interview questions - workers' compensation compensation ... · 6/22/98 page 1 interview...

6/22/98

INTERVIEW QUESTIONS - WORKERS' COMPENSATION

COMPENSATION SERVICES ISSUES

JURISDICTION: MANITOBA

I. COMPENSATION SERVICES ISSUES

1. Is there a requirement, statutory or otherwise, requiring the regular review andpotential readjustment of the rate of temporary wage loss benefit paid to an injuredworker?

If yes, what is the basis for adjusting the temporary wage loss benefit (i.e., a differentbasis for calculating the rate; a change in circumstances or level of disability)? And,are there any statistics or data regarding how often the rate is adjusted down or up?

Wage loss benefits are paid for loss of earnings capacity: 90% of net averageearnings for the first 24 months and 80% of net average earnings after 24 months ofcumulative benefits.

By policy, the rate of wage loss benefit is reviewed at 12 weeks for workers withirregular earnings pattern (see attached policy 44.80.80.20, "Wage Loss Reviews"and policy 44.80.10.10, "Average Earnings"). As well, by policy, the wage lossbenefit may be reviewed at any time if the board believes that there has been achange in loss of earnings status or at the request of the claimant.

There is automatic indexing of wage loss benefits on the first day of the monthfollowing the second anniversary of the accident and annually thereafter on thebasis of changes in the industrial average wage.

2. Are permanent disability awards, both partial and total, subject to review andreadjustment? For example, is there a requirement, statutory or otherwise, requiringthe regular review and potential readjustment of the rate of permanent disabilityaward?

If yes, what is the basis for adjusting the award (i.e., a different basis for calculatingthe rate; a change in circumstances or level of disability)? And, are there any statisticsor data regarding how often the rate is adjusted down or up?

See above.

The functional impairment award is not subject to regular or periodic review, butmay be adjusted at the request of the worker if the injured worker's condition hasworsened; a worker may not apply for an adjustment within 24 months of lastimpairment rating.

Interview Questions - Workers' Compensation SystemCompensation Services Issues - MANITOBA

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There are no statistics available on the incidence of adjustment of either the wageloss benefit or the functional impairment award.

3. Is there any prohibition in the workers' compensation legislation in your jurisdictionagainst "topping up" (i.e. purchasing private disability insurance which providesincome in addition to workers' compensation payment??)

There is a prohibition against topping up in Manitoba (see attached Fact Sheet on"Collateral Benefits").

A worker's wage loss benefit will be reduced by the value of other collateral benefitsprovided to the worker. This includes disability insurance benefits (private, CPP,UI), and any wages paid by the employer in addition to the wage loss benefits,which will be deducted from the wage loss benefit amount1.

4. What factors, if any, other than earnings, are used to determine workers' compensationbenefits (for example what impact does age, marital status, number of dependents,retirement, education and training have on the calculation of benefits)?

Age has no impact on the calculation of wage loss benefits. However, thepermanent impairment award and lump-sum survivor benefits are reduced by twopercent for each year that the worker is over 45 to a maximum reduction of 40%.

Marital status and number of dependents is indirectly taken into account in thecalculation of wage loss benefits which are calculated based on gross income lessdeductions for probable tax, CPP, and UI (which takes into account number ofdependents) (see attached fact sheet, "Calculation of Benefits").

5. Is deeming used in either

1) setting the duration of temporary benefits or

2) as the basis for calculating permanent disability awards

(where "deeming" means deeming a worker ready to return to work, and/or as capableof earning income at a particular income level, though the worker may not haveactually returned to work or may be earning income at a lower level)?

And if yes, what are the prerequisites for applying deeming? And, are there anystatistics or data regarding the frequency with which deeming is used?

Deeming is generally applied as a last resort after the worker has exhausted allreasonable and available vocational rehabilitation/re-employment options,including job search. In order to deem, the WCB must demonstrate that the worker

1 Where topping up is provided in a collective agreement entered into prior to January 1, 1992, theemployer may top up the workerís wage to 100%, but only for 24 months on each individual claim.


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has the physical capacity, education and skills to competitively find and keepemployment in the occupation of group of occupations on which the earningscapacity is based and that work exists. The WCB may also deem where the workerrefuse to co-operate in or discontinues a suitable return or rehabilitation plan (Seeattached policy 44.80.30.20, Post Accident Earnings - Deemed Earnings Capacity).

There are no statistics available on the incidence of deeming.

6. Does the jurisdiction have an electronic claim files system in place? When was itintroduced? What are the perceived advantages and disadvantages of electronic claimsfiles?

No.

