Grievance Case Summary - G-366

The Grievor was required to travel for a mandatory periodic health assessment and audiogram. He submitted an expense claim for mileage and meals. The claim was partially denied on the basis that he had not attended at the closest available facility. The Grievor argued that the documentation he had received from Health Services regarding the periodic health assessment only identified the farther location, however, the partial denial was confirmed. The parties agreed that the standing and time limits requirements had been met, but could not reach an informal resolution on the merits.

The Level I Adjudicator found that the Grievor did not present the grievance within the time limit set out in Section 31(2) of the Act. He concluded that the Grievor knew of the denial after the original decision and that the second denial was merely a restatement of the first decision.

The Committee found that, as the Grievor submitted new information and new arguments, after the original decision, the time limit should run from the second denial and therefore the Grievor has met the statutory time limit.

On the merits, the Committee found that, while the Grievor had made a mistake in choosing the location of the health assessment and audiogram, this was because the information he received from Health Services was confusing and unclear. The Committee recommended that the Grievor's claim be paid in full.

The Committee also commented on several fairness issues related to the new grievance process. The Committee noted that a form letter advising the Grievor of his right to make submissions under the Commissioner's Standing Orders (Grievances), 2003 acted to limit his right to be heard. It recommended that the Early Resolution phase of the grievance process be kept separate and apart from the Submission phase. Finally, the Committee found that while the Level I Adjudicator was not bound by the parties' agreement that the time limit had been respected, before ruling that the grievance was out of time, the Level I Adjudicator should have given the parties the right to be heard on the issue.

The grievance should be allowed.

The Commissioner has rendered her decision in this matter, as summarized by her office:

The Commissioner agreed with the ERC that the limitation period started on June 14, 2003, since the Respondent's reply on that date was a new decision made after he had considered, for the first time, new information that had the effect of putting the matter in a whole new light. Accordingly, the grievance was timely at Level I.

As for the merits, the Commissioner agreed with the ERC that it was reasonable for the Grievor to understand from the Health Services' memorandum that audiograms were only available at three specific locations. Accordingly, by going to the center, the Grievor attended what he thought to be an adequate medical center as it was, of the three facilities, the closest to his work site that could provide all the necessary health services. The Commissioner believed that the Grievor was simply attempting in good faith to follow the policy of minimizing costs by using the closest facility. She further agreed with the ERC that it was reasonable for the Grievor to think that he had all the preauthorization he needed.

The Commissioner therefore allowed the grievance.