Original Decisions

Overview

The ministry makes a large number of original administrative decisions that may have an impact on ministry clients. Therefore a ministry decision maker has a duty of fairness to each individual about whom these decisions are made. These are the principles that govern decision making and the steps to follow when communicating decisions.

Policy

Effective: March 12, 2010

Decisions about income assistance, disability assistance, hardship assistance and supplements are made at the local Employment and Assistance Office or the local Prevention and Loss Management Services office.  Exceptions to this are decisions about applications for the persons with disabilities designation (PWD) and issues related to health supplements, which are made at Health Assistance Branch.

Effective: November 9, 2012

Denial Decision

A denial decision is a determination by the ministry that the client is not eligible for assistance.

Example:  Mike walks into his local employment and assistance office to attend his ‘eligibility interview’. He sits down with his EAW and goes over his application and documentation. It is apparent from the application that Mike has assets over the asset limit and is not eligible for income assistance. The EAW explains to Mike that he is not eligible to receive income assistance and why he does not meet the eligibility criteria. The ministry has made a decision to deny Mike income assistance.

Discontinuation Decision

A discontinuation decision is a determination by the ministry that the client is no longer eligible for assistance that they had been receiving.

Example:  Lindsay has been receiving income assistance for the last 5 years. The ministry has decided to review whether Lindsay continues to meet the conditions of eligibility under the Act and regulations.  The EAW sends Lindsay a letter requesting that she come to a meeting and sends Lindsay a form for her to complete and return by a specified date explaining that her assistance may be affected if she does not respond.  Lindsay does not show up to the meeting or return the form by the specified date and does not respond to subsequent attempts to contact her.  In accordance with the legislation, clients must supply the ministry information when requested so that the ministry can determine if they continue to be eligible for income assistance.  When they eventually speak, the EAW explains to Lindsay that she is no longer eligible for income assistance because she did not respond to the requests to supply information.  The ministry has made a decision to discontinue Lindsay's income assistance.

Reduction Decision

A reduction decision is a determination by the ministry that the client is no longer eligible for the amount of assistance they were receiving. In this case the client is eligible for a lesser amount of assistance.

Example:  Ellen is a single parent with one child. Recently the father of her child contacted the ministry to advise that he was successful in obtaining an order for full custody. The father states that the child has moved into his residence and is no longer living with Ellen. The ministry worker contacts Ellen to discuss the facts of the case. Ellen states that the information from the father is incorrect and the child is still in her care. The father subsequently submits copies of the custody order and the child’s school registration, which confirms the father’s address as the child’s primary address. After reviewing the evidence and ministry legislation, the ministry worker determines that Ellen’s income assistance is to be reduced to the rate for a single person. The ministry worker contacts Ellen and informs her of the change to her assistance rate and the reason for the reduction in her assistance rate. The ministry has made a decision to reduce Ellen’s rate of assistance.

Effective: November 9, 2012

The ministry must provide substantive reasons to clients when communicating decisions. Ministry staff must offer to provide the substantive reasons in writing when communicating decisions.

If a client accepts the offer for written reasons and that decision is mailed to the person, the person will have 20 business days from the date they were notified of the decision to request a reconsideration.

[For more information on offering written substantive reasons to clients, please see Procedures – Communicating Decisions]

A substantive reason is a complete response that answers the following: what was requested, what is denied, what legislative criteria (criterion) were (was) not met and why not?  The reasons must reference the specific legislated eligibility criteria (criterion) that are (is) not met and specify the circumstances/facts the client presented, or failed to present, that the ministry assessed and determined were the reasons the client did not meet the legislated criteria. Ministry policy must also be referenced when it is included in the assessment and determination of eligibility. 

If the request is for a specific time period or a specific type of assistance, the decision should also include the specified time period or the specifics of the request for assistance. 

Example 1
A client's assistance is reduced in the month of January 2010. Any decision to reduce a client's income assistance must include specific details regarding the information and/or documentation the ministry reviewed that led to that decision. The specific time period must be included as part of the decision if the assistance or benefit was requested for a specific time period.  The decision must also include a complete description of the legislated criteria that must be met to be eligible for income assistance, the legislative authority for reducing income assistance and the reasons the information/documentation the ministry reviewed support the decision to reduce the client's income assistance.

Example 2
If a client has requested 6 massage therapy visits and is denied, the decision should include the specific number of visits that were requested and denied.  The decision must include a complete description of the legislated criteria that must be met to be eligible for massage therapy visits, the facts that were assessed, and the reasons (how or why) those facts support a denial, and the legislative criteria that were not met and therefore resulted in a refusal to provide 6 massage therapy visits.

