Expected to Work/Barriers to Full Employment Policy & Procedures

Published Date: August 01, 2011
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17 Appeal and Decision Review

Introduction and Authority

AUTHORITY

Income and Employment Supports Act, Sections: 35 , 36.1, 37, and 43-48
Income Support, Training and Health Benefits Regulation, Sections: 73-74 , 92-94 and 96-97
Disability-Related Employment Supports Review Committee Ministerial Order, Section 7

INTENT

To ensure that decisions made by Alberta Community and Social Services are supported by legislation (either Act or Regulation) and are fair.

POLICY

Matters that are subject to appeal to an Income and Employment Supports Appeal Panel include any decisions of the Director relating to:

Some decisions of the Director are not subject to appeal to the appeal panel. These exceptions are identified in IESA Section 44 and ISTHB Regulation, Section 97.

Powers given to the Minister under IESA and associated Regulations are not within the jurisdiction of the appeal panel to rule upon. While Community and Social Services staff cannot deny an individual the right to appeal a matter that is under the discretion of the Minister, the jurisdiction of the appeal panel is limited to decisions of the Director only.

Appeals to an Income and Employment Supports Appeal Panel

An individual has the right to appeal to the appeal panel, if he/she disagrees with a decision made by Community and Social Services regarding:

  • Eligibility for assistance under Part 2 of IESA that affects the amount or value of income support and benefits (including supplemental benefits), and/or training benefits; and,
  • Eligibility for employment and training benefits under Sections 4 and 5 of the Employment and Training Benefits for Persons with Disabilities Regulation (also known as Disability Related Supports).

Review of Decision by a Community and Social Services Internal Review Committee

Requests for coverage of a specific health benefit that is generally not provided may be made to the Health Benefits Exception Committee (HBEC). The HBEC ensures that individuals have access to health benefits required to meet their unique medical needs when conventional treatments, and goods or services that are normally covered, prove to be inappropriate or ineffective. The HBEC process ensures that decisions are equitable and meet the parameters established by legislation, Community and Social Services agreements with professional associations, Drug Benefit Lists and medical best evidence.

Decisions related to the provision of Disability Related Employment Supports (DRES) must be appealed to the Disability Related Employment Supports Review Committee (DRESRC). DRESRC reviews a decision to ensure that it is equitable and that it meets the parameters established by legislation. Committee members are government employees appointed by the Minister of Community and Social Services.

The authority for HBEC and DRESRC to review matters relating to DRES and Health Benefits is provided under ISTHB Regulation, Section 97 and Disability-Related Employment Supports Review Committee, Section 7, respectively. A ruling made by members of HBEC and DRESRC is final.

Options for Review and/or Appeal of Decision

The following matrix outlines decisions affecting an individual’s eligibility, income support and benefits which are within the appeal panel’s jurisdiction to rule upon. An alternate review medium is also identified for decisions that are beyond the jurisdiction of the appeal panel.

 

Type of Decision

Jurisdiction

Appeal to
Income and Employment Supports Appeal Panel
Review of Decision by Internal Review Committee

Whether an individual has met residency and citizenship requirements as a condition of eligibility under the Income Support (IS) program (residency and citizenship requirements themselves, are not subject to appeal)

Yes N/A
The amount or value of IS and benefits payable based on information provided in the Income Support Application form Yes N/A
Other eligibility criteria for IS benefits Yes N/A
Compliance with Child Support Services (CSS) as a condition of eligibility under the IS program Yes N/A
Eligibility for CSS based on decisions under Part 5 of IESA (including case management decisions) No N/A
Compliance with CSS as an eligibility condition for Alberta Adult Health Benefits (AAHB) Yes N/A
Financial eligibility for AAHB or Alberta Child Health Benefits (ACHB) Yes N/A
Other eligibility decisions for AAHB or ACHB No N/A
Health benefits coverage and requests for coverage outside of professional service agreements and Drug Benefit Lists No HBEC
DRES decisions involving provision of employment and training benefits except for those made under Sections 4 and 5 of the Employment and Training Benefits for Persons with Disabilities Regulation No DRESRC
DRES decisions related to employer and educational institute eligibility No N/A
Case management decisions that do not impact the amount or value of IS and benefits that a client is eligible to receive No Review of Decision by Supervisor/Manager at Alberta Service Centre
Assessment of an overpayment under IESA Section 35 Yes N/A
Determination that repayment of an amount (otherwise repayable) is not required under Section 96 of the ISTHB Regulation Yes N/A
Determination that a Repayment Agreement is not required under IESA Section 16

Yes
Before the Repayment Agreement is signed 

N/A
Amount repayable under IESA Section 16 (i.e., Repayment Agreement) Yes
If the amount was unknown when the agreement was signed
N/A
Determination of the repayment rate

Yes
To a minimum of $1.00

N/A
A sponsor debt under IESA Section 37 Yes N/A
Decisions that relate to appointing a financial administrator or issuing third party payments - when no consent is given by the client Yes 
Appeal panel must rule on the decision
N/A