Thursday, November 17, 2011

LRB overturns decision of a Claims Review Committee

Vice Chair Elena Miller's decision in Matson v. Interior Health Authority issued on November 15, 2011 will be of interest to those unions where long term disability claims are adjudicated by a claims review committee.  This regime is to be found in the health care collective agreements, the provincial public service and other, primarily, public sector collective agreements where the plan is self-funded but its administration is contracted to one of the usual insurance companies.  It is well established that these committees, made up of three doctors whose jurisdiction is limited to reviewing medical decisions, fall within the broad definition of an arbitration board and their decisions are reviewable pursuant to s.99 of the Labour Relations Code.

The Vice Chair set aside the decision and remitted the matter back to the committee because the CRC's decision did not provide reasons which allowed the basis of the decision to be understood.  The LRB stated that while the decision recounted a lot of evidence, there was no link or "meaningful references or connections ...made between that evidence and the conclusion that Matson is not totally disabled from any occupation."

It is a useful decision to consider when assessing whether to pursue a s.99 review of a CRC decision, particularly where there vague allegations that a claimant may be feigning the disability.

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