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HomeMy WebLinkAbout1984-0241.Peters.87-03-05IN THE MATTER OF AN ARBITRATION Under THE CROWN EMPLOYEES C'jLLECTIVE BARGAINING ACT ,. _ Before THE GRIEVANCE SETTLEMENT BOARD BETWEEN: OPSEU (Susan Peters) Griever Before: For the Griever: For the Employer: Hearings: - And - The Crown in Right of Ontario (Ministry of Health) E. B. Jolliffe Vice-Chairman I. J. Thomson Member G. Peckham-~ Member . . N. Roland COUtlSel Cornish & Associates Barristers & Solicitors J. Zarudny Counse 1 Crown Law Office, Civil Ministry of the Attorney General June 13, 1985 September 11, 12, 13, 26, 27, 1985 October 17, 18, 1985 November 28, 29, 1985 .Tanuarv 15. 16. 17. 1986 Employer - l- Between: IN THE MATTER OF AN ARBITRATION Under THE CROWN EMPLOYEES COLLECTIVE BARGAINING ACT Before THE GRIEVANCE SETTLEMENT BOARD Before: OPSEU (Susan Peters et al) - and - The Crown in Right of Ontario (Ministry of Health) Edward B. Jolli.ffe, Q.C. I.J. Thomson George Peckham For the Grievors; Nelson Roland -- Cornish h Associates Barristers & Solicitors Ministry of the Attorney General For the Employer: -- John Zarudny Crown Law Office, Civil 241/84 Grievor Employer Vice-Cha~irman Member .-Member Counsel Counsel Hearings at Toronto: - June 13, September 11,12,13,26 and 27, 1985 October 17 and 18, 1985 November 28 and 29, 1985 January 15,16 and 17, 1986 February 11,12,19,20 and 24, 1986 z .? - 2 - DECISION The Grievor in this case, Ms. Susan Peters, was one of eight clerks at the London~ District office' of OHIP in the Ministry of Health who grieved in Nov,ember, 1982, that their positions as Clerk 3 General in the Out-of-Province Claims Unit (hereinafter called the "OOP" unit) were improperly classified. They requested that their positions be re-classified Clerk 4 General, retroactive to October, 1979: Exhibits 2 and Exhibits 4A to 4G inclusive. 'i.. The consensual basis for such claims is to be found in Articles 5 and 27 of the collective agreement between Management Board of Cabinet and Ontario Public Service Employees Union, Exhibit 1, (said to be effective from January 1, 1982 to December 31, 1983) and in succeeding agreements. There is also- a statutory basis for such claims set out in subsec.,tio~n 18(2) of the Crown Employees Collective Bargaining.Act, as follows: In addition to any other rights of grievance under a collective agreement, an employee cl&ning, (a) that his position has been irrproperly classified . . . . . . . may process such matter in accordance with the grievance procedure provided in the collective agreement, and failing final determination under such procedure, the matter may be processed in accordance with the procedure for final determination applicable under section 19. The matter did not come on for hearing until June 13, 1985, and further hearings were continued from time to time until February 24, 1986. After protracted correspondence between counsel and the ~Registrar of the Board, a "procedural agreement" was reached and filed as Exhibit 3 on the first of 19 hearing- days. The importan t paragraphs of that agreement are as fol .lows: The parties in this matter (namely, OPSEH representing eight individual employees and the Ministry of Health) hereby agree as to the following on a without prejudice and without precedent basis: 1. The Final Decision of the Grievance Settlement Board in respect of the Classification Grievance pf Susan Peters, dated November 19th, 1982 will be.binding on all parties to the extent that the award determines the proper classification of Sue Peters, in respect of the follwing classification grievances: i) Jccelyn A. Marier - Grievance dated Nov. 19, 1982; ii) R. Sue Macpherson - Grievance dated Nov. 19, 1982; iii) Debra J. Lydestad - Grievance dated Nov. 19, 1982; iv) Lynne L. Byblyk - Grievance.dated Nov. 19, 1982: v) Silvia A. Weinhardt - Grievance dated Nov. 19, 1982; vi) Comelia Voorhaar - Grievance dated Nov. 19, 1982; and vii) Joanne Gatt - Grievance dated Nov. 29, 1984 The result in the Sue Peters case, in terms of whether or not Sue Peters is properly classified as a Clerk 3 General as opposed to a Clerk 4 General, will be binding upon the parties as if there had been separate arbitration hearings and awards in the seven cases noted @ve. 2. The employer will waive its right to make a preliminary objection as to the jurisdiction of theBoard based on any argument that there has been noStage 2 meeting in the Sue Peters case. 3. The employer will provide OPSEU and Sue Peters through their counsel with at least one week's notice prior to June 13th, 1985 (namely, no later than 5:00 p.m.,~June 6th, 1985) with respect to any preliminary objections relating to ;. _., -4- arbitrability which will be raised by the employer - otherwise, the employerwillbe deemed to have waived its rights in respect of any such preliminary objections. 4. The counsel for OPSEU and Sue Peters will provide the employer's counsel with at least one week's notice tie. no later than 5:00 p.m., June 6th, 1985) with advice as to whether or not there will be any "usage" issue in the Sue Peters case and, the title of the position involved, the position number and the name of the Ministry and incumbent involved. Ms. Peters testified for nine days, concluding on November 28, 1985,and again in reply on February 12, 1986. She had served withOHIP foralmosteightyears, including five as an "Out-of-Province' claims clerk. The only other witness called by her counsel was Dr. Peta Tancred-Sheriff,. who has written extensively on women's work, classification and bureaucratic organization. Witnesses called by the Employer's counsel were Mr. Wayne Ferris, who'has served since 1979 as Group Supervisor and latterly Group Leader of the OOP unit at London, and is now classified Clerk 5 General; Mr. J.M. Delaney, the OHIP District Director since June, 1983, and Mr. Bryan C. Neale, Regional Personnel Administrator with the Ministry'of Health. Throughout the course of hearings more than 75 documents were tendered in evidence, some more important than others. Certain exhibits include several hundred pages, adding to the bulk of material requiring consideration. The .Board is grateful to witnesses for their explanations of such documents, without which many would have been incomprehensible. The Ontario Health Insurance Plan, generally known as OHIP, functions as a Division of the Ministry of Healthy by authority of the Health Insurance Act and then Regulations thereunder. -The OHIP headquarters is, at Kingston, but there are District Offices in London and eight other cities as well as "Satellite Offices" in 10 locations such as Sarnia. In the District Office at London, the Plan's work is carried on by information and assistance clerks and those who process medical and hospital claims from within Ontario, but there'is --- or was in November, 1982 --- a group of eight exclusively concerned with claims for services outside Ontario. Broadly speaking, the Grievors in this case are engaged in answering inquiries, as well as investigating and processing claims and authorizing payment to~or on