applied to about 250 workers since January 1995 Deeming used to calculate wage loss rate; applied when worker completed all vocational rehabilitation and retraining; about 160 cases a year Deeming used to calculate wage loss rate; applied when worker completed all vocational rehabilitation and retraining; only used as a last resort Goal is return to work, but deeming used to calculate wage loss rate; applied when worker completed labour market reentry plan Electronic claim file Equity/adequacy studies Part image; part electronic; since 1992 Comprehensive initiative underway to review all policies, including adequacy of benefits Image system since 1993 No imaging system Comprehensive electronic and image system since 1989 No research on adequacy and equity of benefits No research on adequacy and equity of benefits No research on adequacy and equity of benefits

2 Compensation Services, Adjudication and Appeals Compensation Services and Adjudication Page 2 ALBERTA SASK MANITOBA ONTARIO Adjudication Approach Inquiry based Inquiry based Inquiry based Inquiry based New evidence After case has been transferred from adjudicator to case manager, case manager will deal with new evidence, unless question of entitlement Returned to decision maker for reconsideration Returned to decision maker for reconsideration Several opportunities for review and reconsideration by decision maker of original decision based on submission of new evidence Board policy Board policy binding on adjudicators; room for discretion which is reviewable Board policy binding on adjudicators; room for limited discretion which is reviewable Board policy binding on adjudicators; room for limited discretion which is reviewable By statute board officers required to decide each case on its merits and is not bound by legal precedence; when facts equally balanced to give benefit of doubt to claimant Consistency mechanisms Quality assurance program Case conferencing and training Quality assurance program and supervisory reviews of decisions Quality assurance program Access to information Workers Complete access to own file Complete access to own file Complete access to own file Complete access to own file, except harmful healthcare information Employers Complete access to own file Complete access to own file Complete access to own file Complete access to own file Employers to Workers Only if issue under dispute, then all relevant information Only if issue under dispute, then all Only if issue under dispute and relevant information. Worker has opportunity to object to release and decision on relevant information up to board officer, subject to appeal employer is a party to dispute, then all relevant information. Worker has opportunity to object to release and decision on relevant information up to board officer, subject to appeal Employer has access to information in worker's file, subject to worker's approval of release of health care information. If worker objects to release, may proceed to appeal Informal review Internal appeals advisory service No attempts to resolve disputes between client and case manager. More commonly, claimant encouraged to contact supervisor when disagree with decision Supervisory review of complex issues where there is a complaint PARD process, effectively an early resolution approach and philosophy applied at the initial adjudication stages Independent Complaints Process No independent complaint process; provincial ombuds may handle service and administrative complaints No independent complaints process; complaints to manager and dealt with as a disciplinary issue No independent complaints process; internal to board is office of "Fair Practices Advocate"; may recommend changes but no power to overturn decisions No independent complaint process; provincial ombuds may handle service and administrative complaints

3 Compensation Services, Adjudication and Appeals Compensation Services and Adjudication Page 3 Compensation Services Readjustment Short-term rate QUƒBEC NB NS PEI Loss of earnings rate reviewed at first, second and third anniversary. General annual adjustment for cost of living Reviewed after 12 weeks to determine more accurate net average earnings basis. Twelve month review and any time there has been a change in circumstances. Reviewed after 12 weeks to determine more accurate net average earnings basis. Reviewed after 6 weeks to determine more accurate net average earnings basis. Long-term rate Loss of earnings rate reviewed at first, second and third anniversary. General annual adjustment for cost of living. Permanent impairment only adjusted at request of claimant General annual adjustment for cost of living. Permanent impairment not subject to set review but may be adjusted if new information comes to light Extended earnings replacement benefit based on permanent impairment benefit rate is set at 26 weeks and reviewed at 16 months; only reviewed again if change in claimant's condition of greater than 10% Extended earnings loss rate reviewed two years post accident. General annual adjustment for cost of living. Permanent impairment award not subject to set review Topping-up No prohibition Topping up prohibited; will reduce Topping up currently prohibited, but compensation benefit by amount prohibition being phased out and is provided to worker by other sources. allowed if provided for in collective If worker's wage exceeds maximum agreement insurable, employer may top up above this amount Topping up prohibited; will reduce compensation benefit by amount provided to worker by other sources. If worker's wage exceeds maximum insurable, employer may top up above this amount Factors in calculating rate Just earnings (based on taxable income and T-4), except for permanent impairment which is adjusted based on age Just earnings (based on taxable income and T-4) Just earnings (based on taxable income and T-4) Just earnings (based on taxable income and T-4) Deeming On completion of all retraining and vocational rehabilitation a suitable job is determined for the claimant based on age, experience, education and income replacement amount calculated on basis of average salary for this job Deeming used to calculate wage loss rate; applied when worker completed all vocational rehabilitation and determined to have a work restriction; estimated that less than 200 cases a year and declining Deeming used to calculate extended earnings replacement rate; determined by rehabilitation counselor (may be invoked if claimant not cooperating in rehabilitation) In calculating a worker's extended earnings loss, the board will make an assessment of a worker's earning capacity taking into account the worker's training, experience, education and aptitude Electronic claim file Image system since 1985 Image system since 1993 No imaging system Image system since 1990 Equity/adequacy studies Recent external report made Entering into a consultation process recommendations on level of benefits; on a number of issues CSST considering changes Tri-partite committee has been struck to review legislation and Auditor General undertaking a systems review No research on adequacy and equity of benefits

