- Information is collected and disclosed during decision making. Such collection and disclosure may relate, among other matters, to:
- Making inquiries concerning injuries, treatment and disability, or concerning employers’ business activities, or
- Explaining decisions made by the WCB.
- Workers, employers, and in certain cases, primary health care providers must receive a written explanation of the reasoning leading to a decision.
- The written explanation to the worker must include and/or refer to the information that was used to arrive at the decision. This may, as circumstances dictate, include both personal information and personal health information that is relevant to the decision being communicated.
- The employer at time of injury is entitled to know the reasons for a claim decision, and therefore a separate letter outlining the decision and reasoning must be sent to the employer, but the explanation provided to the employer and/or health care provider should be communicated in such a manner as to convey the basis for the decision without disclosing the specific personal and/or personal health information used in making the decision. Where there are multiple claims with separate employers, each employer will receive a separate letter of explanation.
- In some cases, non-compensable personal health conditions, personal financial circumstances, or family matters play a part in decisions about the claim or employer account (e.g., Section 101 decisions). This information must be provided to the worker when explaining the decision; however, this information must not be provided to the employer or the health care provider. The explanation provided to the employer and/or health care provider should be communicated in such a manner as to convey the basis for the decision without disclosing the non-compensable factors that contributed to the decision.
- Others affected only need to be informed of the extent or duration of WCB payment.
- Written explanations prepared by the WCB staff will not include copies of claim documents. Copies of claim documents may be provided on request in accordance with Points 28 to 45.
- In all cases, the onus is on the WCB to explain decisions, and disclose the information relevant to these decisions. Information that is relevant will have some reasonable connection with, and some value or tendency to prove or disprove a matter of fact significant to the decision (POL 05/2017, Privacy of Information).
- The decision maker will determine what information is relevant to the decision on a case-by-case basis. The relevant documents will include only those that directly relate to the evidence considered and weighed in making the decision.
- The file may include information that the decision maker did not use because it is not directly related to the issue or decision. For example, in determining duration there may be three medical reports that provide clear, direct evidence that the duration was too long, just right, etc. There may also be two other reports that are less current and, therefore, are not used. These two other reports would not be relevant.
- Any in-depth telephone discussions about a decision with workers or employers will be recorded on the claim or employer account. This is separate from the additional right a worker or employer has in some circumstances, to obtain copies of the documents in the claim or employer account.
Identification and Authorization
- Staff should identify the worker, employer or their respective representatives before providing any information in person.
- Where staff recognizes a person on sight, information can be provided.
- Where staff do not recognize a person, the following steps are to be taken:
- The person is required to present photo identification (e.g., driver’s licence), and
- The person’s signature should be verified against documents already on the claim or employer account (e.g., forms Worker’s Report of Injury - W1, Employer’s Authorization Letter of Representation - EREP, Worker’s Authorization Letter of Representation - WREP).
- Before providing any information to a worker’s representative, staff must ensure a valid Worker’s Authorization Letter of Representation (WREP) document or suitable alternative consent form (e.g., a letter from the worker’s lawyer) is on the claim or has been received, indicating that this person acts on behalf of the worker. This authorization remains in effect until rescinded by the worker.
- Before providing any information to an employer’s representative, staff must ensure a valid Employer Authorization Letter of Representation (EREP) document or suitable alternative consent form (e.g., a letter from the employer’s lawyer) is on the employer account or has been received, indicating that this person acts on behalf of the employer. This authorization remains in effect until rescinded by the employer.
- Where staff receive telephone requests for information from workers, employers or their respective representatives, these may be transferred to the appropriate staff assigned to the claim or employer account in question.
- Staff should verify the identity of the person on the telephone by reference to information already on the claim or employer account.
- Where staff are unsure of the identity of a person on the telephone, information should not be provided, and an alternative should be used:
- Call back to a number already on the claim or employer account.
- Fax the requested information to a number already on the claim or employer account, or
- The caller should be advised to make their request in writing.
- Where information is provided on the telephone or in person, this should be recorded on the claim or employer account.
- Certain information can never be provided on the telephone. For example, electronic banking information, social insurance number, or provincial health number.
- Staff must avoid identifying the source of information which adversely affects entitlement to benefits, when there is a realistic possibility that the safety and security of the source may be at risk as a result. One criterion for judging this would be whether the safety and security of WCB staff has been in question on this claim or employer account.
- Where there are concerns as to the sensitivity of information, staff should consult their supervisor.
- Where a medical summary is requested, the request should be sent to Medical Services for response.
Third Party Requests
- Inquiries from Members of the Legislative Assembly or Members of Parliament should be directed to the Executive Inquiry and Information Officer or designate, who is empowered to discuss claims or employer accounts without written consent. If copies of documents are required, Sections 173 and 174 procedures will apply.