Effective: November 9, 2012

At any time before a request for reconsideration is made, a client may request and will receive copies of all documents and information on which the ministry decision was based. The information will be severed in accordance with Freedom of Information and Protection of Privacy legislation.  A formal request under Freedom of Information and Protection of Privacy legislation is not required by the client.  Where the person requesting the information is not the client, proper authorization by the client will be required prior to its release.

[For more information on Freedom of Information and Protection of Privacy see Related Links – Information Privacy and Security (FOIPPA).]

Effective: September 29, 2009

Administrative Fairness means:
 

  1. The client has a right to know the case and respond

A client who is affected by an administrative decision has the right to know the case being made against him or her and must be given an opportunity to respond.
 

  1. The decision maker cannot be biased

An unbiased decision maker means that the person who decides the case will be impartial and will make a decision based only on the arguments and evidence that the parties present. It also means that the decision maker cannot have (or appear to have) any personal connection with the parties or any personal interest in the outcome of the case.
 

  1. The person who hears the case must make the decision

The ministry worker who hears or reviews the client’s request is obligated to make the decision. They may seek advice but must not delegate the actual decision or allow advice to take the place of their own reasoning.
 

  1. The decision maker must give reasons for the decision

The decision maker must give reasons for the decision so the parties can see that the ministry considered the submissions made. A decision should clearly explain the reason the ministry came to that decision so that the parties understand.

Effective: September 29, 2009

These principles guide the entire ministry decision making process, beginning with the making of an original decision. Ministry staff should abide by these principles at all times, not only when they are in the role of a decision maker, but also when they are providing clients with information.

The most important requirement of Administrative Fairness at the original decision stage is providing the client with adequate reasons for a decision.
 

  • Reasons – A client must be provided with clear and substantive reasons for decisions that affect them – referring to the legislation and the specific evidence or information relied upon, as well as the decision maker’s actual reasoning in making a decision.

Other examples of Administrative Fairness principles include the requirement that decision makers be free from any bias or appearance of bias, and the requirement that the official who hears the case must decide the case:
 

  • No Bias – A client is entitled to an impartial decision from someone with no personal interest in the decision and no actual or perceived bias. Even where the decision maker has no prior involvement with any of the parties involved, they should avoid showing bias in their attitudes or assumptions towards particular types of people or particular situations.
  • The Person Who Hears the Case Must Make the Decision – The ministry worker who hears or reviews the client’s request is obligated to make the decision. They may seek advice but must not delegate the actual decision or allow advice to take the place of their own reasoning.

One of the most fundamental principles of Administrative Fairness is that clients have the right to know the case against them and have an opportunity to respond. This principle requires a number of important procedures, including adequate notice, and disclosure of information. These procedures are of the utmost importance at the original decision stage.
 

  • Notice – A client is entitled to be notified of decisions affecting them and of any additional rights they may have, including reconsideration and appeal.
  • Disclosure – A client is entitled to access any and all information considered by the ministry in making decisions affecting them. This material constitutes the “case against them”.

Procedures

Effective: February 27, 2017

Communicating Decisions – Five Steps to Follow

Every time a client receives a denial, discontinuation or reduction in assistance, the following five-step process must be followed:
 

  • Step One: Start with a well-documented decision
  • Step Two: Inform the client of the decision
  • Step Three: Offer the right to reconsideration of the decision
  • Step Four: Explain the reconsideration process
  • Step Five: Explain the right to appeal

Step OneStart with a Well-Documented Decision

Document the substantive reasons for the decision

Providing substantive reasons means that the ministry worker needs to provide sufficient detail to explain why the client’s assistance was reduced or discontinued, or why their request for assistance was denied, and how the client’s circumstances did and did not meet the legislated criteria and/or policy.

This involves providing details about the decision, referencing the relevant legislation and answering the following questions:
 

  • What information or evidence was considered in making the decision? What assumptions were made?
  • What information or evidence was lacking?
  • What were the legislative criteria? Which criteria were satisfied and which were not? Why or why not?

[For more information on substantive reasons, please see Policy – Substantive Reasons.]

Identify the evidence that influenced the decision

The worker must ensure that they communicate the reasoning the worker followed in reaching the decision – in other words, how did each piece of information or evidence apply to each of the legislative criteria?

Cite the legislative criteria that were met and not met

Identify the relevant section(s) of the Act and/or Regulation that were used to make the decision. Make sure that the client’s case refers to these section(s). Explain how the legislation was applied to the client’s circumstances and how the client’s circumstances did and did not meet the legislated criteria. 

Update the client case to document the date the client was notified of the decision, the details of the decision, and the documents used as evidence when making the decision.