4 Compensation Services, Adjudication and Appeals Compensation Services and Adjudication Page 4 Adjudication Approach QUƒBEC NB NS PEI Inquiry based; CSST is conciliation minded Inquiry based Inquiry based (early identification and streaming) Inquiry based (early identification and streaming) New evidence Returned to decision maker for reconsideration Case will only be sent back to adjudicator if it is a question of entitlement Returned to decision maker of record for reconsideration Addressed by case manager Board policy Not a lot of policy; substantial majority of provisions in the statute itself; any policies must be consistent with statute and all decisions of board officers are reviewable Board policy binding on adjudicators. There is not a lot of room for the use of discretion in the application of policy, but adjudicators are trained to use their judgement Board policy binding on adjudicators; room for discretion which is reviewable Board policy binding on adjudicators; room for discretion which is reviewable Consistency mechanisms Comprehensive information management system designed to promote communication [Quality assurance eliminated because ineffective] Training Quality assurance through adjudication advisors None identified Access to information Workers Employers Employers to Workers Complete access to own file Complete access to own file Complete access to own file Complete access to own file Complete access to own file Complete access to own file Complete access to own file Complete access to own file Employer has access to worker's Employer has access to information in information except medical worker's file, subject to the worker's information which must be released to approval. If worker objects to employer through designated health release, the board official will excise professional. Only relevant information information not considered relevant will be released unless issue under appeal, then all information used in making dec Only if issue under dispute, then only information that relates to issue under appeal Only if issue under dispute, then only information that relates to issue under appeal Informal review No No (except for new decision making review process for deeming) All negative decisions must be reviewed by decision maker of record No Independent Complaints Process No independent complaint process; internal ombuds may handle service and administrative complaints No independent complaints process; complaints to manager and dealt with as a disciplinary issue No independent complaints process; internal process to deal with complaints through quality assurance No independent complaints process; in practice complaints handled by Director of Client Services

5 Compensation Services, Adjudication and Appeals Compensation Services and Adjudication Page 5 NFLD YUKON NWT Compensation Services Readjustment Short-term rate Reviewed after12 weeks to determine more accurate net average earnings basis. Board policy requires claim be reviewed every 30 days for possibility of applying deeming, but in practice worker not deemed until reached maximum medical improvement TTD benefit adjusted annually for cost of living (CPI) Long-term rate General annual adjustment for cost of living. Permanent impairment not subject to set review but may be adjusted if new information comes to light General annual adjustment for cost of living. Permanent impairment not subject to set review but may be adjusted if new information comes to light General annual adjustment for cost of living. Permanent impairment not subject to set review but may be adjusted at request of worker Topping-up Topping up prohibited [enforcement issues with this provision] No prohibition No prohibition Factors in calculating rate Just earnings (based on taxable income and T-4) Just earnings (based on taxable income and T-4) Just earnings (based on taxable income and T-4) Deeming Deeming used to calculate long-term extended earnings loss benefits; applied when worker has reached maximum medical improvement and taken vocational retraining Deeming used to calculate long-term extended earnings loss benefits; applied when worker has reached maximum medical improvement and finished vocational retraining. It is estimated that about 25 to 30 people currently in the system have been deemed Not used Electronic claim file Image system since 1993 No imaging system No imaging system Equity/adequacy studies No research on adequacy and equity of benefits No research on adequacy and equity of benefits No research on adequacy and equity of benefits