- Where under a legal obligation to disclose information (e.g., courts, law enforcement agencies, maintenance enforcement officials, ombudsman, employment insurance officials) and where the party is requesting copies of claim documents, the WCB will provide such copies double-enveloped and delivered via suitable means of assured delivery.
- In accordance with POL 10/2017, Interjurisdictional Agreement on Workers’ Compensation (IJA), staff will respond to requests from other WCB jurisdictions for the exchange of IJA claim or employer account information. Staff will take the same identification precautions that are used for inquiries from workers and employers.
- Information sharing agreements will be executed by the Chief Executive Officer or designate after review by the Corporate Solicitor. Legal Services will centrally store the original signed agreements with copies held in the relevant departments.
- Although individual agreements will vary on specific terms, all third parties will be bound by a confidentiality clause regarding the use and storage of information requested, stating:
- Information is to be used only for the purpose requested.
- Information is to be used only by the parties to the agreement, except where subsequent disclosure is specifically permitted by the WCB (e.g., as evidence), and
- Information will be afforded adequate and appropriate security as outlined by the WCB.
- Information sharing agreements for providing bulk data on a one-time basis will include these conditions:
- Will not use the information for commercial purposes, and
- The request is for the purpose of enhancing prevention, treatment or return-to-work programs.
- The Director of Communications is designated as the WCB contact for all media inquiries and is authorized to provide information to the media after consultation with senior management.
- Where the media approaches the WCB, the Director of Communications shall ask the media representative to obtain a signed waiver from the customer before any information is disclosed.
Methods of Disclosure
- Business may be conducted by email but out-going communications may not be private or secure and could be intercepted. The WCB has, therefore, ensured all email messages include a confidentiality disclaimer and will be considered acceptable, unless the respondent declines this method of communication.
- Bulk data may be sent through email, postal service or courier service.
- Copies of claim documents may be provided on request to workers, dependents, worker representatives, employers or employer representatives.
Workers, Dependants and Representatives
- To request copies of claim documents, a worker, dependant or worker representative must use a Worker’s Request for Copy of File (WROI) form. No formal appeal is required, and it is not necessary to identify the issue in dispute. However, in accordance with subsection 173(3), the information provided is to be used only for the purposes of a reconsideration or review of a decision of the WCB.
- To request copies of claim documents, a worker’s representative must submit a Worker’s Authorization Letter of Representation (WREP) in addition to the Worker’s Request form. When a worker is unable to sign the authorization letter due to psychological or functional incapacity, the worker’s spouse or legal representative may act on the worker’s behalf.
- Once the Request form is received, copies of claim documents will be reviewed to determine if any information should be redacted or removed. Typically this would be information that falls under Points 56 and 57 below.
- After review, the claim documents will be provided to the claimant by means of a double-envelope system. This includes:
- An outside envelope with the name and address of the claimant, and
- An interior envelope with a bold notice to the effect of: "THIS DOCUMENT IS CONFIDENTIAL AND IS TO BE OPENED ONLY BY [WORKER’S NAME].”
- The claim documents may be delivered by one of the following methods:
- Upon providing proof of identity, claimants may pick up their information at the WCB office. The WCB should obtain an acknowledgement of receipt.
- Claimants who live in a city or a town may receive their information by courier.
- Claimants who do not live in a city or town may receive their information by express post. This will ensure that there is a record of the envelope and a signature required on delivery. In addition, the envelope may be traced if it does not arrive as anticipated.
- There will be no charge in the first instance, but any subsequent request for the same copies shall be subject to an administration fee of $50.00 plus a charge of $0.25 per page.
- Documents received after an initial request for copies of claim documents has been processed will be provided to the worker, dependant or their representative upon request. A new WROI is not required in order to provide updated claim information.
Employers and Representatives
- To request copies of claim documents, an employer must use an Employer's Request for Photocopy of Relevant Records in File(s) form for each claim. No formal appeal is prerequisite, but the issue in dispute must be clearly identified and must concern a decision made on the claim or a pending appeal.
- To request copies of claim documents, an employer’s representative must submit an Employer Authorization Letter of Representation (EREP) in addition to the Employer's Request for Photocopy of Relevant Records in File(s) form for each claim.
- Where the employer requests copies of claim documents:
- The decision maker Operations staff will identify which documents are relevant to the decision in question. Copies are made only of those claim documents that are identified as relevant to the decision on the claim. Copies may be redacted to block out irrelevant information.
- After identification by the decision maker, the selected copies will be compiled by Operations staff. These will be provided to the worker by the means described in Point 37, along with a letter of initial notification that they have 15 business days from receipt of the letter to request a reconsideration of the copies to be provided to the employer. Any objections raised by the worker must be related to specific documents and be provided in writing with reasons given.
- On the expiry of the initial notification period and after considering any objections received, the staff responsible for the claim will:
- Determine what information will be sent to the employer or employer’s representative.
- Explain any changes in the selected copies to the worker or the worker’s representative, in writing by express post, of their decision, and
- Provide the worker or the worker’s representative with 15 business days for final objections.