behalf of Ontario residents (of their district) with QHIP coverage who incur medical and/or hospital expense while away from Ontario. The protection afforded by OHIP is not exactly the same for Out-of- Province claimants as for those in Ontario and the conditions and procedures for making and proving claims are necessarily different. For these reasons specialized OOP units were -6- established some years ago at London and other District Offices. They receive claims originating in all parts of the world, approximately as fol~lows:. (a) From other Canadian provinces: 10 per cent (b) From the U.S.A.: 75 per cent Cc) From elsewhere abroad: 15 per cent Obviously there are wide variations in procedures and problems ,among the three groups above. The law may be different in other provinces: certain matters are dealt with under inter- provincial agreements or understandings, but their fee scales and hospital charges are comparable to those in Ontario and on the other hand; claims originating in the U.S.A. are characterized by billing practices and higher charges which vary from state to state (oreven between institutions) while professional standards and practices are somewhat different from those in Canada. Other problems naturally arise in connection with claims originating in Europe, Asia or Africa. Another feature of foreign claims is that many Ontario residents while abroad are. covered by "travel insurance" policies and are not entitled to recover from OHIP that part of their expense payable by~an insurance company or plan. The OOP unit at London in 1982 had a Group Leader with supervisory responsibility. Doubtful points could be referred to i ? - 7 - him or occasionally to the 'Medical Consultant or even the District Manager. In the great majority of cases, however, the processing clerks work independently, relying on their experience and judgment, fortified by a large stock of reference material to which they have access. The issue here is whether their work is underclassified at the level of Clerk 3 General. It is not for this Board to fix the standards whereby employee positions should be classified. Counsel were in agreement that written standards for Clerk 3 General and Clerk 4 General already exist and must be respected. They were created by.the Employer, which is exclusively authorized by statute ~to do so. Subsection29(1) of The Public Service Act provides that the Civil Service Commission (subject to the approval of the Lieutenant-Governor in Council) may make regulations "prescribing methods of evaluation and classifying positions" and "prescribing classifications for positions." Further;. Section 7 of the Crown Employees Collective Bargaining Act provides that "upon, being granted representation rights, the employee organization" --- in this case OPSEU --- "is authorized to bargain with the employer on Terms and Conditions of Employment, e>cept as to matters that are exclusively the function of the employer under subsection 18(l)..." Subsection 18(l) is as follows: Every collective agreement shall be deemed to provide that it is the exclusive function of the employer to manage, which function, without limiting the generality of the foregoing, includes the right to determine, s 3 -8- (a) employment, appointment, complement, organization, assignment, discipline, dismissal, suspension, work methods and procedures, kinds and locations of equipment and classification of positions: and (b) merit.system, training and development, appraisal and superannuation, the governing principles of which .are subject to review by the employer with the bargainlng . agent, and such matters will not be the subj,ect of collective bargaining nor come within the jurisdiction of a board. Thus the merits or demerits of a classification standard or standards are not subject to review by this Board. Nevertheless, the application of the existing standard or standards t,o a given position can be correct or incorrect, and it :.;~.y. :. is the application which often becomes controversial, sometimes resulting in arbitration by this Board of a grievance alleging that "my position has been improperly classified," which simply amounts to saying that the Employer's standards have been incorrectly~ interpreted and applied in respect of a particular position. The Standards themselves, although striving to be comprehensive and precise are clothed in general language, characterized by brevity. On the other hand, in a case like this, there is a massive body of ev,kdence relating to the position's requirements, duties and responsibilities, many of which defy brief description. The claim here is that the position has not been correctly classified in accordance with the existing standards. The object of reviewing and analysing~ the evidence is to - 9 ‘- ascertain whether the position, as it existed in November, 1982, "fits better" in one standard than in the other. A.perfe'ct fit in any standards is unlikely. The starting-point must therefore be the text of the Clerk General series, at least as far as the level of Clerk 4 General, which is the level claimed by the Grievors. As previously stated, the OOP clerks consider their . ..*.; positions to be wrongly classified Clerk 3 General and seek re- classification to Clerk.4 General. The series, Exhibit 50, defines standards for five.different clerical groups: general, clerical typist, typist, clerical stenographer and secretarial. The only paragraphs which need be quoted herein are those in the preamble and in Classes 1 to 4 relating to the General Clerical Series, as follows: KINDSOF~PKCOVEPED: --- These five series cover all office positions and office supervisory positions that are not covered by a specialized clerical, technical, equipment operating, or professional class series. GENERAL ctERIcAL SERIES - 7 CLASSES: -- This series covers positions where the purpose is to perform clerical work entirely or in combination with incidental typing, stenographic or machine operating duties. Where exclusion of the latter would significantly change the character of a position, or where they occupy a large proportion of the working time, the position should be assigned to one of the specialized classes, e.g. Clerical Typist. Positions for which specialized clerical series exist,, e.g. Clerk, Mail and Messenger, Clerk, Filing, etc. should not be assigned to this series. Group leader responsibility normally begins at the third level, while the fourth and above usually cover positions ~involving line supervision; however, non-supervisory positions can also be included. 51000 CL!Wil, GENERAL CLASS DEFINITION: Employees in positions allocated to this class perform elementary, routine clerical tasks, which require little lmowledge of office procedures and can be learned within a few hours. Assignments that are not self-checking are preceded by detailed instructions and are checked on completion. Although, in some positions, employees may assist others by performing parts of more complex assignments, they are not themselves responsible for the satisfactory completion of the overall tasks. This is a terminal class for persons continuously performing simple clerical activities. It may also cover positions of employees in training for higher level clerical work. QUALIFICATIONS: 1. iGrade 10 education, preferably Grade 12; working knowledge of arithmetic, spelling, punctuation and grammatical usage; some familiarity with elementary methods'of checking names and numbers and of sorting and filing. 