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WCB Dispute Resolution and Decision Review Board

Posted in: Claims Costs,WCB Law,WCB Lawsuit Settlements | Posted by Rebecca Ingram on August 23, 2016

Although the WCB Alberta is committed to making fair decisions on claims, with rationale that is understood by all interested parties, not everyone is always in agreement when a decision is made. Every WCB claim is different because each work-related accident is unique unto itself. There are enough similarities in the types of accident, types of injury, methods of treatment, durations of disability and return to work plans that allow claims to be processed within structured WCB policies, procedures and guidelines. However, these standards and protocols do not always allow for the individual nuances and circumstances of a claim to be taken into consideration when decisions are made.

What happens when an employer disagrees with a decision made on an injured worker’s claim or doesn’t understand the reason why a decision was made?

Every employer has the right to question and request a review of any decision made on a claim, however it is important to have a clear understanding of the reason for the decision before proceeding with an appeal. The WCB will provide a copy of the claim file so that all the information relevant to a decision can be looked over.

The WCB Alberta provides informal avenues of appeal that promote discussion between the WCB decision maker and a dissatisfied party (worker or employer) to try to come to a mutually acceptable resolution. If the issue can not be resolved through this informal conversation, there are formal review bodies, both internal and external, that will examine a decision to determine if it has been made correctly and fairly. This ensures that when a claim decision is in question, every attempt is made to listen to the concerns, review how the decision was made and provide the rationale that was used to make the decision. Read more about the appeal process in our blog, The WCB Appeals Process.

What if, as an employer, you have gone through the informal channels, but you still disagree with the decision?

This is where the formal internal review body, the WCB Dispute Resolution and Decision Review Board (DRDRB) becomes involved. The DRDRB is the next level of appeal if a satisfactory conclusion to an issue can not be reached on an informal basis.

The DRDRB was established, in accordance with the Workers’ Compensation Act of Alberta, for the purposes of conducting a review of adjudicative decisions. It is made up of employees of the WCB who act as resolution specialists. They use a process that is intended to be flexible, informal, collaborative and focused on looking for opportunities to resolve issues.

In order to access the DRDRB, a ‘Request for Review’ form, or G40, must be completed and submitted to the WCB within one year of the date the decision in question was made. Once the form has been submitted, a WCB supervisor will be in contact with the requestor to attempt to resolve the issue and this is often enough to get satisfactory results. If not, then the request is forwarded to a DRDRB Resolution Specialist.

Prior to examining the claim, the specialist will contact the review requestor to make sure they fully understand the issue in dispute. The specialist will also want to know what the requestor’s understanding of the decision is, and what they feel is the best approach to resolve their issue.

The three most common types of review are:

  1. Documentary Review: The review specialist will examine the claim file with specific focus on the issue in question. Then they assess the decision making process to ensure the decision was made in accordance with existing WCB policy and procedures, and took into account all information relevant to the decision. They may contact any or all interested parties, including but not limited to the injured worker, the employer, the WCB decision-maker, for further clarification or understanding.
  2. Telephone Conference Review: The review specialist will examine the claim file and issue, then contact all interested parties to set up a conference call. During the call, the review requestor and other interested parties will be able to provide additional information, respond to questions and engage in open discussion regarding the issue of concern. This approach is useful when distance is a factor, or if direct contact between the interested parties might help resolve the issue.
  3. In-Person Hearing Review: The review specialist will examine the claim file and issue, then contact all interested parties to set up an in-person meeting. Much like the Telephone Conference, all interested parties will be able to provide additional information, respond to questions and engage in open discussion regarding the decision in question. This is particularly beneficial if the use of graphics, photos, re-enactments or demonstrations are involved.

After the review is complete, the review specialist will re-examine the claim file with respect to the decision in question, how the decision was made and any additional information obtained from the review. Based on their evaluation of all information available, they will either decide to uphold or overturn the original decision. Once a decision is reached, a letter will be sent advising of the outcome of the review and the rationale that was used to arrive at their conclusion.

In the end, even if an employer still disagrees with a decision, they will have had an opportunity to discuss the decision, express their concerns and perhaps gain some insight as to how the DRDRB came to their conclusions and why the decision was not overturned. Fortunately, there is still an external body of appeal and the issue can be forwarded to the next level, the Appeals Commission.

Although the WCB appeals process is informal and employers can handle a review themselves, they can also contact the WCB Employer Appeal Consulting for advice or they can authorize a representative to act on their behalf. Any fees for lawyers or employer representatives are the responsibility of the employer and are not covered by the WCB.

If you are looking for additional information about the DRDRB process, need assistance with appealing a WCB decision or wish to obtain representation for WCB matters, you can always connect with us on Facebook ,Twitter , or LinkedIn. Or contact us directly at BCL.Calgary@bclconsulting.ca, BCL.Edmonton@bclconsulting.ca or at 1-844-377-9545.




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