Implementing an ARO decision

A worker contacted the Commission about a delay in implementing a request from the appeals resolution officer (ARO). Four months after the ARO sent the worker’s claim file back to Operations with instructions to obtain more medical information, the work was not done. Workload was the primary reason given for the delay. The claims adjudicator said she was still waiting for one doctor’s report and a copy of the worker’s birth certificate to process a non-economic loss (NEL) referral.

A review of the worker’s file revealed that the WSIB had received the medical report three months earlier. However, it was part of a fax that the representative submitted and was not filed separately. The claims adjudicator said she had not seen the report but would look at it immediately and contact the worker within one week with the outcome of her review.

The request for the birth certificate to process an NEL assessment was based on a policy that applies to claims made since 2002. The Commission noted that this worker’s claim was before that. The claims adjudicator acknowledged her error and immediately sent the NEL referral form for processing.

When the Commission reviewed the file one week later, the claims adjudicator had contacted the worker and her representative to provide a claim status update and sent the new medical information to the medical consultant for review. NEL assessment arrangements were also underway.