Phase 2 of the audit focused on claims management. The report was released on May 28, 2019.
“While workplace injury claims are generally being managed in line with policies, there are a number of things that aren’t working as well and need to be improved at the Workers’ Compensation Board. Timeliness, and processes for complaints and protection of privacy, are just some of the areas that should be addressed to improve the way claims are handled for Nova Scotians.” Auditor General Michael Pickup.
Timeliness and Communication
Quality assurance, training and performance documentation
Timeliness and Communication Q&A
Quality Assurance, Training and Performance Documentation Q&A
|Several foundational elements of the WCB’s business model were evaluated as part of this performance review. While the importance of the need for improvement in parts of the process cannot be overstated, the audit found those foundational elements are overall functioning in line with policy. Findings included:
- WCB Nova Scotia is managing claims effectively, and in keeping with our policies and procedures.
- WCB makes decisions appropriately. In 30 claims decisions tested, the report found that all 30 were reasonable, consistent with the information on file, and sufficiently supported.
- Appeals were evaluated in line with policies
- WCB managed workers’ return to work on a timely and appropriate basis
- Our service contract for the treatment of complex strains and sprains in injured workers was appropriately procured and is well managed.
However, there were very important areas for improvement. The audit found that:
- We need to do better in the time it takes us to make and deliver written decisions, and that the way rates are calculated needs to be easier to understand. We also need to make and implement appeal decisions more quickly. Learn more.
- We need to implement a more rigorous process for complaint submission and management. Learn more.
- We need to improve the process when medical files are redacted for release to employers as part of the appeal process. Learn more.
- We need to improve file review, training and performance documentation. Learn more.
Nova Scotia’s Office of the Auditor General (OAG) news release