Consultation summary of stakeholder feedback on the dispute resolution and appeals processes value-for-money audit

Feedback on the consultation process

We are always looking at ways to make our dispute resolution and appeal processes less adversarial and improve outcomes – including resolving disputes as quickly and possible.

We received many submissions and are confident that they provide a comprehensive and broad variety of perspectives. We are committed to ongoing collaboration with our stakeholders in the months to come, including through a series of consultation workshops and webinars where stakeholders will be able to provide input and feedback into our tactical proposals for implementing specific audit recommendations.

Here is a summary of what we heard in the submissions and our response to the feedback.

Changes to time limits

Here’s what we heard:

Most stakeholders did not support any change in time limits that were not already outlined in the current legislation nor in current administrative practice.

What we’re doing:

It is not within the jurisdiction of the WSIB to make any changes to time limits, and we do not intend to pursue any administrative practice changes to time limits with the Ministry of Labour, Immigration, Training and Skills Development. 

One-year Appeal Readiness form submission timeline

Here’s what we heard:

Through our consultation, we heard both support for, and concerns raised against, implementation of an administrative time limit of one-year to file the Appeal Readiness form. Many raised the ongoing challenges that representatives are facing, with long wait lists being typical. As a result, people with workplace injuries and illnesses are waiting for long periods of time (upward of 12-18 months) to start their appeals process through representatives. We also heard from representatives and stakeholders that the ability to gather further evidence and form a comprehensive and compelling argument for appeal would be compromised if we move forward with this time limit.

What we’re doing:

Our goal is to continuously improve so that we can better meet the needs and expectations of people with workplace injuries and illnesses. We don’t think it’s fair for people who need our help to languish in lengthy processes. We want to do everything possible to make it better, easier, and faster for people to receive a quality and fair resolution over a dispute on their claim.

In consideration of the feedback received, we will pause work on implementation of an Appeal Readiness form submission timeline until other recommendations of the audit have been implemented. We believe other suggestions, when implemented, could address some of the issues this recommendation seeks to resolve. We will then be able to better assess and evaluate the success of all the changes made and revisit this recommendation to determine whether a time limit is still needed, and, if so, what the appropriate time limit might be.

Making certain decisions final decisions of the WSIB and appealable directly to the Workplace Safety and Insurance Appeals Tribunal

Here’s what we heard:

We received differing perspectives on this recommendation. Some consultation submissions described concerns with defining “standardized calculation” issues as well as not limiting appeal rights under section 119 of the Workplace Safety and Insurance Act (WSIA). Other submissions suggested creating a dedicated team at the WSIB (in the Appeals Services Division) to make decisions on these types of issues and allowing the appeal to proceed through the Appeals Services Division rather than directly to WSIAT first.

What we’re doing:

We will assess and evaluate processing these types of issues through a dedicated team of Appeals Resolution Officers with expertise and specialization in particular topics.

We are always looking at ways to make our dispute resolution and appeal processes less adversarial and improve outcomes – including resolving disputes as quickly and as fairly as possible.

We will also explore processes that would allow us to expedite certain final decisions in cases where an appellant is pursuing an issue at the WSIAT, so that they may pursue all related issues at the same time to achieve faster outcomes.

30 days to implement appeal decisions

Here’s what we heard:

In some responses, we found that stakeholders misunderstood the intent of the recommendations and the questions posed for feedback. For those that understood the scenario and responded to the questions from that understanding, all the responses were supportive of us clearly stating what information is required in an appeal, and being accountable to implement appeals decisions within the 30-day timeframe.

What we’re doing:

We are committed to asking as early on as possible for the information we need to implement a decision from all people involved in the appeal. This will ensure that, from the start of the appeal, everyone knows what information they need to provide to not only receive the best decision possible, but also have it implemented in a timely manner. In most cases, this service standard is within 30 days.

We will work from the beginning of the dispute (either from the receipt of the Intent to Object form or the Appeal Readiness form) to understand the issue, why there is disagreement, and the desired resolution. By ensuring a clear understanding of the dispute from the perspective of the appellant, we will be better positioned to identify missing or beneficial information and request it as soon as possible, supporting a 30-day implementation once the decision is made.