2. Preference may he given for some satisfactory previous work experience or training. . . 3. Ability to understand and carry out simple work instructions in an office setting; ability to learn to USC simple office equipment. Revised, December, 1963 - 11 - CLERK 2, CENFXAL CLASS DEFINITION: ,i_ bployees in positions allocated to this class normally perform a number of clerical tasks of limited complexity according to established procedures, where the prime responsibility is for accuracy and an acceptable rate of production. Decision-making consists of determining whether material conforms to specific, set-out procedures or standards and requires little background knowledge of regulations or statutes. tiployees may initiate standardized letters involving little original composition.such as form letters,acknowledgments, reminders, etc. .~ They may slso assist with the training of junior staff. Assignments of unusual difficulty are preceded by-detailed instructions or are carried out under close supervision. The work is reviewed for adherence to procedure and acceptable standards of accuracy @volume. QUALIFICATIONS: 1. Grade 10 education, preferably Grade 12; working knowledge of arithmetic, correct punctuation; spelling and grannnatical usage; some knowledge of common office practices. 2. At least,tuo years satisfactory experience as a Clerk 1, General, or an equivalent combination of experience and education. 3. Ability to follow specific clerical instructions; ability and willingness to perform clerical work of limited complex- ity at acceptable standards of speed and accuracy. Revised, December, 1963 - 12 - 51004 cm 3. CENEXAL CLASS DEFINITION: Employees in positions allocated to this class, as ojourney- man clerksfit, perform routine clerical work of some complexity accord- ing to established procedures requiring a backgT.ound knzwledge of spec- ific re,tiations, statutes or local practices. Decision-making involves some judgment in the selection of, alternatives within a comprehensive framework of guidelines. Lnitiative is in the form of following up.errors or omissions and in making corrections as necessary. Doubtful matters not covered by precedent are referred to supervisors. Pluch of the work is reviewed only periodicGUy, principally for adherence to policy and procedures. Typical tasks .at this level include the preparation of factual reports, statements or memoranda requiring some judgmentin the selec-; tion and presentation of data; assessment of the accuracy of statements or eligibility of applicants, investigating discrepancies and securing~~ further proof,or documentation as necessary; overseeing, as a Group Leader, the work of a small subordinate staff by explaining procedures, assigning and checking work. . This is a terminal class for many positions involving the competent performance of routine clerical work common to the office concerned. QUALIFICATIONS: 1. Grade 12.or an equivalent combination of education, training and experiexq . 2. About three years satisfactory clerical experience. 3. .4bility to understand and explain clerical procedures and require- ments; ability to organize and complete work assignments within prescribed time limitsr 3bi3,ity to maintain good working relation- ships with other employees and the public served. Revised, December, 1963 - 13 - 51006 CLERK 4. CEWRAL .CI.AS?i DEFINITION: BnZnployees in positions allocated to this class perform a variety of responsible clericel tasks requiring a go+ background knowledge of specific re@ations; statutes or local practices. Decision-making involves judgment in dealing with.variations from established guidelines or standards. h'omally, employees receive specific instructions only on unusual or special problemu as the work is performed under conditions'that permit little opportunity for direct supervision by others. '~stters involving decisions that depart radically from established practices are referred to super- visors. Tasks typical of this level include the evaluation or assess- ment of a variety of statements, applications, records or similar material to check for conformity with specific regulations, statutes or administrative orders, resolving points not clearly covered by these instructions, usually by authorizing adjustments or recommend- ing payment or acceptance; supervising a small group of njourneyman clerks' or a larger group of,clerical assistants by explaining pmce- dures, assigning and checking work and maintaining discipline. QUALIFICATIOKS: 1. Grade 12 education or an equivalent combination of education, traintilg and e.xperience. ~*', ?',I '.. 2. About four years of progressively responsible clerical exper- ience or ah equivalent combination of experience and higher educational qualifications. 3. Ability to communicate clearly both orally and in writing; _ ability to instruct and supervise the work of subordinates. ~w Revised. December. 1963 The progression of responsibi lity and skills required may be seen in the stand~ards for classes 1 and 2, but of course the most important are the. standards for 3 and 4 quoted above. In Goobie 240/84 (Verity) grievance alleging improper classifi it was pointed out that a cation may succeed before the Grievance Settlement Board on either of two grounds: (1) The measurement of the Griever's job against the wording of the applicable class standards, the so;; called "Standards Test," or - (2) On proof that, notwithstanding the wording of the class standards, other employees performing equivalent duties are classified at a higher level --- known as the usage approach. The principlesabove were established by the Board over a period of years and received judicial approval in the Brecht case (1982) 40 O.R. (2d) 142 (Divisional Court). _e The usage approach was referred to in paragraph 4 of the procedural agreement, Exhibit 3, quoted above, but it was not resorted to by counsel for the Grievors. The Grievors' case rests soiely on the language of the standards compared with facts established in ~evidence. 