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INCOME SUPPORT PLAN (ISP) – HUMAN RESOURCES DEVELOPMENT CANADA (HRDC)
Proactive DR Approach Reaps Positive Benefits
The Early File Review Project
Summary:
Through intensive team work and active early intervention, officials at Human Resources Development Canada took on a 2,000 case Canada Pension Plan (CPP) disability case backlog, identified 900 cases for review, and settled 202 cases.
Introduction:
The problem: The Pension Appeals Board (“the Board”) faced a backlog of over 2,000 Canada Pension Plan (CPP) disability cases.
The solution: Many cases settle very shortly before the hearing date. Officials responsible for HRDC’s Income Support Plan (ISP) formed a team that included members of HRDC’s Legal Services Unit (LSU) and the Medical Expertise Division (MED). This team identified and settled appropriate cases through early file reviews. This project resulted in immediate savings, longer term efficiencies and high satisfaction levels among clients. The following summary describes the key lessons.
Background:
Team approach: The project team included 21 MED physicians, 15 LSU counsel, and support staff. Two coordinators, one physician and one lawyer, oversaw the project.
Focus: The project focused on the Greater Toronto Area for two reasons:
- Appellants awaiting Pension Appeals Board hearings in the Greater Toronto Area had been waiting the longest to have their appeals heard, with some clients waiting for several years; and
- the Toronto area accounted for 25% of the Board’s caseload.
Phased approach: The project took six months (from January to June 2002) and operated in three phases.
Phase 1: In January and February 2002, MED physicians reviewed approximately 10-12 files per day. These doctors made one of the following recommendations:
- proceed to a Board hearing;
- proceed to a Board hearing with a request for additional information (e.g. independent medical examinations, additional medical reports from client’s physician); and,
- settle. All recommendations to settle were subject to a second opinion by a MED physician. If the second physician failed to agree on the recommendation, the file proceeded to a Board hearing.
Phase 2: Beginning in February 2002, legal counsel sent letters to each appellant (and representative) explaining the project and requesting that any additional information be forwarded within 30 days. The majority of responses to these letters were received by early March 2002. The files were then jointly reviewed (30 minutes/file) from a medical and legal perspective. Four options were available to the team following the file review:
- proceed to a Board hearing;
- request additional information;
- settle; or,
- further review for complicated files.
Phase 3: Beginning in May 2002, each physician member of the team was assigned approximately 10 files to be reviewed according to their respective schedules. A review day was scheduled where the physicians met with their counterparts from Legal Services to agree on the chosen option for each particular file.
Outcomes: Of the 702 cases reviewed, 202 were settled. This works out to a settlement rate of approximately 30 percent.
Benefits: The project produced a number of quantitative and qualitative indicators of success.
- Speed and satisfaction: Appellants who settled early received disability benefits more quickly. Clients also provided positive feedback on the streamlined process.
- Savings: The settlement of 202 cases resulted in 14 fewer weeks of hearings. Each week of hearings involves travel and accommodation costs for two physicians, two legal counsel, four or five adjudicators, and staff.
- Efficiencies: In addition to reducing the backlog
and allowing the Board to focus on the cases it really needed to
hear, this project helped participants to identify ways of streamlining
the early File Review process. The data generated by the project
helps to:
- identify the most useful types of additional information for those conducting file reviews;
- train staff in a new approach to file review; and,
- acquire a better understanding of the appellants’ perspective of the appeals process.
Lessons Learned
A number of important lessons can be gleaned from the project, including:
- Pilot project design teams should expect DR processes to be revisited and reformulated at various stages in the pilot project.
- Significant backlogs are difficult to manage in a reactive way. Conversely, a proactive approach can lead to very positive results for an adjudicative process faced with a significant caseload
- Detailed communication to clients at the beginning of a pilot project pay off, both in qualitative and quantitative terms.
- Timely requests for additional information were crucial to filling gaps in some of the files and to earlier settlements.
- Files that may have settled just prior to actual hearing were settled much earlier in the adjudicative process, thanks to a systematic approach to file reviews and assessments.
Conclusion:
“Justice delayed is justice denied.”
Timely assessment procedures are directly related to the early resolution of disputes. This project demonstrated the huge dividends that flow from early dispute resolution including: greater client satisfaction, cost savings, identification of efficiencies, and myriad case management benefits.
Agencies with adjudicative functions should encourage staff to be proactive rather than waiting until the hearing room door to consider settlement. While EFR stood for Early File Review in this project, one might also translate the acronym as Efficient Fair Resolutions!
