Document name

Injury Claims – Administrative Errors

Document number

POL 03/2022

Significant delay, means an action or activity that occurs later than what is to be expected, impacting a claim to a noticeable degree in that it results in an extended period of disablement for an injured worker or additional costs to an employer.

1. The Workers’ Compensation Act, 2013 (the “Act”) authorizes the WCB to rescind, alter or amend any decision it has previously made (Section 20(5)).
    
2. The WCB considers it appropriate and fair to remedy an administrative error that adversely impacts a worker’s benefits or the costs applied to an employer’s experience which affects the employer's experience rate.
    
3. No person shall knowingly provide false or misleading information to the Board (Section 180(a)). This may include failing to inform the WCB that an administrative error has occurred.
    
4. While administrative errors made by WCB staff have the potential to impact multiple customers, the intent of this policy is to ensure the identification and correction of errors that unfairly impact individual customers based on the unique circumstances of each claim.

1. For the purpose of this policy, an administrative error is a clerical, calculation or file management error made by a member of the Workers’ Compensation Board (WCB) staff. A file management error includes mistakes made during the administration of a claim.
   1. Clerical or calculation errors may include, but are not limited to, the following:
      1. Incorrect information entered when calculating benefit entitlement such as rate of pay, hours worked, shift premium, vacation or overtime pay, earnings from prior years, dependant information, TD1 status, etc.
      2. Calculation errors.
      3. System errors.
      4. Other data entry errors.
   2. File management errors may include, but are not limited to, the following:
      1. A significant delay in arranging medically requested treatment/diagnostics.
      2. A decision is missed (i.e., WCB staff failed to make a decision or take certain actions at specific points in the management of the claim).
      3. A significant delay in arranging approved services to a worker (e.g., an appropriate vocational rehabilitation plan).
      4. Incorrect approval of travel, sustenance expenses, medical aid or other rehabilitation costs.
2. Situations involving potential administrative errors will be reviewed on a case by case basis considering the individual circumstances of each claim.
    
3. Once an administrative error has been discovered, the WCB will immediately review the claim, notify the worker and employer, and correct the error.
    
4. There is no time limit for when an administrative error may be discovered and corrected on a claim file, however the recovery of an overpayment of benefits must follow the limitations of actions legislation in force.
    
5. The identification and correction of an administrative error is not considered to be a reconsideration of a previous decision. Situations when an actual decision is reversed are directed through POL 23/2014, Reversing Decisions.
    
6. Administrative errors do not include those caused by external conditions that are outside WCB’s control. This includes the activities, actions, or availability of an employer, worker, treatment centre, or any other party involved in the management of a claim.
    
7. The impact of an administrative error may result in either an overpayment or underpayment of benefits to a worker. Benefits impacted may include, but are not limited to, the following:
   1. Earnings loss benefits.
   2. Travel and sustenance expenses.
   3. Annuity amounts.
   4. Medical aid or rehabilitation.

Overpayment

8. If an administrative error results in an overpayment of benefits to an injured worker, recovery efforts will be made in accordance to POL 17/2016, Overpayment Recovery – Compensation.
    
9. Claim costs incurred from an overpayment are automatically removed from the employer’s claims cost experience when the overpayment is discovered and recorded on the claim file (POL 27/2016, Experience Rating Program – Discounts or Surcharges).
    
10. Overpayments may not be recovered when a worker is still entitled to the benefits they have received, typically as a result of a file management error.
    1. When recovery of the overpayment is not pursued, these additional costs will be relieved in the form of an overpayment write-off.
11. When an overpayment is written off, a worker's annuity amount is automatically adjusted (POL 05/2020, Annuities).

Underpayment

12. If an administrative error results in an underpayment of benefits to a worker, WCB will recalculate benefits to provide additional entitlement.
     
13. Employers are not provided cost relief for the additional claims costs that result from an administrative error when a worker is provided additional benefit entitlement.

Other

14. No interest will be payable on retroactive entitlement payments unless a decision to issue earnings loss benefits has been based on a successful appeal (POL 14/2016, Interest on Benefits Accruing from Successful Appeals).
     
15. Workers and employers may appeal any claim decision (POL 21/2013, Appeals – Claims). This includes decisions made by WCB to correct administrative errors.
     
16. If a worker knowingly provides false or misleading information that leads to an overpayment, POL 26/2013, Fines and Penalties may apply.