5 - 15 - Among the numerous documents in this case is Exhibit 51, the "Position Specification and Class Allocation Form" said to apply to fh,e~Grievors' positions. Effective April 1, 1982, it, gave the Class Allocation as "Clerk 3 General" for the following reasons: Journeyman clerical work of some complexity requiring a background knowledge of the Health Insurance Act and Regulations as applicable to Claims and Enrolment portions. Decision-making and initiative involves appraising amount of claim for payment, determining cause for rejected claims and taking remedial action. Apart from the reasons given, the specification contains what purports to be a lengthy and detailed description of the job including its purpose, a "summary" of duties and,responsibilities (with percentage estimates of the time required for each function)- and the "Skills and Knowledge Required." The previous title of the job is given as "Claims Clerk" and a hand-written amendment makes the new title "Claims Processing Clerk." The remarkable featu~re of Exhibit 51 is that there is nothing in a lengthy description to disclose that the Grievors are exclusively engaged in processing out-of-province claims or answering queries about coverage abroad. The only words giving a clue to those essential feature of the job are in paragraph 3: - maintaining records of in/out of province/country medical/paramedical/hospital accounts by sources documenting each account and maintaining log; - 16 - Such words suggest that the processing of forei is no different from processing Ontario claims, which far from the truth. gn claims would be The result of serious omissions is that Exhibit 51 does not describe fairly or accurately the job being considered now. It is apparent-that its language derives from earlier descript- ions written when OHIP was attempting to have all claims pro- cessed by one group of employees. The attempt was abandoned and separate specialized units were organized for OOP purposes. The classification system simply failed to keep abreast of an import- ant organizational change. In many cases the position specifica- tion has been an important and helpful part of the evidence, but that is not so in this case. We find Exhibit 51 to be of little value. The grievances of Ms. Peters and seven other OOP clerks were presented in November, 1982. There was no Stage 2 meeting as required by the collective agreement; but that procedure has been waived by the Employer in Exhibit 3. The next development was a Job Audit, Exhibit 54, undertaken-by the Ministry. It is said on the cover-page to have been carried out on February 2 and 3, 1983; the Director's stamp acknowledging receipt was dated June 13. - : ,-17 - The auditor was Ms. Sally Kelly, Personnel dfficer in the HumanResources Branch of the Ministry. She was charged with auditing both the "Pay-Subscriber Group" and the OOP unit, but she overcame the deficiency, so apparent in the Position Specifi- cation of April 1, 1982. In doing so, she interviewed incumbents and supervisors separately, reporting in Part A of her audit on the Pay-Subscriber Group and in Part B on the OOP unit. In this case of course we are concerned only with Part B. ,Ms. Peters was interviewed as a representative incumbent of the OOP unit. On the right margin of the report appear "Corrections/Additions" in her handwriting a,nd also what appear to be comments or corrections by Mr. J.M. Delaney, the District Director. Before this Board Ms. Peters testified in detai 1 and at length. To review all her testimony would require a book-length decision, which is not really necessary. However, on the last ".; page~of the job audit there appears the following statement, signed by Ms. Peters: . . With the noted corrections or additions, I agree that this. is an accurate description of my duties. Mr. Delaney testified briefly before the Board on January 17, 1986. He had signed the job audit under the .following statement: t - 18 - With the noted corrections or additions I agree that this is an accurate description of the requirements of this position. It thus becomes clear that there is a certain degree of agreement between the parties, or at least between Ms. Peters and the District Director. They agree about most of the facts but not necessarily about their significance in light of the class standards. We propose to quote the au'dit report, Part '!B ,'I paragraph by paragraph, taking note of all "Corrections/ Additions" marked on the margins, although the identity of the commentator is not always certain and the meaning of the comment is sometimes obscure. It may also be appropriate at some points, to mention explanations Ms. Peters or Mr. Ferris made in giv~ing their testimony. We are. numbering the paragraphs --- from 1 to 42 --- quoted hereafter., As one of seven staff assigned to the only Out-of-Province Group, the incumbent is responsible for processing claims made against OHIP for hospital and medical services performed out- side Ontario ie. in other Canadian provinces, within the United States and other foreign countries - all out-of-province claims for subscribers residing in the London District are processed by the Group. The reference above to "seven" incumbents seems mistaken. Eight incumbents, including Ms. Peters, had grieved in November, 1982, only a few weeks before the audit. : - 19 - Beside the reference to "other Canadian provinces," there is a pencilled comment --- possibly made by Mr. Delaney: "fading," , followed by three question marks. lie may have had in mind arrangements with other provinces to honour certain accounts, at least up to the OHIP scale. Another comment immediately below the pencilled query appears to be in Ms. Peters' hand: "Still med elms out patient elms" 2) 'Ihe out-of-province claims prccessing group does not operate on a fixed cyclical basis, but rather, claims are processed in date order and input to the computerized system for payment on a continuous basis; subscribers are routinely advised that a cheque normally takes from 4-6 weeks to process thereby establishing an averaging processing time limit for the Claims Clerks: however claims can be processed in as little as 3 weeks .,~_ or t&e as'long.as 8 weeks during the peak workload periods occurring during the winter months ie. clerks process approximately 15 claims per day except during February to July when they will process approximately 30 par day. 3) The Group Leader has assigned claims to the clerks on a subscriber-alpha basis; the incumbent interviewed is responsible for all out-of-province/out-of-country claims for subscribers with surnames beginning with the letters R, P and K. The incumbent interviewed was Ms. Peters. 4) The approximate breakdown of the out-of-province clerks function is 59% - assessing and processing claims, 40% - inquiries and public relations, and 1% miscellaneous duties. 5) The clerks within the group take turns sorting and distributing the mail on a time-allows basis; each clerk priorizes his/her own work, however, hospital claims are usually processed first as payment is expected within 30 days. - 20 - All clerks within the group were females. The'Group Leader, classified Clerk 4 General at the time of the audit, and since re-classified Clerk 5 General, was Mr. Wayne Ferris. 