Please review and confirm the information in the attached summary of information on the appeal structure and process in your jurisdiction.

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1 INTERVIEW QUESTIONS - WORKERS' COMPENSATION INTERNAL APPEALS POLICY AND PROCESS JURISDICTION: QUÉBEC 1. STRUCTURE OF APPEAL PROCESS Please review and confirm the information in the attached summary of information on the appeal structure and process in your jurisdiction. In addition, if not already covered in the excerpt, can you please provide the following information: Who sits on the Appeal Body? Since April 1, 1998, the Québec system has had in place an administrative review process 1. Is the internal appeal process required by legislation? Section requires an administrative review to be carried out by a person designated by the Chief Executive Officer. 2. SCOPE OF APPEAL AND TIME LIMITS If not covered in the summary of your jurisdiction's appeal process: Do employers have the same options as workers to an internal appeal? If not, what differences are there in access to appeal and the appeal process for employers and workers? Employers have the same options as workers for administrative review. 1 Administrative review replaces the former process of internal review through Appeal Panels and conciliation. 6/22/98 Page 1

2 Interview Questions - Workers' Compensation System Appeals Process - QUÉBEC Is there a time limit for bringing an appeal? Is there a time limit imposed on the appeal body for the hearing of an appeal? If there are time limits, to what extent are these time limits achieved at the present time? A person aggrieved by a decision of the CSST has 30 days from the decision of the CSST to request an administrative review; 10 days if the decision relates to an occupational health and safety matter. There is no time limit in the legislation for the completion of the administrative review, but, by policy, the goal is to issue an administrative review decision within 60 days of receiving the request for review. What is the nature of decisions allowed for internal appeal? A person may not request a review of a Medical matter Disciplinary matter; Decision that has already been submitted for administrative review. [See attached sheet describing administrative review process.] 3. PRACTICE AND PROCEDURES How would you describe the basic approach to appeals in your jurisdiction (for example, is it based on an inquiry or an adversarial approach)? The new administrative review process is inquiry based - it is designed to be very flexible, very informal and very accessible. Is the internal review a review and reconsideration of information in the files or are oral hearings held? Is the original adjudicator interviewed as part of the internal review process? The administrative review process is a documentary review of the decision. Adjudicators are not party to the review process and are normally not interviewed, but will be informed of the reasons if a decision is overturned. Are the results of the decisions of the internal appeal body public? Is the internal appeal body required to report publicly on its activities? The results of the decision of the administrative review process are not public; aggregate statistics will be included in the CSST's annual Report. 6/22/98 2

3 Interview Questions - Workers' Compensation System Appeals Process - QUÉBEC Do appellants have complete access to claim files and information in the internal review process (is access right in WCB legislation or a result of Freedom of Information and Protection of Privacy Act). Is further information found in sub-files which do not form part of the claim file? And if so, are sub-files disclosed? "Is relevancy of material in a board file a prerequisite to its disclosure to the affected worker or employer? If so, who determines whether the information is relevant and on what basis? Does the worker or employer have the right to object to the relevancy of the information after it has been disclosed? A worker has full access to their own file and an employer has access to their employer file. An employer has a right of access, free of charge, to their worker's file except for medical information. Medical information may not be released directly to an employer and may only be released to the employer through a designated health professional under the Act. Information not considered relevant to the matter at hand will not be released - if the information is not used for the purpose of making a decision it is not subject to release. However, if the issue is under dispute, any information used in rendering the original decision is considered relevant and subject to disclosure. 4. STUDIES AND STATISTICS Are there any studies respecting client satisfaction with the internal appeals process in your jurisdiction. Are the results of any surveys or reports publicly available? No surveys or reports are available on the new administrative review process. Review Statistics: Nothing is available yet on the new review process. Attached is a sheet summarizing the activities of the old Review Boards - Review Requests Received and Decisions Handed Down by the Review Boards ( ) 6/22/98 3

4 Can a CSST Decision Be Challenged? As a general rule, any person who believes he or she has been wronged by a CSST decision has the right to contest it. The procedure to follow varies, however, depending on the nature of the decision. In most cases, the first step consists of submitting an application for review in writing. It must state the subject of the decision, as well as the grounds for the contestation. This application must be addressed to the CSST office located in the region where the worker lives. The usual time limit for filing an application for review is 30 days after receiving a CSST decision. However, the time limit is only 10 days when the application concerns an inspector's decision, the exercise of the right of refusal to work, or the refusal to re-assign a pregnant or breast-feeding worker. A CSST referee examines the subject of the application and proceeds to re-examine the file. He or she gives the parties involved the opportunity to provide information that could shed new light on the issue without, however, requiring them to attend a hearing. The purpose of this administrative review is to ensure that the decision was rendered in accordance with the law and taking into account all facts and circumstances pertinent to the case. To contest a decision rendered by the CSST following an administrative review, a request must be submitted to the Commission des lésions professionnelles (CLP) within the time limit prescribed by law. The CLP is an administrative tribunal whose members are appointed by the government. Before summoning the parties to a court appearance and rendering a decision, the CLP may offer them conciliation services to give them an opportunity to reach an agreement. Most CSST decisions take effect as soon as they are handed down, even when there is an application for review or a contestation filed with the Commission des lésions professionnelles. However, the law provides for certain exceptions. The Reconsideration of a CSST Decision Reconsideration allows the CSST to review, subject to certain conditions, its decisions in cases where errors were made or where decisions were taken without knowledge of an essential fact. However, reconsideration of a decision that has already been submitted for administrative review is not possible. It should be noted that the CSST can also offer conciliation between workers and employers. Reconsideration is a dynamic process aimed at disencumbering review and appeal structures. When a decision causes dissatisfaction, the CSST encourages communication between the person concerned and the employee handling his file. Before proceedings are undertaken to contest the decision, the reasons for the decision can be explained and, if necessary, information allowing for the reconsideration of the initial decision can be compiled.

5 Table 12 Review Requests Received and Decisions Handed Down by the Review Boards ( ) Review requests received Requests % Requests % Requests % Compensation Requests from workers 16, , , Requests from employers 6, , , Funding Requests from workers Requests from employers 3, , , Prevention-Inspection Requests from workers Requests from employers Disciplinary measures and the For a Safe Maternity program Requests from workers Requests from employers Sub-total Requests from workers 17, , , Requests from employers 10, , , Total 28, , ,951 4 Decisions handed down Decisions % Decisions % Decisions % Initial decision overturned Requests from workers 4, , , Requests from employers 2, , , Initial decisions upheld Requests from workers 7, , , Requests from employers 3, , , Sub-total Initial decision overturned 7, , , Initial decision upheld 11, , , Total 18, , ,990 5 Files closed 27,260 30,872 34, requests were made by a party other than a worker or an employer decisions were handed down regarding requests made by a party other than a worker or an employer. 3 5 requests were made by a party other than a worker or an employer. Note: The data of the 1995 activity report have been modified to include decisions arising out of an agreement requests were made by a party other than a worker or an employer decisions were handed down regarding requests made by a party other than a worker or an employer.