The key to resolving disputes is, I believe, communication and understanding the other party’s perspective.
Recently, my office, once again, experienced the outcome of inadequate communication.
The employer needed to better understand the worker’s functional capabilities. The WSIB agreed functional testing would be helpful. A functional abilities evaluation (FAE) was to be arranged by the WSIB. What should have taken 2 weeks took 3 months.
When the FAE report was finally available to the parties, a month after it was prepared, there continued to be questions of clarity as it relates to the validity of the report. The assessors identified several inconsistencies in performance during the FAE assessment.
When my office inquired on these inconsistencies, we met with the WSIB’s perspective that “there was nothing they could do about it and a second evaluation would bring the same results”. After some discussion, the Case Manager agreed to reach out to the FAE assessors to better understand their inconsistency of performance comments.
This step took another 6 weeks which met with no clarity. The matter had to be escalated to a Director-level for action. Neither the Case Manager or Manager would return calls and/or leave voice messages that the matter was being looked into.
The Director confirmed another Case Manager had been assigned to the file and was able to resolve the issue within 8 hours—subsequently issuing a decision letter.
My office expressed concern to the Director with the lack of communication during this entire process which should have taken 2 weeks to get an FAE; a week to get the report; and 8 hours to resolve the question of performance.
The Director agreed that at the heart of the issue was communication and understand the employer’s perspective.
The take away from this blog is to verbally communicate to all parties involved what exactly you are looking for and what your expected timeline for a response is. Actively monitoring the response and escalating the inquiry is crucial.
You may wonder why the escalation didn’t happen sooner—the answers being provided for the delay in having the FAE were administrative technical issues between the WSIB and the FAE assessor. We were assured the matter was moving forward only to learn of continued interruptions to the process.
Several escalation inquiries took place with the Manager. When the resolution of the clarity question was not forthcoming, that was the “last straw” requiring further escalation to the Director-level.
Due to the pandemic, there has been a significant change in the number of new Adjudicators, Case Managers and Appeals Resolution Officers. My office has found it necessary to educate during telephone calls (followed by written confirmation) of the employer’s issue, expected outcomes and timelines.
Clear, concise, communication with your perspective and expectations should continue to form part of your ongoing WSIB Claims Management Program.