6) ~Claims are usually received in the form of letterhead accounts (ie. statements from hospitals or medical practitioners); the Claims Clerk prepares an index card by subscriber'alpha with copies of all documentation attached: the index card is kept in the clerks'.current file foroneyear - this provides a ready reference and allows the clerk to keep track of duplicate bills eg. subscriber and hospital both submit the same statement; as well as monitoring OHIP residency requirements (ie. must reside within Ontario for four months each year) - in cases of suspected abuse, the Clerk will send a 'proof of residency' cardtothe subscriber requesting details of their continued Ontario residency: in cases of continued abuse, the clerk will refer the ~case to the 'Special Committee', Customer Service Department .for resolution;~ if the subscriber has moved out of Ontario permanently, the Claims Clerk will request a ruling from Head Office regarding cut-off date for processing claims on the subscribers behalf. The original documents are numbered .by a rotating clerk and sentto microfilming; these documents can then be assessed on the microfiche by using the assigned nwnber. Comments were made on the statement above that a ruling is requested from Head Office "regarding cut-off date..." In pen, Ms. Peters appears to have written: "this was in effect at the time of the interview because of organization problems." Next, it was commented in pencil: "cancellation is worked out -. with Cust Svcs." Then - in ink - Ms. Peters wrote "changed lately was in effect of time of audit," and beside that comment she wrote "normal procedure." 7) Upon receiving the letterhead accounts, the clerk will check for the CHIP number and if missing, will attempt to obtain from the alpha-microfiche of subscribers: if problems are still i . -21- encountered, the clerk will either call or write to the subscriber; where the-subscriber haa not provided any address or phone number, the clerk will direct an appropriate ,form letter inquiry to the physician and/or hospital involved. 81 The Clerk ;will then review the letterhead account to ensure that all the necessary information has been provided by the subscriber; in terms of personal information the claim must include the subscriber's surname, initials, OHIP number, Ontario address, address to which the payment is to be sent, patient's name, date of birth, etc.; claims must also include .~_ such professional information as the physicians/practitioners . . .~ full name, initials and.address, diagnosis, description of medical services performed, dates and number of services, fees charged for each service, etc. - where any of the required information is missing or incomplete the Claims Clerk will follow-up with the subscriber, physician/practitioner or hospital as appropriate to obtain the required or clarified information; indoing so the clerk has a number of form letters at his/her disposal to avoid the delays encountered in creating original correspondence or may also make inquiries by phone where appropriate; approximately 55% of claims require follow- up action of this type; this may involve requesting admitting reports, operative reports, etc. Booth in examination and cross-examination Ms. Peters gave an extremely detailed explanation of all the steps which must be taken and other steps it may become necessary to take after an account is received. These are briefly described in the Job Audit above. An attempt was made.on behalf of the Employer to show that there is an established routine or procedure, that there are few variations and that proble?s can be easily referred to the Group Supervisor. In short, the Board is asked to believe that the processing of foreign claims is relatively simple, falling within the Class 3 reference to "routine clerical work of some complexity." i - 22 - Ms. Peters' testimony was supplemented by that of Mr. Wayne.Ferris. Significantly, he was in 1982 "Group Supervisor" and saia his duties have been "the same since 1979". However, he is now "Group Leader,ll classified Clerk General 5. He had undoubtedly been under-classified Clerk 4 General< He has not processed claims himself since 1974. Much thatMr.Ferris said was informative,butwe do not find substantial disagreement between him and Ms. Peters as to the clerks' work. One difference between them was probably natural. Ms. Peters .tended to minimize the degree of supervision required by the clerks; Mr. Ferris tended to maximize it. The truth probably is that a clerk as experienced and able as Ms. Peters requires little or no supervision: a newcomer would require much supervision, even if experienced in processing in- province claims. On the whole, the testimony of Mr. Ferris and evidence later by the District Director, did nothing to persuade us that the processing of foreign claims is "routine clerical work." On .* the contrary, it is extremely complex and calls for good judgment and discretion as well as communication skills. It is now necessary to continue quoting the Job Audit. - 23 - 9) 1520% of out-of-province claims must be translated:, there are a number of staff in the District Office with second language capability whose services may be used for translation, however, where this is not possible the claim documents are forwarded to Translation Services at CUeen's Park; depending on the volume and complexity of material attached to a particular claim, the Claims Clerk may attempt to decipher the information through the use of multilingual dictionaries, thereby avoiding the significant delays which can be encountered in arranging full translation; A marginal comment in pencil --- referring to the first - _, line above --- is: "overall only 5% sent out." This probably means that only 5 per cent were sent away for translations. More were translated 'within the London office, as the next following words explain. 10) In addition to requiring language translation, claims also involve many different currencies which the Claims Clerks must convert prior to the actual claims assessment process: all currericies are converted into Canadian dollars using the exchange rate quoted by the subscriber or, if not indicated, the Royal Bank exchange rate for the day the service(s) was rendered; hospital claims from the U.S.A are paid in American funds but medical claims from the United States (physician/practitioner) are paid in Canadian funds as are all types of claims frcm outside of North America. 11) One clerk within the Out-of-Province Group handles 'lost' out- of-province claims for surnames beginning with ‘M’ and 'N' which have been submitted to the OHIP-Read Office without any reference to the subscriber's Ontario address; the clerk will check the on-line SAS system for the subscriber address and if not available willordera microfiche copy of the last claim processed for the subscriber: theclerkprocesses any claims belonging to the London District Office but refers other claims to the appropriate District for processing with an SAS payment history transcript attached. -24- Some one struck out the word "lost" in the first line above and pencilled "unidentified" on the margin, below which in pen are initials which appear to be those of Mr. Delaney. 