December 2016

10.1: Notice and Internal Review Process

Legislative Authority

Sections 24 - 27, 28(1) and 68 of the Act.
Sections 67 - 71 of Regulation 134/98.
Section 4 of Regulation 136/98.

Audit Requirements

A copy of the Notice of Decision is on file.

Internal review requests are noted and documentation is on file to support internal review decisions.

Application of Policy

Notice of Decision

All decisions affecting eligibility for financial assistance must include the following information:

  • the decision that has been made and how it affects financial assistance or participation;
  • the reason(s) for the decision and the relevant legislative authority under which the decision was made;
  • the effective date of the decision;
  • whether or not the decision can be appealed to the Social Benefits Tribunal (SBT);
  • that an internal review is required prior to appealing a decision to the SBT, and the applicant or recipient must submit a written and signed request for an internal review 30 calendar days after receipt or deemed receipt of the Notice of Decision;
  • the rules and procedures of the internal review process, the timeline for reviewing the decision and providing notice, and the form of notice; and
  • where applicable, the right of the applicant or recipient to appeal a decision to the SBT if he/she still disagrees with the decision upon completion of the internal review, or where the internal review was requested but not completed by the delivery agent within 30 calendar days following receipt of the written request.

Clear explanations to applicants and recipients are intended to prevent requests for appeals that are based on misunderstandings regarding a decision.

Format and Manner of Decisions Approved by the Director

A Notice of Decision must be communicated in writing or in electronic format and delivered to the applicant or recipient in person, by pre-paid regular mail, or sent electronically via Social Assistance Management System (SAMS). Any communication produced and sent through SAMS will be automatically stored in the client’s file. Copies of any notice of decision produced outside of SAMS must also be kept on the file.

Note: The Director has approved the electronic format in development as part of the new technology. Use of any other format requires approval from the Director. In seeking approval, delivery agents should provide written assurances that the proposed format and manner:

  • observes the requirements of MFIPPA;
  • is secure from unauthorized access;
  • allows information to be readily accessible for audit purposes; and
  • meets file retention and destruction requirements.

Request for Internal Review

An applicant or recipient can request an internal review of any decision. Where the decision can be appealed to the SBT, an internal review must be requested before the appeal can be heard (see Directive 10.2: Appeal Process for more information). Decisions that cannot be appealed to the SBT can still undergo an internal review.

If an applicant or recipient disagrees with a decision, he/she must request an internal review within 30 calendar days from the day the decision is received or deemed to be received. The request must be made in writing unless it is in respect of a decision that cannot be appealed to the SBT.

Written requests for internal reviews may be submitted using the Request for Internal Review (Form 2880), or by letter/note signed by the applicant or recipient.
In cases where the Request for Internal Review form is not used, the letter/note should include:

  • a statement indicating that the applicant or recipient wishes to have the decision reviewed;
  • the reason he/she disagrees with the decision; and
  • the name, case identification and signature of the applicant or recipient requesting the review.

Oral Requests and Time Extensions

Under exceptional circumstances, the Administrator may accept an oral request for an internal review and extend the time for submitting a written request beyond 30 calendar days. The Administrator must be satisfied that there are reasonable grounds for granting an extension to the time period. Reasonable grounds may include, but are not limited to, circumstances in which the applicant or recipient could not meet the prescribed timeframe due to:

  • receiving the decision without sufficient time to file the request (e.g., geographically remote locations where mail takes more than three working days to deliver);
  • extenuating circumstances such as a medical condition or bereavement;
  • an emergency medical condition of a person for whom the applicant or recipient is the primary caregiver; or
  • literacy or language barriers.

The Internal Review

An internal review is an informal administrative process, and the applicant or recipient does not require legal representation. However, an applicant or recipient may choose to bring representation to any interview that is conducted during the review process.

Once a request has been received from an applicant or recipient, the internal review must be completed within 30 calendar days. If a review is not completed within 30 calendar days, and the decision can be appealed to the SBT, the applicant or recipient is notified of his/her right to appeal the decision to the SBT without the review.

The reviewer cannot be the original decision-maker, however he/she should have the same or higher decision-making authority. Where appropriate, a delivery  agent may contract with another delivery  agent to undertake an internal review (see Directive 11.2: Delegations of Authority for more information).

During the review process the reviewer:

  • examines the case file, including the Notice of Decision, to determine if the decision was:
  • consistent with the Act, regulations and policy;
  • based on the correct application of the Act, regulations and/or policy;
  • reasonable;
  • based on information that was factual and comprehensive;
  • based on the correct interpretation of facts;
  • the result of appropriate use of discretionary power; and
  • not the result of administrative error;
  • considers additional information provided by the applicant or recipient related to the decision;
  • makes a decision based on the test of reasonableness and information available to the reviewer;
  • clearly summarizes the reason(s) for arriving at that decision; and
  • documents the internal review process.

The reviewer may contact the applicant or recipient to clarify and/or verify information related to the decision, and may accept relevant additional information submitted by or on behalf of the applicant or recipient.

In accordance with both the provincial and municipal Freedom of Information and Protection of Privacy Acts (FIPPA and MFIPPA) requirements, all information used in the review process is available to the applicant or recipient if requested.

Withdrawal of Request for Internal Review

An applicant or recipient may withdraw his/her request for an internal review at any time during the review process. A withdrawal may be oral or in writing, and the applicant or recipient must be informed that a withdrawal means no further appeal to the SBT will be possible.

It is recommended that the Request for Withdrawal of Internal Review (Form 2881) be filled out to confirm the withdrawal of a request. At a minimum, the withdrawal must be noted on the file. The delivery agent is not required to complete the internal review once a request is withdrawn.

More Than One Internal Review Request Related to the Same Decision

Upon completion of the internal review, if the decision is to uphold the original decision, but the applicant or recipient submits new relevant information with a second or subsequent request for an internal review, the Administrator may decide to conduct a second or subsequent internal review.

Calendar Days

The 30-day time period for requesting an internal review and the 30-day time period for completing an internal review are based on calendar days. The time period should be counted according to the following guide:

  • For requests, day one is either the day after an in-person notice is provided or three working days (i.e. not including holidays or weekends) from the day of mailing (it is assumed that correspondence is mailed on the day after it is dated).
  • For reviews, the first day of the review is excluded and the last day is included.
  • For both:
  • where the last day is a holiday, the day after should be counted as the thirtieth day; or
  • where the last day is on a day that is not a business day, the next business day should be counted as the thirtieth day.