6 Compensation Services, Adjudication and Appeals Compensation Services and Adjudication Page 6 Adjudication Approach NFLD YUKON NWT Inquiry based (quick assessment as to entitlement and assignment to case management) Inquiry based (from generalist to specialist approach) Inquiry based (early identification and streaming) New evidence Case will only be sent back to adjudicator if it is a question of entitlement Returned to decision maker of record for reconsideration Case will only be sent back to adjudicator if it is a question of entitlement Board policy Board policy binding on adjudicators; room for discretion which is reviewable Board policy binding on adjudicators; room for discretion which is reviewable Board policy binding on adjudicators; room for discretion which is reviewable Consistency mechanisms Case conferencing Policy forum meets regularly; regular Quality assurance unit education and training. Quality assurance unit being established Access to information Workers Employers Employers to Workers Complete access to own file Complete access to own file Complete access to own file Complete access to own file Complete access to own file Complete access to own file Only if issue under dispute, then only information that relates to issue under appeal. A worker may object to level of information to be released and may appeal to WCRD Employer has access to information in worker's file, subject to the worker's approval. If worker objects to release, the President will determine what information is relevant and may be released and what should be severed Only if issue under dispute, then only information that relates to issue under appeal. A worker may object to level of information to be released; final decision on whether to release the information is the responsibility of director of claimant service Informal review No By policy, prior to going to formal review, all decisions are subject to internal reconsideration; this is simply a review there is no authority to change the decision No Independent Complaints Process No independent complaints process [establishment of independent complaints process was recommended in 1997 statutory review, but not adopted No independent complaints process No independent complaints process

7 Internal Review Process Page 1 ALBERTA SASK MANITOBA ONTARIO Structure of Review Process Name of review body Composition and Size Claims Services Review Committee & Assessment Appeals Review Committee CSRC, 14 full-time WCB employees; AARC, full-time WCB employees Appeals Committee Claims Services Review Office internal Appeals System One manager and five appeals officers all WCB employees Staffed by WCB employees (normally former senior adjudicators) Staffed by Appeals Resolution Officers who are WCB employees Required by statute Scope Yes Yes Yes Yes Any adjudicated decision may reviewed by CSRC; any assessment decision may be reviewed by the AARC Same options and process for workers and employers; any decision of board officer may be appealed Same options and process for workers and employers; any decision of board officer may be appealed Same options and process for workers and employers; any decision of board officer may be appealed Operations Time limits There is a one-year time limit for submitting a request for review; CSRC and AARC have discretion to extend time limit No time limits No time limits Six month time limit for bringing appeal, expect return to work decision where appeal must be brought within 30 days Nature of Review Inquiry based; appellant has power to request oral hearing - questioning permitted but no cross examination; almost all worker reviews oral hearings, employer about one-third Inquiry based; appellant has power to request oral hearing but otherwise documentary review Inquiry based; no oral hearings; a review officer may interview the adjudicator Inquiry based: 3 types of appeal process -review, just file review; inquiry, may gather additional facts; hearing, oral hearing held Reporting Decisions Individual decision not made public Individual decision not made public Individual decision not made public Individual decision not made public Aggregate Activities Aggregate statistics published in annual report of the WCB Aggregate statistics published in annual report of the WCB Aggregate statistics published in annual report of the WCB Aggregate statistics published in annual report of the WCB

8 Internal Review Process Page 2 Structure of Review Process QUƒBEC NB NS PEI An administrative review process No internal review process Internal review unit Internal appeal process Name of review body Composition and Size Staffed by CSST employees N.A. Staffed by WCB employees classified as Hearing Officers Director of Client Services/Director of Employer Services Required by statute Scope Yes N.A. Yes Yes Same options and process for workers and employers; any decision of board officer may be appealed N.A. Same options for workers and employers. Act requires that all disputed decisions must first go through reconsideration, an internal process and then may be referred to internal review by a Hearing Officer Same options and process for workers and employers; any decision of board officer may be appealed Operations Time limits 30 day time limit for bringing an appeal; 10 days if OHS matter. By policy goal is to issue administrative review decision in 60 days N.A. 30 day time limit for bringing a matter for review; decision of Hearing Officer must be rendered in 30 days, subject to extension No time limits Nature of Review Inquiry based; very informal and accessible; documentary review and adjudicator normally not interviewed N.A. Inquiry based; generally file review, though oral hearings may be held; may question, but not cross examine Inquiry based; very informal, generally file review, though oral hearings may be held; may question adjudicator Reporting Decisions Aggregate Activities Individual decision not made public N.A. Individual decision not made public (but this is being considered) Aggregate statistics published in annual report of the WCB N.A. Aggregate statistics published in annual report of the WCB Individual decision not made public Aggregate statistics published in annual report of the WCB