12) Medical Claims - physician/practitioner/labs The Claims Clerk reviews the medical claim to determine the .place of origin (using an Atlas, if necessary); determines where the service was rendered eg. physicians/practitioners office, health spa, clinic, etc - the clerk must ensure that the claim is an original itemized bill-statement from the service provider: the clerk also establishes if payment is to be made to the subscriber (usual) or physician/practitioner eg. physicians/practitioners across Canada and the United States :~ cyan submit a claim agreeing to accept the fee per OHIP Fee' Schedule; these physicians/practitioners can order OHIP claim cards or the subscriber can prov,ide a blank claim card (available in the OHIP Travellers Guide brochure); in this case, the Claims Clerk must write to the service provider detailing the OHIP Fee(s) payable for the service(s) rendered and requesting confirmation that the fee is acceptable to the service provider and that no request for additional payment will be made to the the subscriber. The OOP clerk must be vigilant in identifying the eligibility of the person.providing service and the need for such service. Certain services are not covered by OHIP,..e.g. medical examinations required for-applications for employment or t.he continuance of employment, life insurance, or admissions to -- universities, colleges, camps or recreational activities. 13~) The Claims Clerk transfers information from the letterhead accounts onto an OhTP claim card using dummy numbers indicating province, state or world remaining, as well as a number indicating the physician/practitioner specialty eg. a general assessment performe$by a general practitioner is paid under OHIP Fee Schedule guidelines at $31.90; a general assessment performed by a cardiologist is paid at $39.00 - the clerks have - 25 - lists of physicians by specialists but quite often must call OHIP Head Office for more up-to-date information in .this regard: allmedicalclaims are processed for payment to pay- subscriber or pay-physician in the same way as the claims referred to inPart Aof this audit report ie. assessment and coding of claim cards, batching, numbering, microfilming, keytaping, in-house edit and resubmission, mainframe edit and payment/resubnission. 14) The process differs somewhat in terms of the approach to assessment and medical review ie. mainframe resubmission, which must be taken on the part~of the Claims Clerk and the degree of researchrequired - medical claims are paid at the OHIP rate for a similar service in Ontario; in many cases it is difficult to directly relate a service or procedure to the Ontario Schedule of Benefits; the Claims Clerk must use his/her discretion in terms of "ballparking" claims where the medical terminology and fees vary from those listed in the Fee Schedule; the Claims Clerk must be reasonably flexible in interpreting claims and will normally award the benefit of doubt in favour of the subscriber - in terms of medical claims within Canada, the clerk is able to refer to Fee Schedules from other provinces which are maintained for this purpose; in some situations the~claims Clerk must assess a claim without the benefit of an operative report which would be essential and requested for a comparable in'-province claim; these cases arise frequently with claims from European countries which, may not only be in a foreign language, but may be far from adequate in terms of providing accurate diagnostic and treatment infor- mation: in these situations the Clerk must use her discretion in determining whether or'not to pursue the matter by composing and arranging for translation of an appropriate letter to the service provider involved or "ballparking" the claim; the Clerk would normally seek confirmation of her decision from the Group Leader who may in turn suggest referring the claim to the Technical Assistant or Medical Consultant; all claims for plastic surgery/complicated surgeries, claims which cannot.be identified within the Fee Schedule or claims which involve unusually high fees eg. $2;000.for an appendectomy are referred for adjudication by the Medical Consultant; approximately 10 claims per week will be referred in this manner by the Group Leader: the out-of-province claims clerks have the capability of.assessing operative reports, however, claims in excess of $3,000 must be approved by the Claims Production Manager and the Medical Consultant. 15) Laboratory fees which are paid to the OHIP Fee Schedule are submitted (original bill) by and paid to the subscriber. - 26 - 16) HCSPITAL CLAIMS In terms of assessing hospital claims, theclaims Clerk must determine if the treatment was the result of an emergency and therefore medically necessary: if such is the case, the clerk will process the claim for 100% payment, otherwise the claim is processed at 75% of the standard ward rate: in certain situations a non-emergency hospital claim can be processed by the Clerk at 100% eg. subscriber is out of the country as a student, on sabbatical or business: the emergency vs. elective nature of a hospital claim can be readily determined in most instances, however, if in doubt the Claims Clerk may contact the subscriber or hospital for further information eg. a sub- scriber living in the Windsor area has an accident resulting in treatment at a Detroit hospital- the clerk will correspond with the Detroit hospital in an attempt to discover if the accident took place in Detroit - in which case OHIP pays 100% or the accident took.place in Windsor but the subscriber elected to be taken to the Detroit hospital, therefore treat- ment is considered elective and OHIP willonlypay 75% of the claim. Perhaps the most important limitation on coverage abroad is the 75 per cent rule. In short, for example: a subscriber may not take advantage of the plan by choosing to have elective surgery atan expensive hospital in Florida when he could just as well have had the same operation at an excellent facility in Lon,don before going south. However, the OOP. clerks are often called on to deal with borderline cases where it is not crystal clear whether admission to a hospital was elective or emergent. Judgment, discretion and tact are then required. .$“” 171 A reciprocal arrangement exists between provinces in Canada regarding hospital claims; hospitals providing in-patient services to an out-of-province Canadian will bill their respective Health Plans which, in turn, bills the subscribers Health Plan - these claims are processed by OHIP Head Office: hospital out-patient claims are ,processed by the District Office at a reciprocal flat rate. -.27 - For obvious reasons, the processing of claims originating in other provinces is much simple,r and more expeditious than processing claims from foreign countries. But claims from other provinces amount to only about 10 per cent of the total; 90 per cent originate in the U.S.A. and other foreign ' countries. 18) U.S. hospitals submit separate claims for technical services eg. X-rays versus professional service (physicians/practit- ioners); this is the only instance where the professional portion of a procedure is paid at the same rate as the hospital claims ie. 100% emergency and 75% elective, regardless of the fee set for similar procedures in the GBIP schedule of Benefits. 