Recommendation
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Report response
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Status
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Recommendation 3.1
The Workers’ Compensation Board should ensure that they are consistently communicating
with injured workers on a timely basis and providing all relevant details regarding decisions,
including how benefits were calculated.
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In 2018 the WCB implemented a new service advancement process to ensure case workers are communicating with workers in a timely manner. In Guidewire this will be an automatic activity required to complete, or it will be escalated to the manager. With Guidewire, the WCB will also update letters to provide clarity on how benefits are calculated. The WCB has also implemented a tracking process for decisions and appeals to ensure timely claim decisions and appeal decision implementation.
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Complete
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Recommendation 3.2
The Workers' Compensation Board should review performance standards for requesting
permanent impairment benefit assessments and implement processes to ensure these
standards are monitored.
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Over the next 12 months the WCB will explore best practice for requesting permanent impairment assessments. The new Guidewire system will allow for an activity to be added for case workers once the assessment has been added to the file to ensure benefits are implemented in a timely manner.
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Complete
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Recommendation 3.3
The Workers’ Compensation Board should improve the complaint resolution process, including
implementing proper segregation of duties, and the creation of a formal complaint log that
includes all complaints received, as well as documenting the actions taken, both to make an
initial decision on the validity of the complaint and to ensure service delivery standards are met. Management should also implement a quality review process over complaints.
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Over the next 12-18 months we will undertake a best practice review of complaint resolution processes and revise our program and processes based on that review.
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Complete
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Recommendation 3.4
The Workers’ Compensation Board should ensure that both the injured worker and employer accept the initial accident report.
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The Workers’ Compensation Board agrees that workers should have access to the information on their workplace injury submitted by their employer, and they should understand that the WCB may need to obtain and process information from MSI and Medavie Blue Cross to process their claim. Increasingly, accident reports are submitted electronically by the employer without employer or worker signatures. Over the next 12-24 months the WCB will explore options on how to leverage the new Guidewire system to ensure workers have this information. In the meantime, when the worker has not signed the accident report, the case worker, as part of their initial contact, will read the description of accident to the worker to ensure it is accurate and complete and explain the ability of WCB to obtain medical information needed in relation to the injury from any current or previous health care person.
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Complete
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Recommendation 3.5
The Workers’ Compensation Board should review benefit payment processes and implement controls to ensure that only authorized additions and changes to benefits happen, and that supporting documentation for all payments is on file.
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With the implementation of the Guidewire system, all payments and history is recorded in the claim file and cannot be paid without the record. Over the next 12-24 months the WCB will review the current benefit calculation and payment processes and research best practice to ensure we have appropriate controls in place. Currently long-term benefits are calculated by a quality assurance position for the case worker and then authorized by the case worker.
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Complete
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Recommendation 3.6
The Workers’ Compensation Board should review current practices and implement an updated process, including review and document retention standards, for vetting workers' files to ensure all sensitive unrelated information is removed before being sent to a third party.
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Over the next 12-24 months the WCB will explore best practice options for document review, retention and vetting sensitive information removal.
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Complete
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Recommendation 3.7
The Workers’ Compensation Board should establish processes to ensure that appeal decisions
are made within targeted timeframes, case management is clearly documented to support
reasonable actions were taken to resolve the file in an efficient manner, and proper oversight
exists.
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Over the next 12-24 months the WCB will review the current process and research best practice to ensure an efficient and timely internal appeals process within the policy timelines, including developing standards for documentation and monitoring of performance to standards. To improve timeliness of appeal decisions, the WCB has hired an additional Hearing Officer.
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In progress
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Recommendation 3.8
The Worker’s Compensation Board should establish implementation and monitoring processes
to ensure that all appeal decisions are implemented in a timely and efficient manner.
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We have implemented a process to centralize the review of appeal decisions, document and monitor implementation. With Guidewire, an activity will be added to the file for the case worker to ensure the appeal is implemented. Notification will be escalated to the manager if the activity is not completed.
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Complete
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Recommendation 3.9
The Workers’ Compensation Board should ensure the return-to-work case management
process is accurately documented and tracks the steps taken to return the worker to work,
including any changes made during the process.
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Over the next 12-24 months the WCB will review the capabilities of the new Guidewire system to determine what the best approach will be to ensure accurate documentation of the return to work process.
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Complete
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Recommendation 3.10
The Workers’ Compensation Board should ensure that file reviews are completed as required,
and document actions taken to resolve issues identified.
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Over the next 12-24 months the WCB will explore best practice options for document review, retention and vetting sensitive information removal.
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Complete. This was added to the Enterprise Risk Management process last year and it is reviewed annually.
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Recommendation 3.11
The Workers’ Compensation Board should implement a system to monitor the completion of
training by staff, including notification for when training updates are required.
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We will utilize our Learning Management System for this purpose if possible, or we will resolve it through the planned implementation of a new Human Resources Information System in 2020. By policy, Managers are responsible to ensure employee training is completed and we will reinforce this message to the leadership team in 2019.
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Complete
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Recommendation 3.12
The Workers’ Compensation Board should ensure that all parts of the performance planning
and assessment process are completed and documented.
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We will update our performance planning and assessment process by the end of 2019 and work with the leadership team to ensure all elements of the performance planning and assessment tool are consistently completed and documented.
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Complete.
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