9 Internal Review Process Page 3 Structure of Review Process NFLD YUKON NWT Internal appeal process Internal Review Committee Review Committee Name of review body Composition and Size Five Internal review specialists who are WCB employees Three senior staff, usually director level, of the WCB sitting as a rotating panel of one Full-time chair and vice chair, both board employees, appointed by the board of the WCB, sit as panel Required by statute Scope Yes Yes Yes Same options and process for workers and employers; any decision of board officer may be appealed Internal review only for claim decisions, employer disputes directly to board appeal process Same options and process for workers and employers; any decision of board may be appealed (except third party claims) Operations Time limits Nature of Review 90 day time limit for bringing a matter No time limits for review, subject to extension; decision of internal review specialist must be rendered in 90 days Inquiry based; very informal, generally file review, though oral hearings may be held at request of appellant; may question adjudicator Inquiry based; generally file review, though oral hearings may be held at request of appellant (this is on the rise since creation of Workers' Adviser) No time limits Inquiry based; all file reviews; may send appellant for independent medical examination Reporting Decisions Individual decision not made public Individual decision not made public Individual decision not made public Aggregate Activities Aggregate statistics not published though monitored internally Aggregate statistics published in annual report of the WCB Aggregate statistics published in annual report of the WCB

10 Appeal Process Page 1 ALBERTA SASK MANITOBA ONTARIO Structure of Appeal Process Name of appeal body Appeals Commission - Workers' Compensation Act - Alberta WCB board of directors; the only external appeal body is medical review panel Appeals Commission (the Workers' Compensation Act of Manitoba) Workplace Health and Safety Tribunal Composition and Size 23 members of Commission, appointed by LGIC, one full-time CAC, 7 full-time hearing chairs, 15 part-time commissioners. There is a formal detailed selection and appointment process for Commission members WCB board of directors composed of three full-time members - one independent, one representative or workers and one representative of employers Four full-time commissioners, including CAC, presiding officer (public interest representative) and one representative of labour and one of employers and 17 part-time commissioners composed of labour, employer and public interest representatives. All app Members include the Chair, fluctuating numbers of vice chairs and "side" members representative of employers and labour. All members are appointed by the LGIC Required by statute Scope Yes Yes Yes Yes Workers and employers have same right and options to appeal; any final decision of board may be appealed Workers and employers have same right and options to appeal; any final decision of board may be appealed Workers and employers have same right and options to appeal; any final decision of board may be appealed Workers and employers have same right and options to appeal; any final decision of board may be appealed Leave to Appeal No No No No Independence WCB board member Members of Commission do not sit on WCB board N.A. Members of Commission do not sit on WCB board Members of Tribunal do not sit on WCB board Reporting relationship WCB Informal N.A. Informal; administrative reporting through Registrar Informal Board policy Board policy is binding on Commission N.A. Board policy is binding on Commission Board policy is binding on Tribunal; if Tribunal considers policy unlawful may return matter to WSIB for reconsideration Appeal body rules and policy Set by Commission; WCB has no authority or involvement N.A. The WCB board develops policies and rules of operation of Commission; Commission establishes its own practices and procedures Set by Tribunal; WCB has no authority or involvement