- If no further objections are received, the requested copies will be sent to the employer as outlined under Points 42 and 43.
- Where further objections have been received, they will be considered by the staff responsible for the claim, and the final selection of copies will be explained to the worker in writing by express post. Copies will not be sent to the employer before the expiration of the fifteen days provided for in section 174(7) or the date of a determination regarding the objections, whichever is later.
- If staff are unable to contact the worker, staff will make all reasonable efforts to locate a current address or phone number for the worker (i.e., contacting the spouse, employer, co-workers, etc.). WCB staff will document all efforts to locate the worker. If the worker cannot be located, staff will ensure that copies are made only of those claim documents identified as relevant to the decision on the claim. Copies may be redacted to block out irrelevant information.
- Copies will be provided to the employer by the means of a double-envelope system. This includes:
- An outside envelope with the name and address of the employer, including a specific contact person, and
- An interior envelope with a bold notice to the effect: “THIS DOCUMENT IS CONFIDENTIAL AND IS TO BE OPENED ONLY BY [EMPLOYER CONTACT NAME].”
- The claim documents may be delivered by one of the following methods:
- Employers who have a business address in a city or a town may receive their information by courier.
- Employers who do not have a business address in a city or town may receive their information by express post. This will ensure that there is a record of the envelope and a signature required on delivery. In addition, the envelope may be traced if it does not arrive as anticipated.
- An employer may request that the WCB reconsider the decision regarding the copies of documents within 15 business days of the date of the decision.
Accuracy of Information
- After reviewing copies of documents, workers or employers may submit to the WCB a written explanation of any matter they believe is in need of correction, or submit additional related information to be included in the claim or employer account.
- If the correction required involves markup or removal of claim documents, the number of documents and reason will be recorded in a memo on the claim, without revealing the information removed.
Collection of Personal Health Information
- On occasion, as a result of requesting a worker’s personal health information from a health care provider to determine entitlement, WCB may obtain more personal health information than necessary to determine entitlement. After receiving and reviewing copies of documents, a worker or a worker’s representative may submit to the WCB a written explanation if they have a concern about personal health information collected.
- WCB staff responsible for the claim will:
- Review the medical documents to determine whether the personal health information collected is or is not relevant for the adjudication of the worker’s injury claim.
- Delete all personal health information determined to be irrelevant from the worker’s electronic injury file. If the irrelevant personal health information is included within a relevant document, WCB staff will ensure the irrelevant information is redacted.
- Send the worker or the worker’s representative written notification, by express post, listing the documents which were removed from their file and a copy of each removed document. This will ensure that there is a record of the envelope and a signature required on delivery. The letter will explain any changes in the requested documents and will be documented on the worker’s file. The list of deleted documents will not be disclosed to the employer.
- Any further objections raised by the worker must be provided in writing with reasons. The staff responsible for the claim will determine what information is considered relevant and should remain on file.
- When objections are not resolved by the staff responsible for the claim, the worker will be advised to send a written complaint to the Privacy Officer.
FOIPP Access Requests
- Any application for access to information which cites The Freedom of Information and Protection of Privacy Act (FOIPP) will be sent directly to the Privacy Officer.
Office of the Worker’s Advocate
- The Office of the Worker’s Advocate will be provided with electronic access to claims, subject to a confidentiality agreement. In some cases, they will require copies of claim documents, which will be double-enveloped and delivered via suitable means of assured delivery.
- The following types of documents do not properly form part of the claim or employer account. Copies of these documents should not be provided:
- Legal opinions.
- Comments or advice concerning specific courses of action recommended by the Corporate Solicitor, Legal Services and/or the Privacy Officer.
- Opinions and recommendations of the Fair Practices Office.
- Working papers or notes taken by Board Appeal Tribunal members during the course of a hearing or deliberation.
- Internal Audit investigation reports.
- The working papers or notes of a fraud investigator of Internal Audit, or
- Documents related to the WCB's safety and security administrative procedures.
- Copies of documents identifying the source of information adversely affecting entitlement to benefits may be copied and sent, unless there is evidence that the security of that source may be at risk as a result. One criterion for judging this would be whether the security of WCB staff has been in question on this claim.
- When a worker requests a copy of their claim document, documents containing sensitive medical information considered harmful to the worker or any other person will not be sent directly to the worker. Instead, WCB Medical Services will send the report to the worker’s primary care provider with a covering letter of explanation. The care provider will explain the contents of the medical report to the worker. When staff members are unsure if it is appropriate to send a copy of a sensitive medical report directly to the worker, the advice of Medical Services is to be sought.
- Copies of documents on other claims of the same worker should be provided, where they are relevant to the issue(s) in dispute on the claim just decided.
- Any initial objections to file disclosure will be considered by the staff responsible for the claim. When objections are not resolved, the worker or employer will be advised to send a written complaint to the Privacy Officer. PRO 19/2013, Information Complaints, will apply.