19) The Claims Clerk completes a Form 120 for each hospital claim received; the Clerk must determine if the subscriber has paid any portion of the hospital bill eg. some U.S. and European hospitals require a deposit prior to admission; the clerks will deduct from the hospital bills any charges that are non-insured services under the CHIP plan eg. semi-private or private room charges, telephone, television charges etc. the subscriber is . ..personally liable for these charges directly to the hospital or in the event that the subscriber has paid a portion or all of the hospital bill the non-insured services will be deducted from OHIP payment to the subscriber. 20) If the hospital claim involves charges for blood transfusions, the clerk determines if the hospital concerned is a member of the AmericanRed Cross in which case the blood is replaced by the Canadian Red Cross in a reciprocal arrangement otherwise OHIP will cover the cost of the transfusion. .w 21) 'Ihe Claims Clerks also examine hospital claims and/or invoices ~ for any recording of an additional insurance carrier; in certain instances hospital documents indicate a primary carrier other than OHIP eg. Medicare, which could be evidence of fraudulent use of 0~1~; in these situations the clerk will write to the hospital or Medicare requesting a statement of the portion of the claim paid by Medicare to determine OHIP's portion of payment, if any. - 28 - Being on the alert for evidence suggest ing possible fraud is not a characteristic of "routine clerical work." Even if there were no fraudulent intent on the part of a subscriber, carelessness or ignorance could lead to duplicate payments (to lerk is expected the subscriber) for the same account. The OOP c .i to make sure that this does not happen. 22) If the hospital services rendered are as the result of an accident, the Claims Clerk ensures that a copy of Form 120 is sent to the OHIP Subrogation Department and if the subscriber is also insured under Blue Cross (Canadian Supplementary Insurance) a CODY of Form 120 indicatincl OHIP payment is forwarded to this-organization. A marginal note in ink by Ms.Peters wou Id add the wprds "or personal injury" to the word "accident" in the first line above. The concluding lines --- beginning with the words "is also insured" have been,struck out with a pencil. A marginal note in ink --- not Ms. Peters' writing --- appears to be "no sub," to which Ms. Peters added "actually to the sub." 23) "Hospital" claims may be received from clinics, institutions or spas which are not.covered by OHIP; the Group maintains a record indicating the status of known-facilities relative to OHIP coverage: as the Claims Clerks are made aware of new institutions, etc., the Group Leader will obtain a ruling of their status from-the Medical Consultant eg. OHIP does not consider treatment at Dr. Buyrzinski's cancer clinic in Texas an insured benefit: in some cases OHIPmay cover a portion of the services provided by an institution .eg. initial assessment. -- - 29 - The OOP clerk must exercise caution in identifying an institution providing service, by whatever name it may be called. OHIP coverage does not extend to health spas or similar facilities, or to admissions for cosmetic surgery. There are other limits: fo.r example benefits at the approved rate (up to 60 days' care) are provided only if an acute attack requires the subscriber to be admitted into a tuberculosis sanatorium or psychiatric hospital outside Ontario. 24) 25) Receipted medical and hospital claims submitted tcgether by a subscriber~'can be paid on.one cheque eg. a subscriber was treated as an out-patient in the emergency department of a hospital and has paid for emergency out-patient service plUS the attending physician's fee - the Claims Clerk completes a claim card including both medical and hospital charges: the clerk then uses a dummy diagnostic code on the claim card in order that the claims will reject from mainframe review thus producing a resubmission document and patient history: the Clerk manually assesses the resubmission document in the appropriate currency in order that.the subscriber will receive payment for both hospital and mediFa,l, claims on the same cheque. Hospital claims are numbered and filmed in the microfilm unit, keyed in data entry onto a magnetic tape for processing through the mainframe computer system in Toronto; a hospital claims payment listing is produced which is circulated to the claims clerks by a group 1eader;the clerks identify their claims by subscriber surname and note on their corresponding subscriber index cards, the claim number and the date of payment; all unpaid/rejected hospital claims are &turned to the Clerk as resubmission documents: the clerk identifies the reason for rejection from codes on the hospital claims payment report, which may necessitate pulling the original documentation; the Clerk will correct and process if possible eg. data entry error: if the claim has rejected for reasons of eligibility eg. coverage lapse, the claim/letterhead account and any accompanying original documentation is returned to the originator (subscriber or hospital) explaining the,reason for rejection: claims may also reject if they do not conform to the Medical FuAes programmed into the computer eg. daily payment to a hospital cannot exceed $1500.00. - 30 - An example of recorded hospital accounts appears at page 6 of Exhibit 24. It will be seen that patients' names are deleted, payments were made to hospitals in Iowa City and Paris, France, and one payment reimbursed a subscriber. DATE I 23/05/(15 WOSPITAL CLAXHS STSTEH OUT OF PROYINCE CANAOIAN PAYMENT LIST HElllO PAY WEOISTERED - OAK” TYPE T "OSP DHIP; AIWUUY mmn4t GIVN PdTIfNT imy lO"I, DISCW No No PAID OlLLEO Nb,lE SURNA”E DATE DATE DATE 9991 55.65 sa.7t PAYANE ,O t (MIV OF IOWA HOSPITALS AW CLINICS PPPl m3.92 E63.92 1407 0903a5 040305 PAYABLE TO t 52 6LENAN AVE TDRONYO ONY 9991 6,105.94 11,957.92 2zoa 120205 1**5a5 PAYASLE TO t ~INSYIYUT GUSTAVE RO4tWf 94665 “ILLEJVXF CEDEX PARIS FRANCE TOTAL AH0W-T t 8,X5.51 11,726.S6 26) All claims which pass through'for payment result in the issuance of .a cheque to the subscriber, practitioner depending on the nature of the claim. hospital or 27) Subscribers do not receive a breakdown of fees paid on their :.*. behalf as the only receipt provided is the cheque stub which shows only one claim number and the date of the initial service covered by the claim payment; where subscribers have extended health coverage through a private agent eg. Blue Cross, Mutual of Cmaha, Confederation Life, etc. they are compelled-to contact the District Office to obtaindetails of the payment for referral to the private carrier to determine payments owing under the extended health coverage - these inquiries which may be by phone, in writing or in person (walk-in inquiries) require that the originating Claims Clerks retrieve all documentation surrounding the~claim and develop an itemized account of all services, fees claimed and amounts paid by OHIP; these itemizations and copies of any bills are forwarded by- the - 31 - Clerk to the private insurance carrier; these inquiries may also be received by phone or in writing directly from the insurance carrier and, in these situations the Claims Clerk will respond directly to the carrier ; the Claims Clerks have regular contacts with insurance agencies to provide information with respect to itemizations and to discuss and/or provide additional details surrounding all information forwarded on behalf of individual subscribers. The last few lines of the paragraph above were amended in ink, substituting "sub" (subscriber) for "insurance carrier" and 'carrier" and substituting "inquiries from" instead of "regular contacts~ with." However, all the words inthe last few lines --- beginning with "these . itemizations" --- have been framed with a pencil and marked "out" apparently by Mr. Delaney. There is also a comment in very different pencilled handwriting: "Check with hospital administration frequently." 