7. Have any research or studies been undertaken on the adequacy of benefits provided bythe jurisdiction? Any research or studies on the issue of equity of benefits? Are thesestudies available to the Royal Commission?

No.

8. Claims Statistics:In 1997:

Claims Reported - 43.831Claims Accepted/Adjudicated - 37,649Time Loss - 17,995

Active Claims:

Short-Term 2,510Long-Term Life pension 4,429 Supplements 446 Earnings Loss 543Survivor Claims 861Rehabilitation 986Total 9,775

II. ADJUDICATION

1. How would you describe the basic approach to adjudication in your jurisdiction (forexample, inquiry based approach or adversarial)?

An inquiry based approach is applied in Manitoba; there is ongoing evaluation ofthe claim and WCB decisions are open to reconsideration and review.


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2. In your jurisdiction is the function of adjudicators, at the first stage, similar to aninsurance adjuster?

The function of adjudicators is to determine entitlement and provide appropriateservices and benefits. For short-term serious claims, the focus is on promptadjudication and payment of benefits. For longer term more serious claims, thefocus is early intervention and developing appropriate rehabilitation and return towork strategies. Manitoba is in the process of moving to a case management modelof adjudication.

3. If new evidence is presented on a particular claim, is the claim sent back to theadjudicator for reconsideration?

If new evidence is presented, the information will go back to the originaladjudicator for reconsideration.

4. Are board policies binding on adjudicators? To what extent are adjudicators entitledto exercise discretion? Is discretion applied by an initial claims adjudicatorreviewable?

Board policy is binding on adjudicators. There is room for the exercise of discretionand judgement by the adjudicator or decision maker in most board policies. Anydecision made by the WCB is reviewable.

What, if any, mechanisms are in place to promote consistency in decision making?There are two Quality Assurance units, one in the Claims Services department andthe other in Rehabilitation which undertake spot or ad hoc audits. Staff consultwith supervisors on complex issues. There is an internal audit function.

5. Do workers and employers have access to their information in board files? If yes, isthis because of a provision in the workers' compensation legislation or a result of theFreedom of Information and Protection of Privacy Act? Is further information foundin sub-files which do not form part of the claim file? And if so, are the sub-filesdisclosed?

Is relevancy of material in a board file a prerequisite to its disclosure to the affectedworker or employer? If so, who determines whether the information is relevant and onwhat basis? Does the worker or employer have the right to object to the relevancy ofthe information after it has been disclosed?

The workers' compensation legislation contains access to information provisionswhich override provisions in the freedom of information legislation.


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A worker has complete access to their claim file and an employer has completeaccess to their employer file (technically under the workers' compensationlegislation, the worker or employer has access only when there is an issue underreview, but to meet general rules of natural justice and access to personalinformation requirements, workers and employers are given access to their own fileon request).

An employer has to be party to a reconsideration or an appeal to gain access to theirworker's file. A worker has the opportunity to object to the release of informationbefore it is disclosed. If the worker objects to the release of information the boarddetermines what information is relevant and will release information "that relates tothe matter at hand". The worker or employer can appeal a decision of the board torelease or not release the information to the Appeal Commission (there is a 14 daytime limit to object to the Appeal Commission).

6. Is there any "informal" review process for workers and employers regarding claimsadjudication or assessment decisions (i.e. review by supervisor or manager prior to theformal internal reconsideration or review process and external appeal process, if any)?

If yes, are there any statistics available on the total number of issues reviewed and theallow/disallow rate for this informal review process (are there any statistics kept onthe number of issues reviewed, and the allow/disallow rate broken down by type ofissue - for example, assessment decisions, compensability, level of benefits)?

There is no specific "informal" review process. However, an objection to a WCBdecision would be reviewed by the person who made the original decision and thisreview may include discussion of the issue with the supervisor or manager. If theoriginal decision cannot be changed, the worker or employer would either beadvised of the appeal process or the objection would be forwarded for formalinternal reconsideration.

There is a process for a supervisory review of complex issues where there is anobjection to a WCB decision. No statistics are available on the incidence of suchreviews.

7. Is there a formal "complaints" review process in your jurisdiction, distinct form anyinternal review or external appeals process, to deal with complaints from clients of theboard regarding the conduct of board officers and staff or service issues? If yes, is thisprocess independent of the board?

Internal to the board is the office of the "Fair Practices Advocate". The Advocate isresponsible for dealing with issues of fairness and natural justice. The Advocate hasthe power to recommend changes, but no power to overturn decisions of the board.

External to the board is the provincial Ombudsman.

interview questions - workers' compensation compensation ... · 6/22/98 page 1 interview...

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