December 1996 www.smartt.com/~componet Volume 1.4

CompoNet News

RECOGNIZE AND PREVENT MANIPULATION OF YOUR CLAIMS INFORMATION

The single most important factor in protecting an injured workers rights to fair and legal benefit entitlement, is to maintain control over the management of their claim and to learn to recognize and prevent Board efforts to manipulate file information for the purpose of denying or reducing those benefits.

This is equally important whether a worker suffers an obvious injury and /or disease due to a specific incident or trauma, or an injury and /or disease resulting from an activity over time.

The key to achieving this goal is to maintain an ongoing knowledge of information being gathered and recorded and to ensure that that information is accurate, complete, and supported by fact.

This practice must begin at the moment of injury, or suspicion of injury or exposure, and a trusted co-worker, family member, or friend should be designated and authorized to assume responsibility for protecting your interests in case of a serious incapacitating injury.

An injured worker should ensure complete documentation is undertaken at the time of injury, or incident and request copies of all initial reports at that time, this includes first aid reports, witnesses names and statements, employers reports, and any other documentation warranted by the circumstances. Be sure also, to keep a copy of your own injury report to the Board.

All parties providing any form of information should be immediately informed, verbally (in the interest of expediency), and then with follow-up written confirmation, that you are requesting ongoing disclosure of information, making it clear that this means any and all information created or gathered in any form, including all information provided between parties is to be copied to you on an ongoing basis.

All parties should also be informed in the same manner, that all verbal communication is required to be recorded in writing as to purpose and content, and disclosed accordingly.

It should also be made clear in writing that the location and nature of any and all information held apart from the main claim file be clearly identified on the main claim file.

Documentation should be carefully reviewed for accuracy, and completeness, as well as interpretative statements, or opinion, not supported by fact and /or the greater weight of evidence.

All information should be carefully reviewed and compared for continuity and consistency, with special attention being given to the content of opinions and interpretations for possible discrepancies, as well as selective and manipulative information, submitted by Board employees and consultants.

Discrepancies in the accuracy and /or completeness of information should immediately be challenged with a request for correction being made to the WCB Freedom of Information and Protection of Privacy Office under Section 29 of the Freedom of Information and Protection of Privacy Act with a copy being sent to the Office of the Information and Privacy Commissioner:

David Flaherty
Office of the Information and Privacy Commissioner
4th floor, 1675 Douglas Street
Victoria BC V8V 1X4
Fax : (604) 387-1696

Sections 28 and 29 of the Freedom of Information and Protection of Privacy Act state:

Accuracy of personal information

28. If an individual's personal information will be used by a public body to make a decision that directly affects the individual , the public body must make every reasonable effort to ensure that the information is accurate and complete.

Right to request correction of personal information

29. (1) An applicant who believes there is an error or omission in his or her personal information may request the head of the public body that has the information in its custody or under its control to correct the information.

(2) If no correction is made in response to a request under subsection (1), the head of the public body must annotate the information with the correction that was requested but not made.

(3) On correcting or annotating personal information under this section, the head of the public body must notify any other public body or any third party to whom that information has been disclosed during the one year period before the correction was requested.

(4) On being notified under subsection (3) of a correction or annotation of personal information, a public body must make the correction or annotation on any record of that information in its custody or under its control.

The Boards preferred practice in this regard is to annotate rather than correct information placing the claimants request for correction in a separate 'red dot' folder, however a number of Board officers have admitted that these 'red dot' folders are ignored, as annotations are considered to be corrections the Board disputes and are therefore disregarded.

Sections 99.30 and 99.31of the WCB Rehabilitation Services and Claims Manual state:

#99.30 Disclosure of Claim Files

The standard practice of the Board, is in the adjudication and ongoing management of compensation claims, is that the claim file is the master record for recording all information with respect to a claim. Whatever is done on the claim file and whatever evidence is used in the adjudication process must be recorded or placed on file. When obtained by the Adjudicator or other Board officer, the opinions of both outside physicians and Board Medical Advisers, as well as any further comments on the part of the Adjudicator or other Board officer, are all recorded on, and become part of, the claim file.

Discretion is necessary in documenting the file to ensure that rumour or innuendo is not mistakenly reported as fact where it is unsupported or cannot be verified. Board staff members should confine their file comments regarding claimants, employers and other persons involved in the claim to relevant matters which they have observed personally or for which there is other supporting evidence. They should confine their observations to the particular circumstances of the claim or other matter and should not make general comments about an individual's personality. They should word their comments in the least offensive way possible and avoid derogatory terms.

In recognition of the sensitive nature of sexual assault claims where the employer is alleged to be the perpetrator of the assault, all such cases, regardless of the residence of the worker, are assigned to the Sensitive Claims Area. Disclosure of these claim files for appeal and other legal purposes is administered by the Sensitive Claims Area.

# 99.31 Eligibility for Disclosure

Disclosure of their claim files is provided to a worker or dependant on request. Only one copy is provided and no fee is charged for this disclosure.

The WCB routinely ignores these policies and maintains numerous sub-files containing important information about a claim which is not recorded on the main claim file and is not disclosed to the claimant, but are used in the adjudication of the claim as well as the appeal process.

It is these practices that make it imperative that claimants also make information requests under the Freedom of Information and Protection of Privacy Act in order to secure information Records Management fails to disclose.