11 Appeal Process Page 2 ALBERTA SASK MANITOBA ONTARIO Same minister Yes, Minister of Labour N.A. Yes, Minister responsible for WCAct Yes, Minister of Labour Share premises No, separate premises N.A. No, separate premises No, separate premises Share resources/staff No shared staff; Commission uses N.A. some administrative support services of WCB; sets own budget paid by WCB No shared staff; Commission uses some administrative support services of WCB; budget set by WCB No shared staff or resources; Tribunal sets own budget Appeal to court Only judicial review Only judicial review Only judicial review Only judicial review Operations Time limits One year time limit for bringing an appeal No time limits No time limits; by policy decisions must be published within 60 days of finding Six months to bring an appeal; Tribunal has four month time limit for writing decision Nature of review Inquiry based; de novo; appellant may request an oral hearing but may be denied Inquiry based; de novo; majority of cases file review, appellant may request an oral hearing but may be denied Inquiry based; de novo; Registrar makes recommendation on appeal process to be followed; about onethird of cases by file review the other two-thirds by oral hearing Inquiry based; de novo; option of appellant to proceed file review or oral hearing (less than 10% file review) Summary Dismissal Some provision for summary dismissal, including already been heard, insufficient new evidence No provisions The Commission may charge costs to appellant if appeal considered vexatious or malicious No provisions Standing WCB does not automatically have standing; may apply as an interested party WCB does not have standing WCB and select officers may appear at hearings (rarely used) WCB does not have standing Open to public Not open to the public; rules specify in camera Not open to the public Not open to the public; by policy in camera Up to appellant to consent if someone request attendance at hearing

12 Costs Reporting Policies Appeal Process ALBERTA SASK MANITOBA ONTARIO Not normally awarded, though have May pay interest on award if No costs awarded No costs awarded been rare instances administrative delay Commission rules publicly available; variable release of policies Board appeal policies publicly available Commission policies and rules publicly available Tribunal policies and rules publicly available Page 3 Decisions Decisions not published, but Commission prepares a digest of important cases Decisions not published Decisions public and available electronically Decisions public Aggregate Activities Publishes annual report separate from WCB Board publishes annual report on all board activities and operations Publishes annual report separate from WCB Publishes annual report separate from WSIB ADR No ADR process No ADR process No ADR process Small ADR unit; anyone appealing may request ADR Process Success Rate N.A. N.A. N.A. No statistics Statistics Review Process (1997): Total reviews N.A ,270 4,785 allowed; 1,153 allowed in part; 10,899 denied By worker N.A. N.A. 1,074 N.A. By employer N.A. N.A. 196 N.A. Allow/Disallow Rate N.A. 28/72% 32/68% worker; 28/72% employer 35% allowed in whole or part; 65 disallowed Appeal Process (1997): Total appeals 1, ,563 hearings and 1,460 rulings (1996) By worker N.A N.A. By employer N.A (claims issue) 10 (assessment) N.A. Allow/Disallow Rate 26/63% (11% overturned) 20/80% worker; 12/88% employer 43/57% worker; 14/86% claimemployer and 10/90% assessmentemployer N.A.

13 Appeal Process Page 4 QUƒBEC NB NS PEI Structure of Appeal Process Name of appeal body Commission des Lésions professionnelles (CLP) Appeals Tribunal Workers' Compensation Appeals Tribunal Appeals Tribunal Composition and Size 130 commissioners; 31 One Chair and three vice chairs medical/technical advisors; 41 appointed by LGIC. Panel members conciliation officers and 217 advisors, representative of labour and representative of workers and employers appointed by board of employers to "stand along" directors of WHSCC located commissioners. All appointed by throughout province. Members of government. Advisers appointed on board of WHSCC may be appointed as nominations of worker and employer or panel members. Ten full-time appeal commissioners, including one CAC, and several parttime members all appointed by Governor in Council, but recruited and selected on the basis of civil service competition requirements Chair, plus employer representative and worker representative all appointed by LGIC Required by statute Scope Leave to Appeal Yes Yes Yes Yes Workers and employers have same right and options to appeal; any final decision of board may be appealed, except matters already appealed and where decision based exclusively on report of claimant's own doctor Workers and employers have same right and options to appeal; any final decision of board may be appealed Workers and employers have same right and options to appeal; any final decision of board may be appealed No No Must apply for leave to appeal No Workers and employers have same right and options to appeal; any final decision of board may be appealed Independence WCB board member Members of CLP do not sit on WCB board CAC is non-voting member of board of directors of WHSCC. Panel members may be board members Members of Tribunal do not sit on WCB board Members of Tribunal can not be board members Reporting relationship WCB No reporting relationship informal or formal between CSST and CLP CAC reports to WHSCC on the operations of the Tribunal Informal relationship No relationship formal or informal Board policy The CLP is not bound by CSST policy; in fact the CSST must comply with CLP decision in any particular case Board policy is binding on Tribunal; if Tribunal considers policy unlawful will prepare a paper for the board's consideration and not make a decision until the board has considered the issue Board policy is binding on Tribunal; Tribunal can not refuse to apply board policy that it considers unlawful Board policy is binding on Tribunal Appeal body rules and policy Set by CLP; CSST has no authority or involvement Tribunal bylaws approved by government. Tribunal guidelines are approved by board of directors of WHSCC Tribunal policies and procedures developed and approved by Tribunal; WCB has no involvement or authority Tribunal practices and procedures established in regulations passed by LGIC