Reasons for the dispute and the resolution sought

Here’s what we heard:

We received numerous submissions that expressed concern that an appeal would not move forward if we implement the recommendation. The submissions suggested that the most vulnerable injured or ill people may not be  able to articulate the recommended information for various reasons, which could delay or block their access to a resolution.

What we’re doing:

An appellant explaining why they feel a decision is incorrect and why it should be changed is a requirement found in section 120 of the Workplace Safety and Insurance Act. If a person doesn’t know or isn’t able to explain why they are objecting to a decision, or what resolution they are looking for, will not impact their ability to proceed to an appeal. This recommendation is meant to ensure everyone appealing a decision has an opportunity to provide us with the reason(s) why they disagree, if they are able to. Additionally, it is meant to advise parties of information they need to provide for a timely implementation of the decision (tied to recommendation 1.1, 1.2, and 3.2) so that if they win their appeal, they do not need to wait to have it take effect.

When this information is available and provided upfront, it can help focus our review of the decision and deal with the issue in dispute more holistically. This approach helps to create finality and certainty for the parties involved. The information can be provided and obtained at various stages, primarily during the conversation with the original decision maker, or when completing the Intent to Object form, and when completing the Appeal Readiness form.

Expediting return-to-work decisions through appeals

Here’s what we heard:

Based on the feedback we received on this recommendation, we believe that there may have been misunderstandings of the recommendation and the intent of the questions posed for stakeholder feedback. Some mistakenly thought that we would separate return-to-work issues and move them forward through the appeals process in advance of the parties indicating they are ready to proceed through the appeal process by completing the Appeal Readiness form. Others understood the intent of the recommendation, which was that once an appeal was determined to be ready to proceed by the party and we have received the completed Appeal Readiness form, we would expedite appeals that had return-to-work elements included in the appeal.

What we’re doing:

To clarify, once an appellant submits their completed Appeal Readiness form, we consider them ready to begin the appeals process. If one of the issues raised in the appeal is a recognized return-to-work issue, that entire appeal (that is, all issues related to the issue agenda on the Appeal Readiness form) will be expedited and resolved at the same time by one Appeals Resolution Officer, to prevent further delays. As suggested in submitted feedback, there may be cases where the Appeals Services Division can help expedite the customer-facing decision being made as well, and we intend on exploring that opportunity too.

The vast majority of the responses we received support us expediting appeals that include return-to-work issues within 30 days. This timeframe will help reduce chances of creating undue financial hardship or restricting access to rehabilitation services for people who need it, resulting in fairer, better and more timely outcomes for the people we are here to help.

Alternative dispute resolution methodology

Here’s what we heard:

We received a variety of feedback on this recommendation. Some submissions recommended replicating WSIAT’s successful early dispute resolution process. Others suggested abandoning the recommendation (in particular, the mediation-arbitration model proposed) altogether, as they did not feel it maps to the WSIB system and would therefore be unrealistic to implement. Reasons ranged from a power imbalance for the most vulnerable people with injuries and illnesses to ethical and administrative law reasons. However, the vast majority of feedback agreed with the suggested alternative dispute resolution methods, specifically early and safe return to work, suitable occupations and return-to-work training plans, cooperation, and re-employment. The feedback was also supportive of an external alternative dispute resolution training program and tools to support earlier resolution and mitigation of disputes at different points in the process.

What we’re doing:

To help us deliver timely, fair and quality outcomes, and improve customer experience, we will move forward with the implementation of alternative dispute resolution training, tools and certification and look to use those skills in the pre-hearing and hearing processes, as suggested by stakeholders. We will ensure that an external third-party vendor with expertise in this programming will deliver alternative dispute resolution training to our employees. We will consider all process issues from a holistic perspective and will ensure we make decisions with certainty and fairness.

Many decision makers will also receive alternative dispute resolution training to help resolve disputes more effectively before it moves to the Appeals Services Division.

Once our employees have been trained and we have greater experience applying these techniques, we may consider more formal alternative dispute resolution interventions and mechanisms.

The application and use of alternative dispute resolution methods are not intended to limit any type of entitlement to an issue in dispute nor under any claim, rather, they will be used to maximize opportunities where early resolution is possible. We will preserve the rightful entitlement to benefits and will not delay any final decisions of the Appeals Services Division. We believe that our stakeholders will benefit from our decision makers' alternative dispute resolution training and skill sets.