DRDRB decision implementation

Customer Service (CS) supervisor

Review the DRDRB decision to understand the outcome and whether the decision was unchanged, changed, partially changed, or if alternate direction was provided.  Additionally review whether Interim Relief (IR)Interim relief is financial support provided to workers or employers while they wait for a decision to be made on a RFR or Appeal issue. benefits have been paid to the worker and direction from the resolution specialist.

For questions about the decision, reach out to the resolution specialist. Refer to the Resource Library for additional information.

When the decision is:

• unchangedThe decision is supported and remains in place.:
  • and includes alternate direction and/or IR benefits were paid, assign the claim to a decision maker to action the direction and/or address the resolution specialist's recommendation on IR benefits.
  • with no alternate direction and the worker is not in receiving IR benefits, end this procedure.
• changedThe most recent decision on the issue is not appropriate and is fully reversed. or partially changedSome part(s) of the most recent decision on the issue is changed and further action is required.:
  • Assign the claim to a decision maker to implement the decision, address IR benefits, if paid, and action any alternate direction provided. 

Decision maker

Review the DRDRB decision memo and determine whether the decision authorizes reimbursement of expenses (e.g., travel, subsistence) to the requester and arrange payment, if required.

Consider any direction related to IR benefits, where applicable, and determine the appropriate course of action. 

If IR benefits were paid and:

• no direction was provided: Contact the resolution specialist to confirm whether IR benefits should be discontinued and take action based on the direction provided. IR benefits should not be issued beyond the DRDRB decision date until direction from the resolution specialist has been received.
• direction is provided to discontinue IR benefits and
  • no recovery is indicated, discontinue IR as directed.
  • recovery is indicated, discontinue IR and create an overpayment for the amount paid in IR benefits.

Note: The resolution specialist makes the decision as to whether IR benefits will be discontinued and if they need to be recovered. They communicate the decision in writing to the worker. The decision maker actions their recommendation to pay or discontinue IR benefits and recover the benefits from future wage loss payments.

Decision maker 

Review the DRDRB decision and develop a plan to implement the decision, if needed or to action any alternate direction within 30 days.

Contact the requester to discuss the plan and next steps within five business days of being notified the DRDRB decision is on file. 

When the decision can be implemented immediately and

• no wage loss benefits are payable, continue to step 6.
• wage loss benefits are payable, continue to step 5. 

When the decision requires more time for implementation, explain the implementation plan to the requester. Confirm their understanding of next steps and expected timelines for full implementation. This may include requesting additional information, investigation or arranging assessments or services. Communicate the implementation plan in writing and notify the supervisor of the plan including the expected timeline for completion.

If implementation is expected to take longer than 30 days due to the required actions, discuss a tentative timeline with the requester and notify the supervisor.

Supervisor

Review the implementation plan and provide suggestions or feedback, when needed. 

Decision maker

Review the supervisor's and/or manager's feedback regarding the implementation plan, and address any questions or requests for additional information, if required. Action any recommendations, as appropriate.

Note: The goal is to begin implementation of the DRDRB decision within 14 days of the decision and complete it within 30 days, whenever possible. These timelines are calculated from the DRDRB decision date recorded by the resolution specialist in the Issue Review Screen. 

Arrange assessments and/or services and gather additional information, as appropriate. Take the steps needed to implement the decision and/or action alternate directions. Gather information (i.e., updated earnings, earnings paid during specific time periods such as modified work, etc.) required to issue the payments, if applicable.

During the implementation period, maintain regular contact with the requester to update them on the status of the implementation at least every two-weeks.

If the timeline or plan for implementation changes, call the requester to update them on the plan. Explain the reason for the changes (e.g., awaiting required information, assessment or service) and the expected timeline to complete implementation. Send a letter to update the implementation plan and notify the supervisor of the change.

Once all investigation is complete, consider any benefits the worker may be eligible for based on the changed decision, even when not specifically directed by the DRDRB. For example, if the DRDRB directed the determination of a worker’s fitness level for a specific retroactive period and it is determined that restrictions existed, consideration should be given to whether the worker was eligible for a wage loss supplement for the retroactive period, even though the DRDRB did not provide that direction.

If wage loss benefits are payable, continue to the next step. 

If wage loss benefits are not payable, continue to the step 6. 

When wage loss benefits are payable, request payment of benefits owing to the worker.

• If IR benefits do not require recovery, proceed to the next step.
• If IR benefits require recovery, place wage loss benefits on hold.

Recover IR benefits

If an overpayment for the IR benefits has not been created as outlined in step 2, create the overpayment.

Recover the overpayment from the benefits owing to the worker, if applicable. When the overpayment amount is higher than the wage loss amount owing to the worker, cost correct (forgive) the remainder of the IR benefit overpayment. Obtain supervisor approval, if required. 

Notes: 

• Details about IR payments issued to the worker are not shared with the employer/employer's representative. Do not include any details about IR being discontinued or recovered from wage loss payments in the implementation letter.
• The resolution specialist monitors the claim to ensure IR benefits are discontinued and notifies the worker of the amount of IR recovered from the wage loss payments.  

Decision maker

Ensure all actions taken fully align with the DRDRB decision and the decision is completely implemented. 

A decision is considered fully implemented when all benefits have been issued to the requester, all required referrals or services have been arranged and a letter confirming the implementation is sent. When the implementation plan extends over a long period (e.g., a retraining program), the plan is considered implemented as of the date the plan and benefits are approved at the required Levels of Authority. 

Call the requester to advise the DRDRB decision is fully implemented and send the appropriate letter. 

Note: Information related to IR benefits should not be addressed in the discussion or the letter. DRDRB is responsible for monitoring the claim to ensure IR benefits are discontinued and recovered from any wage loss benefits paid. Refer to the Key Information section for further details about protecting the requester's privacy on IR benefits.

Notify the supervisor that the decision implementation is complete. Include details about whether benefits or services to the worker increased, decreased or were unchanged as a result of the implementation. 

CS supervisor 

Review the steps taken and confirm the decision is fully implemented. Implementation is complete when all benefits have been issued and/or referrals for services have been completed, and a letter is sent confirming the implementation. 

If the implementation is complete:

• Update the status of the implementation in eCO.

If the implementation is incomplete:

• Provide feedback or guidance to the decision maker, if needed.
• Review the file again before 30 days from the date the decision was received. If the decision has not been implemented, continue to monitor the file until implementation is completed and then repeat this step.

Notes:

• When the plan will not be completed for an extended period of time (e.g., an academic program), the plan can be considered implemented as of the date the plan and benefits are approved by the required Levels of Authority.
• The resolution specialist(s) monitors the claim until the decision is fully implemented. 

Decision maker

Review any recommendations from the supervisor. Return to step 4 to continue implementing the decision, if the supervisor is indicating it is not fully implemented. Discuss the outstanding actions with the supervisor, if needed.