14 Appeal Process Page 5 Same minister QUƒBEC NB NS PEI Yes, Minister of Advanced Education Yes, Minister of Labour and Labour Yes, Minister of Labour (prior to 1997 amendments the CLP's predecessor reported to Minister of Justice and CSST to Minister of Labour) Yes, Minister of Provincial Affairs and the Attorney General Share premises No, separate premises Head offices located in same premises No, separate premises No, separate premises Share resources/staff No shared staff or resources; CLP budget set by government and paid by CSST No shared staff; Tribunal uses administrative support services of WHSCC; budget approved by board of directors of WHSCC No shared staff or resources; Tribunal sets own budget The Secretary to the board of directors of WCB is Secretary to Tribunal Appeal to court Only judicial review WC legislation provides appeal to court of appeal; WHSCC may also take a question of law to Appeal Division of Supreme Court Only judicial review Access to judicial review; the Act provides that the WCB may bring a question of law to Appeal Division of Supreme Court Operations Time limits 45 day time limit to bring an appeal; No time limits for certain OHS matters a 10 day time limit. CLP must render a decision in 9 months; for certain priority matters 90 day limit with no more than 60 days from hearing to issue decision Must bring an application for leave to Must apply for appeal within 30 days, appeal within 30 days of board then 30 days from notice of appeal decision. No time limits on Tribunal for must submit argument; employer then hearing appeal has 30 days to respond. The Tribunal must set a hearing date within 90 days of receiving final documents Nature of review Sui generis approach - combination of inquiry and adversarial; de novo; oral hearings are the normal procedure, though appellant may request a file review Combination of inquiry and adversarial - Inquiry based approach; hearings where issue under dispute cross recorded but most appeals dealt with examination is permitted; oral hearings by file review rather than oral hearing are the normal procedure, though (oral hearings the exception) appellant may request a file review; appeal hearings are on the record Inquiry based approach, all hearings recorded; all appeals must be in writing but oral hearing may be held to hear verbal arguments Summary Dismissal Yes the Act provides for the summary dismissal of frivolous or vexatious complaints No provisions No provisions No provisions Standing The CSST does not have standing WHSCC does not have standing WCB has standing and may appear and make specific or general representations on the issue WCB does not have standing Open to public Records and hearings have public status similar to any quasi judicial process in Québec Not open to the public Not open to the public Not open to the public

15 Costs Appeal Process QUƒBEC NB NS PEI No costs awarded No costs awarded No costs awarded No costs awarded to date Page 6 Reporting Policies CLP rules of practice published in Gazette Tribunal bylaws are publicly available Tribunal bylaws and policy being rewritten; will be available to the public Regulations a matter of public record; but internal practices and procedures not made public Decisions Decisions public Decisions public Decisions on the record Decisions on the record Aggregate Activities Publishes annual report separate from CSST Publishes annual report as part of WHSCC annual report Publishes annual report separate from WCB Publishes annual report separate from WCB ADR Process Success Rate CLP offers voluntary conciliation services About 28% of cases before appeal body settled by conciliation; about 60% success rate No ADR process ADR process initiated in 1997; still in development N.A. No statistics yet N.A. No ADR process Statistics Review Process (1997): Total reviews N.A. N.A. (no internal appeals process) 3,808 reviews filed (1996); 907 backlog; 4,001 decisions N.A. By worker By employer Allow/Disallow Rate N.A. N.A. N.A. N.A. N.A. N.A. N.A. N.A. N.A. N.A. 19/81% N.A. Appeal Process (1997): Total appeals 7,139 appeals received; 7,692 closed; 8,500 pending; 3,620 decisions 556 appeals received; 127 from past years; 550 appeals resolved 441 appeal decisions; 127 appeals pending; 300 decisions to render 12 appeals received By worker By employer Allow/Disallow Rate N.A. 96% of appeals initiated by workers N.A. 8 N.A. 4% by employers N.A. 4 N.A. 54% allowed;19% partially allowed; 35% denied; 1% withdrawn N.A. 8 worker appeals - 3 allowed; 1 denied; 4 decisions not rendered. 4 employer appeals - 0 allowed; 3 denied; 1 decision not rendered