When the WCB does provide disclosure through either a request to the Records Management Unit or the Freedom of Information Office, they are, in the greatest percentage of instances, incomplete, and the information that is provided only includes information updated to the time of request rather than the date disclosure is provided, which means disclosures are routinely outdated by several months by the time they are received.

It is important to understand the serious implications of this practice in that, it denies claimants the right of access to the same information as is being used to make decisions about them.

It also denies claimants the ability to be appropriately informed in order to evaluate and prepare for exercising their right to appeal.

Therefore, a claimant should, upon receipt of a decision, immediately request disclosure updated to the time disclosure is provided, as well as requesting automatic updates of information up to and including the date the appeal is to be heard, as is provided to the appellant bodies.

The appropriate appellant body should be notified of this request and a request should be made for an extension of time in all matters relating to the appeal process equivalent to the length of time required to receive all information from the Board, and effect all necessary corrections and /or submissions.

Requests under the Freedom of Information and Protection of Privacy Act should be made to the appropriate appellant bodies as this has proven to reveal off-the-record involvement by appellant bodies which the claimant was previously unaware of.

Careful attention should also be given to dates, and envelopes should be kept attached to the related information for referral to post marks, as a common practice of the Board has displayed significant discrepancies in the dates of documentation and the post marks related to that same information, creating a false impression as to when a claimant actually gained access to the related information. Similarly strict records should be kept of fax transmittals and telephone communications.

All verbal communication with the Board, or anyone you are referred to by the Board, without the protection of a trusted witness, or being tape recorded, should be strictly avoided. This practice will prevent discrepancies in information arising out of one of the Boards most common methods of file manipulation which is the "interpretative reporting of information".

Board medical examinations and physical testing should be conducted in the presence of a trusted witness and if this is not possible should be tape recorded assuring the examiner or tester is questioned through-out as to the purpose of requested undertakings and their impression of the results, as evidence has shown a common problem to be that the content and conclusion of reports provided to the file are often far different than what the claimant was led to believe at the time, or in fact what the results actually were.

Demand verification, in writing, from any Board officers making decisions on your file as to any assistance or advice they received from any other Board officers in reaching their decision, as it has also been proven that the Board officer writing the decision has often had the decision dictated to them and in some cases by the very manager who may ultimately conduct a Manager Review, in other cases the Board officer whose signature adorns the document has proven not to be the author or even to possess a reasonable knowledge of the content or history of claim, and further evidence has shown the submission of documentation by Board officers who are supposed to be prevented under the Act from influencing the adjudication process.

In summary it is imperative that claimants keep these key points in mind:

On-going involvement and knowledge about the management of your claim file is essential to fair and legal benefit entitlement.

The WCB will diligently oppose all attempts for access to information. Secrecy is the key factor in allowing the practice of file manipulation to continue unchecked, the longer the information remains on file unchallenged, the more the problem is compounded, and the more difficult it becomes to effect correction. It is your right to be kept informed and participate in the fair adjudication of your claim, you have an undeniable right to your information, the Boards refusal to provide that access nullifies any decision they or the Appellant Bodies render.

Do not tolerate passive action on behalf of the Information and Privacy Commissioner's Office as they have shown a tendency to attempt to submissively negotiate the Freedom of Information and Protection of Privacy Act rather than enforcing it, allowing the Board to misuse sections of the Act based on their own self-serving interpretation.

Know and demand strict enforcement of your rights and know that the Information and Privacy Commissioner's decisions are subject to Judicial Review.

The WCB maintains their corporate interests as the primary consideration above all else.

Many Board officers intentionally manipulate the gathering, reporting, and filing of information for the purpose of denying or reducing legitimate benefit entitlement.

Many Board officers maintain an amiable relationship, intentionally misleading claimants to avoid suspicion while manipulating the management of the file to effect dis-entitlement of benefits.

Numerous sub-files are maintained and used for adjudication and appeal purposes which are not provided to the claimant with disclosure, and supportive documentation previously noted as being part of the claim record has been proven to be removed from the file.

Minor to moderate injury estimated to represent a short term claim will be generally dealt with reasonably until there is any sign of the possibility of long term complications or disability at which point a concerted effort will be initiated to disallow or substantially minimise benefit entitlement. Beware of claim designation changes, or adjudicator changes.

Clear, complete, detailed reports from outside medical practitioners are essential, the Board is required to return incomplete, unclear medical reports, however, they instead promote minimal reporting that is easily subject to manipulative interpretation.

Decisions rendered by appellant bodies, based in whole, or in part, on information held apart from the claim file, and withheld from the claimant, and /or on incomplete claim file information, are not legal.

Negligent and /or illegal claims management is legitimate grounds for Judicial Review and provides the claimant with the opportunity to have their case heard before a Supreme Court Justice.


QUOTE OF THE DAY:

BOARD OFFICERS GO TO GREAT LENGTHS TO MOULD A CLAIM FILE
INTO A COLLECTION OF ONLY THE INFORMATION WHICH ALLOWS THEM
TO PROMOTE AN INTERPRETATION THAT BEST SUITS
THE BOARDS CORPORATE INTERESTS
THAT’S THEIR JOB

SENIOR BOARD OFFICER - 20+ YRS