Published Date: January 26, 2012
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Appeal and Decision Review/ Introduction and Authority
To ensure that decisions made by Human Services are supported by legislation (either Act or Regulation) and are fair.
Matters that are subject to appeal to an Income and Employment Supports Appeal Panel include any decisions of the Director relating to:
- Eligibility or continuing eligibility, for the amount or value of assistance under Part 2 of the Income and Employment Supports Act (IESA);
- An amount payable under IESA Section 35; and,
- Any other matter provided for in the Income Support, Training and Health Benefits (ISTHB) Regulation.
Powers given to the Minister under IESA and associated Regulations are not within the jurisdiction of the appeal panel to rule upon. While Human Services staff cannot deny an individual the right to appeal a matter that is under the discretion of the Minister, the jurisdiction of the appeal panel is limited to decisions of the Director only.
Appeals to an Income and Employment Supports Appeal Panel
An individual has the right to appeal to the appeal panel, if he/she disagrees with a decision made by Human Services regarding:
- Eligibility for assistance under Part 2 of IESA that affects the amount or value of income support and benefits (including supplemental benefits), and/or training benefits; and,
- Eligibility for employment and training benefits under Sections 4 and 5 of the Employment and Training Benefits for Persons with Disabilities Regulation (also known as Disability Related Supports).
Review of Decision by a Human Services Internal Review Committee
Requests for coverage of a specific health benefit that is generally not provided may be made to the Health Benefits Exception Committee (HBEC). The HBEC ensures that individuals have access to health benefits required to meet their unique medical needs when conventional treatments and goods or services that are normally covered, prove to be inappropriate or ineffective. The HBEC process ensures that decisions are equitable and meet the parameters established by legislation, Human Services agreements with professional associations, Drug Benefit Lists and medical best evidence.
Decisions related to the provision of Disability Related Employment Supports (DRES) must be appealed to the Disability Related Employment Supports Review Committee (DRESRC). DRESRC reviews a decision to ensure that it is equitable and that it meets the parameters established by legislation. Committee members are government employees appointed by the Minister of Human Services.
The authority for HBEC and DRESRC to review matters relating to Health Benefits and DRES is provided under ISTHB Regulation, Section 97 and Ministerial Order No. 71/2011, respectively. A ruling made by members of HBEC and DRESRC is final.
Review of Decision – Training Eligibility
An individual has the right to request a Review of Decision if he/she disagrees with a decision that impacts eligibility to attend Human Services funded training. A Review of Decision is conducted by different sources depending on who the Authorized Official is that made the decision related to training eligibility.
Decisions made by an authorized Training Provider: conduct a Review of Decision related to training eligibility through an Internal Training Provider Review Process.
Decisions made by an authorized assessment agency: conducts the Review of Decision when an assessment that impacts eligibility to attend a Non-AFA and/or Contracted Training Provider, is being disputed. The Review of Decision completed by a Contracted Assessment and Case Management Centre is final.
Decisions made by an authorized Human Services employee that determine eligibility to attend a Non-AFA and/or Contracted Training Provider are also subject to Review of Decision by a Human Services Supervisor or Manager. A Review of Decision completed by a Supervisor or Manager is final.
Options for Review and/or Appeal of Decision
The following matrix outlines decisions affecting an individual’s eligibility, income support and benefits which are within the appeal panel’s jurisdiction to rule upon. An alternate review medium is also identified for decisions that are beyond the jurisdiction of the appeal panel.
|Type of Decision||
Income and Employment Supports Appeal Panel
|Review of Decision by Internal Review Committee|
|Whether an individual meets residency and citizenship requirements as a condition of eligibility under the Income Support (IS) program (residency and citizenship requirements themselves, are not subject to appeal)||Yes||N/A|
|The amount or value of IS, benefits and training benefits payable based on information provided in the Learner Income Support Application form.||Yes||N/A|
|Compliance with Child Support Services (CSS) as a condition of eligibility under the IS program||Yes||N/A|
|Eligibility for CSS based on decisions under Part 5 of IESA (including case management decisions)||No||N/A|
|Eligibility for Human Services funded training as determined by an AFA Training Provider||No||Review of Decision by Training Provider|
|Eligibility for Human Services funded training as determined by an authorized Contracted assessment agency||No||Review of Decision by an authorized assessment agency|
|Eligibility for Human Services funded training at a Non-AFA/Contracted Training Provider as determined by an Human Services Authorized Official (Human Services employee)||No||Review of Decision by a Supervisor / Manager|
|Eligibility for Human Services funded training without meeting the requirement to be “out of school for 12 consecutive months”||No||Review of Decision by Regional Learner Specialist|
|Maximum duration of months that training benefits may be provided||No||N/A|
|Counsel to Leave Employment||No||Review of Decision by a Supervisor/Manager at an Alberta Works Centre.|
|Decisions based on the submission of a Change in Circumstances form (e.g., changes to income, assets, marital status, family size, accommodation) or requests for supplementary benefits||Yes||N/A|
|Acceptable attendance as a condition of continuing eligibility for Human Services funded training||No||Review of Decision by Training Provider|
|Review of Decision by a Regional Learner Specialist related to acceptable attendance when absences from training exceed 3 consecutive weeks||Yes||N/A|
|1st instance of failure to meet acceptable progress requirements as a condition of continuing eligibility for Human Services funded training||No||Review of Decision by Training Provider|
|2nd instance of failure to meet acceptable progress requirements as a condition of continuing eligibility for Human Services funded training||No||Review of Decision by a Supervisor / Manager|
|Health benefits coverage and requests for coverage outside of professional service agreements and Drug Benefit Lists||No||HBEC|
|DRES decisions made under Disability Related Employment Supports & Services Regulation||No||DRESRC|
|DRES decisions related to employer and educational institute eligibility||No||N/A|
|Financial eligibility for Alberta Child Health Benefits (ACHB)||Yes||N/A|
|Other eligibility decisions for ACHB||No||N/A|
|Assessment of an overpayment under IESA Section 35||Yes||N/A|
|Determination that repayment of an amount (otherwise repayable) is not required under Section 96 of the ISTHB Regulation||Yes||N/A|
|Determination that a Repayment Agreement is not required under IESA Section 16||Yes
Before the Repayment Agreement is signed
|Amount repayable under IESA Section 16 (i.e., Repayment Agreement)||Yes
If the amount was unknown when the agreement was signed.
|Determination of the repayment rate||Yes
To a minimum of $1.00
|A sponsor debt under Section 37 of IESA||Yes||N/A|
|Decisions that relate to appointing a financial administrator or issuing third party payments - when no consent is given by the learner||Yes
Appeal panel must rule on decision