Appeals Department 2017-05-10T13:59:14+00:00

Appeals Department

 

The Appeals Department is an independent body reporting directly to the Executive Office and is therefore not influenced to follow operational decisions through its reporting structure.

The appeal process is informal and non-confrontational. Appeals Officers will ensure there is sufficient information on the file to address the customer’s concern and come to a reasoned decision through an inquiry model of review.

In accordance with their Mission, Values and Guiding Principles the Appeals Officers consider all the file information relevant to the appeal issue. After the review is complete, the Appeals Officer will issue a written decision following the Decision Template.

Appeal reviews are generally conducted in chronological order of their receipt. The Appeals Department strives to issue a decision within 30 days of having received the appeal.

Customers who disagree with an appeal decision may appeal directly to the Board Appeal Tribunal who act as the final avenue of appeal.

Mandate
The Appeal Department is established by Board Policy to provide an independent review of any claim decision. Appeals Officers have the authority to reject, confirm or alter any claim decision, in accordance with the WCB Act and Policies.

Mission
Governed by their Values and Guiding Principles, and in accordance with the WCB Act and Policies, Appeals Officers are responsible for achieving fair and reasonable resolutions to requests for reconsideration put forward by workers and employers, through an independent and unbiased review.

Values
Appeals Officers believe in and act upon the following values:

    • Accuracy / Thoroughness – We are responsible for a detailed and complete review of all information relevant to the issues before us.
    • Timeliness – We believe in the principle, “justice delayed is justice denied”. We are responsible to ensure a timely resolution of the issues before us.
    • Consistency – We strive to maintain consistency in the application of WCB legislative authority, policy and procedures and in the appeal decision-making processes.
    • Independence / Impartiality – We will remain independent from the worker, employer, caregivers and WCB staff at all times. We ensure the impartiality of our decisions.
    • Integrity / Respect – We will always act with integrity and treat customers with respect and in a non-discriminatory manner.
    • Openness / Accountability – We believe in being accountable for the decisions we make. We are open to consider new information and address any questions pertaining to our actions.
    • Professionalism – We believe an effective appeal process is critical to the success of the WCB. We will be professional in all our actions.

Guiding Principles

  • Code of Conduct
    Appeals Officers are governed by the following code of conduct:

    • We will act in a fair, impartial and non-discriminatory manner in all matters.
    • we will remain independent from the worker, the employer, and the WCB decision maker at all times.
    • We will avoid any Conflict of Interest or perception of bias.
    • We will treat all parties and participants in an appeal process with courtesy, dignity and respect.
    • We will approach every request for consideration with an open mind, fairly weighing and assessing the evidence provided.
    • We will reach conclusions based on objective and independent assessments of the facts and in accordance with the Guiding Principles and the WCB Act, Regulations, Policy and Procedure.
  • Principles of Natural Justice
    Appeals Officers agree to the following principles:

    • To act fairly and in good faith.
    • To act without bias.
    • To give each party the opportunity to state their case.
    • To give each party the opportunity to refute statements that may be prejudicial to their case
    • To ensure there is no abuse of power
    • To ensure the decision is made by those who hear the evidence
  • Principles of Evidentiary Review
    Appeals Officers adhere to the following principles when making decisions:

    • The Appeal Department follows an inquiry model of review and is not bound by judicial rules of evidence. The Appeals Officer must ensure there is sufficient information available to arrive at a fair and reasonable decision.
    • The greater Burdon of Proof normally lies with the party bringing forward the appeal. However, an appeal may not be rejected simply because the¬†customer did not sufficiently advance his case. If further investigation is warranted, it must be carried out.
    • The Standard of Proof is the balance of probabilities based on all evidence presented, appropriately weighted in accordance with its credibility, with each case decided on the individual merits and justice of the case.
    • All information contained on the file and provided by the customer, shall be considered, and given weight appropriate to its value. Information which is not on the file and not accessible to all parties will not be considered.
    • Where there are multiple work-related and non work-related causes for an injury or condition, in order to establish compensability, the work relationship must be “substantial”. The work relationship need not be the “predominate” cause, neither is it sufficient that the work relationship be “trivial”.
    • In assessing the credibility of witness testimony, the Appeals Officer must consider whether the witness is at arms length, has a conflict of interest or a personal stake in the outcome of the situation. The test of truth is the harmony of the information with the physical evidence and common experience.
    • When evidence, information or testimony is conflicting, greater emphasis is placed on information supported by physical evidence, documentation or independent corroborating statements.
    • Where information or testimony changes as time goes by, or where there is significant time between an alleged injury and the first medical attention, lacking evidence to the contrary, the appellant’s version of events can be accepted as factual. However, that in itself is not sufficient to accept the appeal. In order to accept the appeal, the story must be corroborated with supporting evidence.
    • Decisions cannot deviate from the WCB Act, and Regulations, and shall be consistent with the WCB Policy and Procedures. Where a situation does not fall cleanly within the written authorities, the Appeals Officer will consider the original intent of the applicable authority.
  • Conflict of Interest – Apprehension of Bias
    The Appeals Officer will withdraw from a review of an appeal if they:

    • Are related, are friends / close personal acquaintances, or have a close affiliation with any party to the appeal
    • Made the decision being appealed
    • Would be observed by a well-informed observer to have a bias or conflict of interest.

Decision Template
The appeals officer will provide a written decision, ensuring plain language principles are applied, outlining the following elements.

  • Issue – A brief description of the specific issue(s) under dispute.
  • Authority – An explanation of the legislative and/or policy authority under which the decision is made.
  • Relevant Information – An outline of the information relevant to the issue under dispute, and which provides a basis for the conclusion.
  • Decision – An explanation of the outcome of the review and the basis for the decision, including where applicable why various arguments of positions were accepted or rejected.