Fairness review form

Every participant in the workers’ compensation system deserves to be treated fairly. WCB’s Code of Rights and Conduct explains the rights of workers and employers in their interactions with us. If you feel you were treated unfairly, it is important your concern is resolved at the earliest opportunity; often a service concern can be resolved through collaborative conversation. If you believe you were treated unfairly:

• Step 1 Speak with a supervisor
• Step 2 Speak with a manager
• Step 3 Request a formal fairness review

Note: A formal fairness review by the Fair Process Review Centre (FPRC) is a free service and should be initiated within 60 days of the process or behaviour that led to your concern. Additional information can be found here.

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IMPORTANT

The FPRC is only able to review concerns about procedural and behavioural fairness. The FPRC does not have the legislative authority to review or change worker claim and/or employer account decisions. The internal Dispute Resolution and Decision Review Body (DRDRB) and external Appeals Commission (AC) perform these functions.

Behavioural fairness reviews look at how you were treated, including whether WCB staff followed the Code of Rights and Conduct, meaning:

• the decision maker treated you with fairness and impartiality
• you were able to participate in decisions affecting you
• your privacy and confidentiality were protected and respected
• you felt listened to and heard
• what could and could not be done was clearly outlined to you
• if a mistake was made, the problem was addressed quickly with an appropriate apology

Procedural fairness reviews look at concerns about the process followed to reach a decision and whether processes followed are consistent with legislation, regulation and policy or procedure. A procedural fairness review does not involve a review of the actual decision or outcome itself but will evaluate whether:

• timely decisions were made and implemented without delay
• effective and timely communication was provided, including receiving notice of a decision and clear reasons for a decision
• full, correct and relevant information was always provided
• access to information was provided as appropriate
• consistent and impartial decisions were made without bias
• you were given the appropriate forum and opportunity to be heard and to express your opinion and views

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I am an: *

Injured worker

Injured worker representative

Employer

Employer representative

Name: *

Address: *

Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ---------------------------

Phone number (with area code):* ( ) -

Email address: *

WCB claim number:

WCB account number (employers only):

Company (employers only):

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Important timeline information

• Requests for a formal fairness review should be initiated within 60 days of the behavioural or procedural action that led to your concern. This is referred to as the 60-day window.
• If your fairness concern is outside of the 60-day window (i.e., 61 – 365 days ago), the fairness review officer may consider extending the time period, provided there is a reasonable explanation for the delay.

The FPRC does not conduct fairness reviews more than one year after the interaction that led to your fairness concern.

Approximately when did this behavioural or procedural action occur? * Select date

If this is outside the 60-day window (i.e., 61 - 365 days ago), please describe the reason for the delay in asking for a fairness review.

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Did you contact the supervisor and/or manager to discuss your concern? *

Yes

No

If yes, please provide their name(s), the date(s) you discussed your concerns with them and the description of the conversation(s) you had. If no, please discuss your concerns with them first before requesting a fairness review. This is the first step in addressing concerns and is part of WCB’s Code of Rights and Conduct. The FPRC cannot move forward with a fairness review until these steps are completed.

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Please summarize your concern.*

Please describe why you feel the actions taken were unfair to you. Please be as specific as possible and include the date of these actions.*

The FPRC cannot change policies set by WCB-Alberta and does not have the legislative authority to review or change worker claim and/or employer account decisions. The internal Dispute Resolution and Decision Review Body (DRDRB) and external Appeals Commission (AC) perform these functions.

Potential outcomes after a fairness review may include:

• an apology,
• a written explanation or detailed breakdown of information,
• addressing a delay,
• recommending a meeting, or
• improvement to a process.

Please describe the outcome or result that you seek from a fairness review. *

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