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Expected to Work/Barriers to Full Employment Policy & Procedures

Published Date: May 23, 2017
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17 Appeal and Decision Review

Right to Appeal and the Appeal Process

AUTHORITY

Income and Employment Supports Act, Sections: 43-48
Income Support, Training and Health Benefits Regulation, Sections
: 73-74 , 93-94 and 96-97


INTENT

The process to obtain a Review of Decision or to appeal a decision to an Income and Employment Supports Appeal Panel is transparent and conducted in a fair and timely manner.

POLICY

Community and Social Services is required to inform an applicant or recipient (client) when a decision is made that affects his/her eligibility, income support, and/or other benefits. Specifically, workers are required to:

  • Provide details of the decision and rationale explaining why the decision was made;
  • Advise the client of his/her right to appeal the decision to the appeal panel within 30 days of receiving notice of the Department’s decision;
  • Explain the process involved in appealing a decision to the appeal panel;
  • Inform the client that he/she must initiate the appeal process by submitting a written Notice of Appeal to the Alberta Works Centre or to the Appeals Secretariat;
  • Explain that benefits under review and/or appeal are not issued pending the outcome of an appeal hearing; 
  • Advise a client with eligibility for the same benefit(s) under another department and/or a non-government program, that he/she must pursue these alternate options, (including appeal), prior to initiating an appeal with the appeal panel; and,
  • Document all eligibility decisions and issues that are under appeal in Mobius Notes.


Notification:

A Community and Social Services staff member (the worker) makes a decision regarding eligibility for assistance under Part 2 of the Income and Employment Supports Act (IESA), based on information contained in the Income Support Application. After determining eligibility for assistance, the worker is required to notify the client of:

  • The details of a decision (with supporting rationale) that affects eligibility for assistance under Part 2 of IESA;
  • His/her right to appeal this decision; and
  • The process and the 30-day time limit to appeal the decision to the appeal panel.


A client is deemed to have received notification:

  • Verbally, on the date that the conversation with the worker takes place; or,
  • In writing, on the date that the notice is presented to the client by the worker; or,
  • As outlined in IESA, Section 45(3).


If the client is informed verbally, the worker must enter the following in Mobius Notes:

  • The date the conversation took place, 
  • The decision that the client was informed of, and 
  • Verification that the client was notified of his/her right to appeal the decision within 30 days of the date when the conversation
    took place.


If the client is informed in writing, a copy of the letter must be filed on Section 4 of the client’s file. The content of this letter should inform the client of:

  • The decision and rationale supporting why the decision was made, and 
  • The right to appeal the decision (in writing) within 30 days of first receiving notification from the Department.


Informal Review

Clients who do not agree with a decision regarding eligibility for assistance under Part 2 of IESA, are advised to contact a Supervisor (or designate) at the Alberta Works Centre where the original decision was made. The Supervisor is able to informally review the decision and may vary or reverse it. If the Supervisor upholds the original decision, he/she can provide clarification by explaining applicable sections of IESA, associated Regulations and policy used to make this decision. The Supervisor may also discuss potential alternatives and other resources available to the client.

The Supervisor should attempt to resolve the situation (if possible) prior to an appeal being initiated with the appeal panel. If a client is not satisfied with the Supervisor’s explanation, the client has a right to appeal the decision to the appeal panel.

Initiating the Appeal Process

To initiate the appeal process, the client must submit a completed EMP 0547A Notice of Appeal form, (or any type of written notice requesting an appeal), to an Alberta Works Centre or to the Appeals Secretariat. The preferred method to access the EMP 0547A Notice of Appeal is through the worker or Supervisor at the Alberta Works Centre, after an attempt to resolve the situation has been made. The Notice of Appeal form can also be accessed on the Appeals Secretariat website and/or by contacting the office of the Appeals Secretariat directly.

When submitting a Notice of Appeal, the client must identify the decision that is being appealed and the reason for appeal. The written Notice of Appeal must be submitted to an Alberta Works Centre or to the Appeals Secretariat within 30 days of first receiving notification of the decision and the right to appeal.

In situations where an Alberta Works Centre receives an appeal, the EMP 0547A Notice of Appeal is registered and uploaded in to the Appeals Information Management System (AIMS) within two business days of being received. The worker documents in Mobius Notes that a Notice of Appeal has been received and entered in AIMS. The Alberta Works Centre notifies the Appeal Secretariat by sending an email to CSS.Appeals@gov.ab.ca or sending a copy of the form to the regional office of the Appeals Secretariat.

In situations where an EMP 0547A Notice of Appeal form is received by the Appeals Secretariat, the form is registered and uploaded in AIMS. The EMP 0547A Notice of Appeal is then scanned and emailed to the appropriate Alberta Works Centre.

Extension to 30-Day Time Limit to Submit an Appeal

The Minister’s authority to grant an extension beyond the 30-day time limit to appeal a decision is delegated to the Appeals Secretariat.

In circumstances where a Notice of Appeal is filed after the 30-day time limit has expired, the Supervisor is required to send an EMP0002 Request for Appeal Extension letter to the individual. The Request for Appeal Extension outlines how to request an extension to the 30-day time limit to appeal a decision.

Requests for an extension to appeal must be submitted in writing and must indicate the date that notice of the decision was received and the reason(s) why the Notice of Appeal could not be filed within the 30-day time limit. Appeal extension requests must be forwarded to:

Appeals Secretariat
2nd Floor, Agronomy Centre
6903 116 Street
Edmonton, AB  T6H 5Z2
 
The Appeals Secretariat may contact the Alberta Works Centre to verify the nature of the decision under appeal as well as the timeframe and method in which the client was notified of the decision. The Appeals Secretariat may also consult with an Alberta Works Centre representative to clarify any information provided by the Department.

