Original version : WSIB/WSIAT Quality Loop Framework




WSIB/WSIAT Quality Loop Framework

The Workplace Safety and Insurance Act provides the legislative scheme under which the Workplace Safety & Insurance Board (“WSIB”) and the Workplace Safety & Insurance Appeals Tribunal (“WSIAT”) operate. It also defines the legal relationship between the two agencies. That relationship can best be described as “arm’s length”, with WSIB having broad authority to administer the scheme and WSIAT having exclusive jurisdiction to hear and decide appeals from final decisions of the WSIB in areas prescribed by section 123 of the Act.

The legal structure of this relationship requires ongoing and regular interaction between these two agencies. These interactions include the provision of the record and the policy to WSIAT by WSIB as well as WSIAT’s review of WSIB final decisions and WSIB’s implementation of WSIAT decisions.

In order to ensure an orderly transfer of the required information and to ensure the optimum case process for injured workers and employers within the system, the two agencies work together to improve the management of appeals across the system. In keeping with this, a staff working group exists (Quality Loop) between WSIB and WSIAT to identify and address problems and opportunities for system improvement.

It is important to emphasize that this work is carried out in full recognition of the need to preserve the arm’s length relationship between WSIB and WSIAT. It is designed not to infringe upon the respective role or authority of either agency, but recognizes that improved communications, understanding and system knowledge will contribute to better decisions and service delivery for workers and employers.

The appendix below identifies some key areas where improvement opportunities have been and are being pursued through joint activities.

Appendix
WSIB/WSIAT Quality Loop Framework Document

• WSIB and WSIAT identify and consider appropriate options to address systemic issues (example: code of conduct for representatives).
• WSIB and WSIAT improved the flow of case specific information between the two agencies to facilitate WSIAT’s new case management model and more efficient case handling (example: development of the WSIB certified file to ensure completeness of the record transferred to WSIAT).
• WSIB and WSIAT agreed to a set of guidelines for “whole person” adjudication to be applied by decision-makers throughout the system. This concept is based on the principle that decision-making and disability-related cases should not be fragmented by issue or by body part, as this can lead to incomplete and unfair results as well as process duplication.
• WSIB and WSIAT conduct research on decisions and the results are shared where relevant.
• WSIB and WSIAT conduct regular training sessions and pursue opportunities for training and information exchanges where appropriate.
• A sub-committee of WSIB front-line managers and WSIAT representatives has begun to meet to discuss implementation issues arising out of WSIAT orders with a view to improving communications and reducing implementation delays.
• WSIAT invites submissions from WSIB’s Legal/Policy Branch on issues identified as being of interest.
• WSIB’s Legal/Policy Branch reviews released WSIAT decisions and provides support and advice, as appropriate, to the business units that implement the decisions.
• Parties to an appeal may apply for reconsideration of a decision. On occasion, WSIB’s Legal/Policy Branch applies for reconsideration or clarification of WSIAT decisions.
• WSIB and WSIAT share medical information where it is appropriate to do so.

Examples of this sharing include:
(a) WSIB staff have attended medical training sessions organized for WSIAT adjudicators
(b) Medical discussion papers, covering a variety of medical topics commonly involved in appeals, are prepared by medical experts selected by WSIAT. Each Discussion Paper provides a general overview of a topic, written so as to be understood by lay individuals. The papers are intended to serve as educational tools, providing general information to assist Panels’ and parties’ understanding of the medical issue in question. Copies of these Discussion Papers are publicly available and provided to WSIB
(c) All new medical evidence submitted at a WSIAT appeal is placed in the appeal file and returned to WSIB at the conclusion of the appeal
(d) Medical Evidence in (c) includes Independent Medical Assessor reports relied on by WSIAT in reaching its decisions. These reports are regularly reviewed by WSIB’s Clinical Services (Medical) Branch.








The Workplace Safety and Insurance Board
200 Front Street West
Toronto, ON M5V 3J1
Phone: (416) 344-1000
Toll free: 1-800-387-5540
Ontario Toll free: 1-800-387-0750
TTY: 1-800-387-0050
Web site: www.wsib.on.ca