Attach the Assisted Eligibility Decision Report to ICM

If the Assisted Eligibility Decision Tool was used in making the decision, the report should be attached to the client case.

Step Two – Inform the Client of the Decision

Explain what the decision means and what will happen next

The ministry worker must be specific about what was requested, and ensure that the client clearly understands what kind of assistance has been discontinued, reduced or denied. If assistance has been reduced, make sure the client understands the exact amount involved.

Example: If the decision denies a request for assistance for a specific time period (eg: March-May 2007) or for a supplement for a specific item (eg: an electric wheelchair), the worker should include those specific details when communicating the decision.

Offer to provide written substantive reasons for the decision

The ministry worker must offer to provide written substantive reasons when communicating decisions. When a client accepts the ministry’s offer to provide written reasons, an Original Ministry Decision letter (HR3318A/B) must be completed and printed. A separate HR3318A/B is completed for each original decision where the client has accepted written reasons for the decision.

An “Eligibility Denial Message” can be used to advise a client of a denial decision via My Self Serve (MySS). Reconsiderations are initiated via the ‘Request Reconsideration’ button on the ‘Service Requests’ screen. 

 If the client requests a reconsideration of a decision, the denial message will populate Section 2 of the HR0100.

Example:  A client requested a crisis supplement as well as a supplement for moving, transportation and living costs in the same meeting. The ministry worker determines that the client is not eligible for either supplement. The ministry worker orally communicates these decisions to the client and offers to provide written reasons for the decisions. The client accepts the ministry’s offer. In this case the ministry worker must complete two HR3318A/B letters; one for the denial of the crisis supplement and one for the denial of the supplement for transportation, moving and living costs.  

The ministry worker completes the HR3318A/B, selecting the decision made by the ministry, providing the substantive reasons for the decision and citing and attaching the legislation or policy under which the decision was made.

Once the HR3318A/B has been completed, attach copies of all documents considered in making the decision and provide a hardcopy to the requestor.  If the decision is being made over the phone the ministry should offer to leave the letter at the office for the client to pick up, mail the letter to the client or provide the letter via MySS Message.

If a client accepts the offer for written reasons and the HR3318A/B is mailed to the person, or provided via MySS Message, the person will have 20 business days from the date they were notified of the decision to request a reconsideration. A client has the ability to initiate a Reconsideration Request in My Self Serve. At midnight on the 20th business day the ‘Request Reconsideration’ button is automatically disabled.

[For more information on reconsideration see Related Links – Reconsideration and Appeal.]

The ministry worker notes on the case that the client has accepted the offer to provide written reasons, received the HR3318A/B and copies of all documents considered in making the decision. The ministry worker then copies the HR3318A/B to the case.

If the client wishes to proceed directly to reconsideration at the time the decision is communicated, the ministry worker does not need to fill out the HR3318A/B and only needs to complete the HR0100. [For more information on completing the HR0100 please see Related Links – Reconsideration – Procedures.]

Prevention and Loss Management Services (PLMS) does not use the HR3318A/B. Instead, PLMS staff use the Notice of Decision - Section 10 Denial letter (HR3198) or the Notice of Eligibility Decision (HR3200) to communicate decisions to clients.

Disclose all of the information used to arrive at the decision

Inform the client that all of the information that the ministry considered when making the decision is available to them.

The overriding rule regarding disclosure is that the client must know the case against him or her in order to be able to respond. Unless particular information is specifically protected by law - for example, personal information belonging to a third party – the client is entitled to see whatever is in their case. The general guideline is: if the evidence or information played any part in the decision-making process, even if it is merely background information, or if it was not directly referred to in your decision, the client should be provided with a copy of it.

The information will be severed in accordance with Freedom of Information and Protection of Privacy legislation. If there are any concerns about disclosing private or sensitive information to the client, such as private personal information belonging to third parties, the ministry worker should contact Information Access Operations [see Contacts].

[For more information on Freedom of Information and Protection of Privacy see Related Links – Information Privacy and Security (FOIPPA).]

Step Three – Offer the Right to Reconsideration

Explain how the client can respond to the decision

Inform the client of their right to request a reconsideration of the decision. Inform the client that a reconsideration decision is not a review of the original decision; it is an entirely new assessment of the client’s request.

If the client requests a reconsideration at any time, the ministry worker or another ministry staff member must provide the client with a Request for Reconsideration form (HR0100).

While not all decisions are open to reconsideration, the client has the right to request a reconsideration of any decision, including denials, discontinuance, or reductions in assistance as well as approvals and even situations where the ministry does not consider a “decision” to have taken place. The ministry decision maker who is making the reconsideration decision will determine if reconsideration is available, including whether the request was submitted within the time limit.

