Alberta Fair Practices OfficeAlberta Fair Practices Office

Fairness Review - Client Intake Form

Client Intake Form

Personal information you provide to the Alberta Fair Practices Office (FPO) is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act (FOIP) and is managed in accordance with Part 2 of FOIP. The personal information you provide may be used by the FPO for the purpose of conducting fairness reviews for claims within the workers’ compensation system (Workers’ Compensation Board - Alberta (WCB), Appeals Commission for Alberta Workers’ Compensation (Appeals Commission), and the Medical Panels Office (MPO)), and to provide recommendations as a result of its review. The information will also be used for providing appeals and advisory services for your WCB claim.

Your personal information may also be used to contact you to complete a survey and will not be used or disclosed for any other purpose, without your written consent or unless required to do so by law. Should you have any questions pertaining to the collection of your personal information please contact Fair Practices Office: Suite 1000, 10th Fl, 10123 – 99th St NW, Edmonton, AB T5J 3H1; info@fpo.alberta.ca or 1-866-427-0115.

  1. The Fairness Review Branch (FRB) is only able to review complaints about:
    • Behavioural fairness – refers to a potential breach of the WCB Code of Rights and Conduct, or how a party was treated, which includes respect, communication and dignity.
    • Procedural fairness – refers to the processes leading up to a decision, which includes timeliness, communication and whether processes are consistent with legislation, regulation and policy or procedure.
  2. A fairness review conducted by the FRB does not replace an appeal process or change an appeal decision. A fairness review is neutral and impartial, meaning the FRB neither advocates for a complainant or a system partner, nor intervenes in a given situation but considers whether an unfairness has occurred.
  3. The FRB is not able to review matters previously investigated by the Alberta Ombudsman nor matters where the Court has taken an action or made a decision.

The FRB may refuse to review a complaint if it relates to a matter, action or alleged breach of the WCB Code of Conduct which you have known about for more than 24 months. If you submit a complaint after more than 24 months has passed, the FPO will consider the circumstances of your complaint and determine whether to conduct a review.

OUTCOME:

The FPO cannot change or set aside a decision or policy made by WCB, Appeals Commission or Medical Panels Office. Potential outcomes after a fairness review may include:

  • an apology,
  • a written explanation or detailed breakdown of information
  • the correction of information (e.g. something that was missed or forgotten),
  • addressing a delay,
  • going through the decision-making process again,
  • improvement to a procedure or process, or
  • referral to appropriate resources, as necessary.

If so, you will be asked to complete an Informal Representative Consent Form.

Important Note: If the form is incomplete, it may cause a delay in proceeding with assessing your complaint.

Form is not submitted

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FPO Authorization Terms

Fairness Review Authorization

I authorize FPO to conduct an impartial review into my complaint.

The FPO will collect my personal information directly from the WCB, AC and MPO pursuant to section 23.2(4) of the Workers’ Compensation Act.

I authorize the FPO to collect information, including personal information, about my claim verbally, electronically, in writing and/or in person for the purpose of providing fairness review services. The WCB, AC and MPO is authorized to disclose personal information to the FRB that is necessary for the purpose of providing fairness review services. This includes, but is not limited to, a copy of my claim file and copies of correspondence sent to me by the WCB, AC and MPO.

Expiry of Authorization

This authorization will expire when one of the following occurs:

  • The fairness review matter has been concluded
  • The services of the FRB is no longer required: or
  • You rescind the authorization

Should you wish to revise or rescind this authorization, you are responsible for submitting a written notification to your fairness review officer. You may also submit the request in writing to the FPO at info@fpo.alberta.ca.

Should you require further assistance from the FRB following the expiry of this authorization; you will be required to submit a new authorization form.

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