16 Appeal Process Page 7 Structure of Appeal Process Name of appeal body NFLD YUKON NWT Workers' Compensation Review Division Panel of board members of the WCHSB Appeals Tribunal Composition and Size One full-time chief review commissioner and up to 7 part-time review commissioners all appointed by LGIC Panel must include a chair, an alternate chair, and one member representative of labour and one representative of employers. Appeals heard by a panel of three members. Panel members appointed by the Chair of the board of directors of WCHSB Five members all appointed by the Minister from the members of the board of directors of the WCB; chair appointed on recommendation of board of directors as a whole; of other four members two are employer representative and two are labour representatives Required by statute Scope Yes Yes Yes Workers and employers have same right and options to appeal; any final decision of board may be appealed Workers and employers have same right and options to appeal; any final decision of board may be appealed Workers and employers have same right and options to appeal; any final decision of board may be appealed Leave to Appeal No No No Independence WCB board member Members of Review Division do not sit on WCB board Appeal body is entirely composed of members of board of directors Appeal body is entirely composed of members of board of directors Reporting relationship WCB No relationship formal or informal N.A. N.A. Board policy Board policy is binding on Tribunal Board policy binding on appeal panel of board Board policy binding on Appeals Tribunal of board; the board of directors has the power to stay a decisions of the Tribunal and order it to rehear a matter Appeal body rules and policy Review Division policies and procedures developed and approved by Tribunal; WCB has no involvement or authority Appeal policies developed and set by board of directors Appeal policies developed and set by board of directors

17 Appeal Process Page 8 Same minister NFLD YUKON NWT Yes, Minister of Environment and Labour N.A. - appeal panel not independent of N.A. - appeal panel not independent of board board Share premises No, separate premises N.A. - appeal panel not independent of board N.A. - appeal panel not independent of board Share resources/staff No shared staff or resources; Review Division sets own budget N.A. - appeal panel not independent of board N.A. - appeal panel not independent of board Appeal to court Only judicial review Only judicial review Only judicial review Operations Time limits 90 days to bring an appeal; Division has six month time limit for issuing decision There are no time limits for claims issues; assessment issues must be appealed within 180 days; OHS matters must be appealed within 21 days and refusal to work issue within 7 days No time limits Nature of review Inquiry based approach, hearings are on Inquiry based approach, hearings may be the record; in practice most appeals dealt transcribed depending on the issue; with through oral hearing increasing use of oral hearings Inquiry based approach, hearings are de novo; majority through oral hearings Summary Dismissal No provisions No provisions No provisions at present, but under consideration Standing WCB has standing and may appear and make representations on the issue WCHSB does not have standing, except Director of OHS; the appeal panel can summon board staff as witnesses WCB does not have standing; may be summoned Open to public Open to public at Commissioners discretion Not open to the public Not open to the public; but appellant may waive right to in camera process

18 Costs Appeal Process NFLD YUKON NWT No costs awarded No costs awarded No costs awarded Page 9 Reporting Policies Review Division policies and procedures are publicly available Polices of the appeal panel are publicly available New rules are currently being drafted and will be gazetted when complete and approved Decisions Decisions are public Decisions are public and available through law library Decisions are not public Aggregate Activities Publishes annual report separate from WCB WCHSB annual report includes statistics on activities of board appeal panel Annual report on Appeals Tribunal actives included in board annual report ADR Process Success Rate No ADR process No ADR process No ADR process N.A. N.A. N.A. Statistics Review Process (1997): Total reviews 1,082 internal review issues finalized 26 requests for review; 10 requests outstanding from previous years; 32 in total 116 reviews received By worker By employer Allow/Disallow Rate N.A. N.A. 91% claims issues N.A. N.A. 9% assessment issues 13/87% 22/78% 23/74% Appeal Process (1997): Total appeals By worker By employer Allow/Disallow Rate 333 appeals received 19 requests for appeal; 7 requests outstanding from previous years; 26 in total 31 appeals received 320 N.A. 97% claims issues 1 3 N.A. 3% assessment issues 46/54% worker appeals; 76/33% employer 39?61% 26/36%