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Management Response


In April 2000 the Insurance Branch implemented as part of its yearly action plan a comprehensive quality management strategy to improve the quality of decisions affecting benefit payments. Various initiatives and studies have since been done.

In November 2001 a policy on documentation and fact-finding for adjudication of Employment Insurance (EI) claims was implemented nationally. The objective of this policy is to ensure that documentation on EI claim files conforms to the standards of administrative law, and the requirements of the EI Act and Regulations. It also recognizes that good documentation supports the quality criteria established in the National Quality Management Policy to improve timeliness, accuracy, and clarity of communication, fairness and client satisfaction.

In April 2002, an interactive on-line fact-finding process within Appli Web (application for EI on-line), was introduced as part of the Government On-Line initiative. This process which is currently being expanded will ensure consistency in fact-finding thereby reducing variances in decision making across the country. As well, HRDC is promoting on-line applications as the preferred channel for accessing EI. As more claims are received through the Internet, the consistency of fact-finding and decisions should continue to improve.

On April 1, 2003, the Commission introduced a National Policy of Levels of Adjudication which set levels of responsibilities under which decisions can be made. The policy ensures consistency in the decisions by ensuring adherence to the proper level of authority. A first level decision is one with straightforward elements that can only lead to one readily apparent conclusion. A national study undertaken in the second quarter of 2003 by Insurance Quality Services concluded that agents are adhering to this policy in the majority of cases.

Internal Audit and Risk Management Services (IARMS) conducted, as part of its 2002-2003 Resource Utilization Plan, an audit of entitlement to EI benefits. The final draft report indicates that in the opinion of the auditors, "activities related to entitlement to EI benefit are well managed and the national quality management initiative and the strategic direction for improving the quality of decisions and benefit payment are contributing to the quality of this process".

I would like to stress that the survey period used in the analysis covered 2000 and 2001. Since that time, the Insurance Branch has actively pursued different avenues to ensure consistency - standardization in both the process and the policies that lead to decisions regarding EI claims. The initiatives implemented since 2000 have resulted in consistency of decisions continuing to improve.

For example, in 2001-02, the overall accuracy rate was 94.41%. The target is 95%. By the end of 2002-03, the accuracy rate had risen to 95.5%, an improvement of 1.09%, which translates into $120M in savings (benefits not improperly paid). And in the first three months of 2003-04, the accuracy rate continues to exceed 95%.

We anticipate that the advancement of automated claims processing (ACP), web-based adjudication tools and services to clients and employers will enable this upward trend to continue.


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