Case Summary : Decision-Making Process

Evidence overlooked

The worker brought a complaint to the Commission about her travel expenses. She was concerned that her claims adjudicator overlooked medical information from her doctor supporting an increase in her travel expense eligibility. The Commission contacted the claims adjudicator who stated that she had not seen the medical information. In reviewing the worker's claim file, the Commission discovered the medical information was attached to a health care travel expense form along with other receipts. When the Commission reported this finding to the claims adjudicator, she immediately reviewed it to determine the impact on prior decisions about travel expenses.

After further investigation, the Commission learned that all expense forms are sent directly to the health care payment processing area, unless it is for an exceptional expense. The Commission felt that what happened in this case, however, suggested that information could be overlooked in the expense payment process. The Commission advised the Director of Administrative Services of this concern and he undertook to remind processing staff to carefully review all expense form attachments to ensure that medical or other important information that might be attached to the receipts is forwarded to the claims adjudicators.

(2005)