4.2 - Appeals

SD has an appeal system in place so that clients and/or applicants who are not satisfied with a decision may have that decision reviewed. This system is meant to determine if the Act, the regulations, and policies of the Department have been interpreted properly and fairly.

A client/applicant is able to appeal any decision that affects his or her eligibility or amount of basic assistance.

If a client/applicant is unable (because of illness, incapacity or disability) to request a review, a representative may act on his or her behalf for the purposes of the review.

Individuals who are no longer eligible for assistance and are waiting for an appeal decision cannot receive social assistance while waiting. Bridging of assistance is not to be provided.

Designations of employees are provided to assist the Minister to operationalize the Act. Through assigning various individuals to act on his/her behalf, no rights or responsibilities of the Minister are diminished or relinquished by this action.

Written designations will be provided to persons required to act on behalf of the Minister at an Appeal Hearing. This designation is obtained by completing the Designation form and forwarding it to the Assistant Deputy Minister for signature.

The Board may recommend either of the following:

• that certain special benefits be issued to clients either as a one-issue benefit or to be added to their monthly assistance cheque or
• that a higher rate of assistance be issued by using the over-ride function.

If the Area Reviewer and/or the case manager and manager in conjunction with the Director of the Region believe that the recommendation of the Board contravenes the Act, they should discuss the issue with our Policy and Federal/Provincial Relations Branch.

If special benefits have been added to the assistance cheque, or if the rate has been over-ridden, this may remain in place until the next Case Review for that case; as the Case Review is considered a reapplication. The benefit may be removed or the rate reduced at a time other than at a Case Review only after three (3) months and only if there have been significant changes in the client's situation.

• An applicant cannot appeal their ineligibility for assistance if they have not completed the application process.
• Emergency benefits of special need may not be appealed.
• Non-financial issues such as granting Designated Needs status or caseplanning decisions cannot be appealed.
• Section 4(4) decisions.
• Decisions of the Medical Advisory Board.

It is the responsibility of the Area Reviewer to ensure all documentation relating to the Department's decision is presented to the Regional Family Income Security Appeal Board, with a copy of all pertinent information made available to each Board member.

All clients that go to appeal will be informed on the Notice of Appeal letter that if they wish to obtain a copy of the documentation pertaining to their hearing prior to the hearing date, they must contact the Area Reviewer. The client must contact the Area Reviewer at least 5 days prior to the hearing date in order to make this request. The Area Reviewer will make this information package available to the client at the regional office 3 days prior to the hearing.

The information in this package will only contain information that is releasable by law. That which the appellant is not entitled to receive will be withheld as per the following subsections of the Family Income Security Act:

Section 13.1(1) - All information acquired by the Minister or another person in relation to any person or matter under this Act, whether of a documentary nature or otherwise, is confidential to the extent that its release would tend to reveal personal information about a person identifiable from the release of information.

Section 13.1(2)  - The Minister shall not permit the release of confidential information to any person without the written consent of the person from whom the information was obtained and the person to whom the information relates.

Before releasing information, the following must be considered:

• client's right to information
• need to protect the confidentiality of those who report potential abuse or fraud
• need to protect the integrity of investigation process

Information may be copied and provided to the clients if they wish, however caution must be used to ensure that what is provided is that which they are entitled to receive as per the Family Income Security Act.

1. Review by Area Reviewer

A "Request for Review" form must be requested by the client/applicant and returned within thirty (30) days after receiving a Notice of Decision as per Section 15(1) of the Family Income Security Act or at any time if they believe there is an unreasonable delay in making a decision regarding their receipt of assistance. The Area Reviewer shall review the case, and advise client/applicant of their decision within fifteen (15) days after receipt of the Request for Review.

The Area Reviewer's decision shall contain the following:

• particulars of decision,
• reasons for making decision, and
• if the client/applicant has the right to appeal to the Regional Family Income Security Appeal Board, a description of how to do so and the proper form.

2. Appeal Hearing

The client/applicant has twenty (20) days after receipt of the decision of the Area Reviewer to request an Appeal Hearing of the Regional Family Income Security Appeal Board by completing and returning the Notice of Appeal form. The Board must hold the Appeal Hearing within twenty (20) days of the receipt of the request from the client/applicant. The client or applicant must be advised of the Board's decision within fifteen (15) days after the Appeal Hearing.

If a case is cancelled and the client wants to appeal that decision, the case manager must use the undo terminate function to reactivate the case and must suppress the case. This should be done when the client has returned the Request for Review form. If the client wins the appeal, the case manager should remove the suppression, correct whatever information made the case ineligible, and make the necessary adjustments to the case etc. so that payments will be produced. If the client loses their appeal, the case manager must cancel the case.