An extension may be approved if the Appeals Secretariat is satisfied that there are apparent grounds for appeal and reasonable grounds for extension.

The Appeals Secretariat will advise the client and the Department whether the extension is granted. If granted, the appeal will proceed to the appeal panel for review and decision.

Note
Under IESA, Section 45(3), the appeal panel has authority to hear an appeal submitted beyond the 30-day time limit, without involvement from the Appeals Secretariat, if the client satisfies the appeal panel that:
  • He/she did not receive notice of the Department’s decision; or,
  • Notice was received later than when it was deemed to have been received.


Administrative Review

A Supervisor (or designate) is required to complete an Administrative Review upon receipt of an EMP 0547A Notice of Appeal, (or any form of written notice requesting an appeal), and enter this information into AIMS.

The Supervisor conducts an Administrative Review by examining the information:

  • On the client file, 
  • Provided by the worker,
  • Provided by the client, and
  • Provided in the EMP 0547A Notice of Appeal and/or the written submission prepared by the client, requesting an appeal.

    Note
    If the appeal deals with Health Benefits as defined in Section 73 of the Income Support, Training and Health Benefits (ISTHB) Regulation, the  Supervisor advises that “Income and Employment Supports Appeal Panel does not have authority to rule on the decision”, and provides information on how to submit the matter to the Health Benefits Exception Committee for consideration.


As part of completing the Administrative Review, the Supervisor is advised to discuss the issue with the client and attempt to resolve it (if possible) prior to scheduling the appeal hearing. In situations where an incomplete Notice of Appeal is received, contact with the client may be necessary to clarify concerns or confirm facts of the decision being appealed. Completing the Administrative Review should not be delayed more than two business days while awaiting this confirmation. Any delay must be documented in AIMS and Mobius Notes, and communicated with the client.  If the Notice of Appeal is not clear, the time limit to complete the Administrative Review does not begin until the issue being appealed is clarified.

The Supervisor is also required to complete a Review of Decision document on AIMs and record this activity in Mobius Notes.

The Supervisor may confirm, vary or reverse the original decision. If the decision is confirmed or varied, the appeal will proceed to the appeal panel unless the client withdraws the appeal request either verbally or in writing. If the decision is reversed, the appeal status on AIMS changes to completed, after the Supervisor completes the Review of Decision.

If the appeal request is not withdrawn, the Supervisor schedules the appeal hearing date using AIMS. If none of the dates/times shown on AIMS are suitable, the Supervisor contacts the Appeals Secretariat to arrange a hearing date.

When the appeal hearing is scheduled, an Appeal Hearing Letter is generated by AIMs and forwarded by the Appeals Secretariat to:

  •  Notify the client of the date, time and location of the appeal hearing, and 
  •  Instruct the client to submit copies of any new information to the Department in advance of the hearing.


The Administrative Review is completed and recorded in the Review of Decision within fourteen calendar days of receiving the client’s Notice of Appeal. In exceptional circumstances where the issue being appealed is complex, up to an additional seven calendar days may be required to complete the Administrative Review.  Examples of complex appeals include:

  • The client appealing more than one decision; or
  • Providing additional information that may impact the calculation of an overpayment.


If there is a delay in completing the Administrative Review, and more than 14 calendar days is required, the reason for the delay must be recorded in AIMS and Mobius Notes.

If the Notice of Appeal is filed after the 30-day time limit has expired, the Supervisor is required to:

  • Inform the client that Community and Social Services will be challenging the appeal panel’s jurisdiction to hear an appeal submitted beyond 30 days;
  • Explain the process to request an extension to appeal to the appeal panel; and,
  • Forward an EMP0002 Request for Appeal Extension letter to the client.


PROCEDURE

Notice of Appeal Submitted Beyond 30-Day Time Limit

To challenge the appeal panel’s jurisdiction to hear an appeal submitted more than 30 days after the individual was informed of the original decision, the right to appeal, and the 30-day time limit to submit a Notice of Appeal, the Supervisor:

  1. Notes on the Review of Decision that the appeal panel may not have jurisdiction to hear the appeal, as per IESA, Section 45(1).
  2. Includes evidence verifying that the client did, in fact, receive notice of the decision more than 30 days prior to filing the Notice of Appeal.
  3. Forwards an EMP0002 Request for Appeal Extension letter to the client.


Benefits Not Regulated by Legislation

If the decision under appeal is not legislated (not addressed in the Act or Regulations), the Supervisor:

  1. Specifies the applicable policy or directive in the Review of Decision.
  2. Includes a summary of the applicable policy or directive to substantiate the decision.


Benefits Regulated by Legislation

If the decision under appeal is legislated (addressed in the Act or Regulations), the Supervisor:

  1. Specifies the applicable section of IESA or the Regulation in the Review of Decision.
  2. Includes a summary of the applicable IESA or Regulation section to substantiate the decision
  3. Records on the Review of Decision that the appeal panel does not have authority to make decisions that exceed limits specified by IESA or the Regulations.


Appeal of Benefits Issued under Director’s Approval

If a client appeals the denial of a benefit that is issued under Director Approval, the Supervisor: 

  1. Includes a summary of the Area Manager/Regional Director’s rationale for denying the benefit.
  2. Records on the Review of Decision that benefits issued by Director’s Approval are under the authority of the Minister, as provided by IESA and associated Regulations; and are not within the appeal panel’s jurisdiction to rule upon.