If it is an advocate or other third party making the request for reconsideration, they must provide a Consent to Disclosure of Information form (HR3198) signed by the client.

Provide a copy of the Reconsideration and Appeals Brochure

Anytime that the ministry makes and communicates a decision to deny, discontinue, or reduce assistance, in addition to offering written reasons, the client affected by the decision must be offered the Reconsideration and Appeals brochure. The brochure provides information about the reconsideration and appeal process. [See Additional Resources – Reconsideration and Appeals Brochure.]

If a decision is communicated in person, simply offer the client a copy of the brochure. If a decision is communicated by phone or by mail, a copy of the brochure should be mailed to the client. A note should be made on the client case to confirm that a brochure was provided, either in person or by mail.

For decisions communicated through MySS Message the brochures for ‘Reconsideration and Appeals’ and ‘Rights and Responsibilities’ are automatically attached to message.

Although the brochure does explain the reconsideration and appeal process in detail, providing the brochure is not a substitute for explaining the process directly to the client.

Explain the consequences of not responding to the decision

Explain to the client that if they do not request reconsideration, the original decision will be implemented.

Step Four – Explain the reconsideration process

Explain the Request for Reconsideration form (HR0100)

Provide the client with an overview of the HR0100, including the sections they must complete.

Explain the deadline and process for submitting new information

Explain to the client that they have 20 business days within which they can request a reconsideration of the decision, starting on the 1st business day after the date they were notified of the original decision. Inform the client that a business day is a “working day”, that is, a day other than a weekend or a holiday. Make sure that you and the client agree about which day the client was notified of the original decision and which day is the 20th business day.

Advise the client that they may submit new information to the ministry to be considered with their request at any time before the reconsideration decision is made.

[For more information on the Reconsideration process please see: Related links – Reconsideration]

If eligible, inform the client of the Reconsideration and Appeal Supplement

A reconsideration and appeal supplement may be provided to or for a family unit that is eligible for income assistance or disability assistance if a recipient in the family unit delivers an Employment and Assistance Request for Reconsideration (HR0100) relating to a decision that resulted in a discontinuation or reduction of income or disability assistance or a supplement.

[For information on the Reconsideration and Appeal Supplements please see – Related Links – Reconsideration and Appeal]

Step Five - Explain the right to appeal

Explain that if the client disagrees with a reconsideration decision, he or she may appeal that decision to the Employment and Assistance Appeal Tribunal. In order to do so, the client must submit a Notice of Appeal form within 7 business days after being notified of the reconsideration decision.  This form may be submitted directly to the Tribunal or can be accepted at an Employment and Assistance Office, which will immediately forward the form to the Tribunal. 

Effective: July 20, 2011

[See also Additional Resources – Effective Date of Eligibility – Workflow Chart]

When the original decision approves the client’s eligibility, the effective date of eligibility is dependent on the type of assistance applied for.
 

  • Applicants for income assistance are eligible for income assistance from the date of their application.  Staff will determine eligibility for income assistance as of the date of the application and may need to pro-rate support and issue the portion of a month’s shelter costs which remain unpaid, as set out in section 26 and Schedule A of the Employment and Assistance Regulation.
  • Applicants for disability assistance, who were already designated as a person with disabilities and are re-applying for disability assistance (returning to the caseload), are eligible for disability assistance from the date of their application. Staff will determine eligibility for disability assistance as of the date of the application and may need to pro-rate support and issue the portion of a month’s shelter costs which remain unpaid, as set out in section 23 and Schedule A of the Employment and Assistance for Persons with Disabilities Regulation.
  • Applicants who qualify as a person who has persistent multiple barriers to employment (PPMB) are eligible to receive income assistance at the PPMB rate on the first day of the month after the date of the original decision.  Staff will determine eligibility as of the first day of the month after the date of the original decision.
  • Applicants for persons with disabilities designation are eligible to receive disability assistance on the first day of the month after the date of the original decision.  Staff will determine eligibility as of the first day of the month after the date of the original decision.
  • Applicants for PWD designation who are found eligible for the PWD designation prior to their 18th birthday will receive benefits effective the date of their birthday.  The imprest cheque will include prorated support and any outstanding shelter for the portion of the month remaining following the client’s 18th birthday.
  • Applicants who are youth in government care (under the care of the Ministry of Children and Family Development), who have been found eligible for disability assistance as of their 19th birthday, are eligible to receive the shelter allowance for the full month in which they turn 19, as calculated in Schedule A for any rent owing, and the support allowance prorated from the day they turned 19 to the end of that month.
  • Applicants for a supplement are eligible for the supplement as of the date of the original decision.  Staff will determine eligibility for the supplement as of the date of the original decision.