28) Itemizations may also be requested by lawyers eg: where death i hae occurred out of the country and an attorney is settling an estate: the Claims Clerks will respond directly to these inquiries obtaining the necessary authorizations where they have not been provided. 29) Itemizations can be very time consuming depending on the number and complexity of services covered by an individual payment: each Clerk will complete approximately 20-25 itemizations per ~' month. .* Beside thee above paragraph was the comment in ink: "some are informed as opposed to typewritten" --- but these words were stru,ck out by an unknown hand. - 32 - 30) Claims Clerks within the Out-of-Province Group are also responsible for dealing with a variety of telephone and written inquiries; each Clerk will handles approximately 100 written and 170 oral inquiries per month; inquiries may relate to (a) general questions regarding out-of-province claims eg. services covered and not covered, procedures for making claims, whether ornotservices provided byaparticularclinic or spa are an insured benefit, etc.: (b).the status of a particular claim or problems surrounding payment eg. cheque not received, payment made to the wrong party: subscriber not being aware of certain payment policies which have resulted in the reduction oft the expected payment: (c) calls f rom out-of-province practitioners and hospitals concerning OHIP's policies and procedures and liabilities for payment: and (d) telephone inquiries from M.P.P. offices on behalf of constituents concerning the status of particular claims; all responses to specific inquiries regarding individual OHIP contracts are handled within confidentiality and Security guidelines. The Ministry has published a booklet entitled "The Traveller's Guide to the Ontario Health Insurance Plan," Exhibit 29. If all residents leaving Ontario were to obtain and study it, no doubt their claims would be submitted in better order and :they would have fewer inquiries and complaints to make. It is clear from Ms. Peters' testimony that many claims are defective when submitted and many~ subscribers do not understand what their rights are. Exhibit 29 explains clearly "How to Claim Benefits." There is an explanation of "Insured Benefits Outside Ontario" and its limitations, a list of "Services not Covered" in Ontario or elsewhere and a list of benefits covered only in Ontario. Moreover, there is a salutary warning at page 9 headed "Important!' a.+ follows: - 33 - Since by law, the Plan cannot reimburse you for more than the amount it would have paid for the same services in Ontario, all of your costs may not be covered. This is of particular importance in some centres'ifi the United States where professional fees may be much higher than in Ontario. The possible advisability of extra coverage from private insurers is discussed onpage 5. claims for physician and practitioner services are reim- bursed in Canadian funds in accordance with the fees listed in the OHIP Schedule of Benefits. , At page 5 travellers are advised that "extra coverage is ~'1~ insurers, several of whom have plans for available from private just that purpose." 31) The Claims Clerks will attempt tohandle allcallsand refer only those which are outside of their terms of reference to the Group Leader; calls will also be referred to the Group Leader if the caller is particularly irate or requests to speak to saneone in higher authority. 32) '. Contact with the public (ie. subscribers, physicians.,~. practitioners and hospital/clinic representatives) is an ongoing and regular feature of the'cut-of-Province Claims function; the Claims Clerks must exercise tact and diplomacy in dealing with inquiries in a number of potentially difficult situations eg. (a) the subscriber is not familiar with and/or .I-. is not prepared to accept OHIPpaymentpolicies; (b) the sub- scriber is upset because payment is being unavoidably delayed :-*.. due to the need to obtain moredetailed information.from the service providers: or (c) the person making an inquiry has limited command of the English language and/or has difficulty in comprehending the advice being offer-ad. A pencilled comment was made beside the opening words Of the paragraph: "Common to all on different basis.“ - 34 - 33) Inquiries may lead to the cancellation of a cheque or recovery of funds eg. (i) a subscriber may not have advised OHIP of a change of address; cheque has not been returned and must be considered lost (ii) payment has been sent to a hospital when, in fact, the subscriber had paid the bill upon being discharged therefore the Clerk must write to the hospital requesting a refund on behalf of the subscriber: a Cheque Registry (subscriber payments) and the Hospita1.Claim.s Payment listing are utilized by the Clerks in researching the status of payment: the Clerks can also obtain copies of cancelled cheques where necessary by contacting the Insurance and Accounting Office. 34) Walk-in inquiries normally cover similar topics as phone and written inquiries, but may also involve taking submissions from subscribers eg. a subscriber may gather all claims accumulated over an extended period and personally deliver them to the Office upon returning to the Province; the Claims Clerk would examine all documentation for accuracy and completeness and assume responsibility for processing the claim. 35) Production Reporting The rate and volume of production is not a critical feature of the Out-of-Province unit, however production reports are maintainedby the Clerk on a daily basis; the daily reports provide a count of claims processed (divided ,into out-of- province and out-of-country), claims referred to the Technical Services Department for adjudication, eligibility rejects, researches conducted, resubmission and adjustment documents processed, form letters, and composed correspondence sent out, walk-in and telephone inquiries received and number of microfilm copies ordered. 36) Actirq Assignments The Out-of-Province Claims Clerk willactas Group Leader in his/her absence: the Claims Processing Supervisor will normally assign one out-of-province Clerk to deputize for the Group Leader if the absence is for one day; for lengthier absences caused by illness, vacation etc. each of the out-of-province Clerks will be assigned specific duties of the Group Leader position. Whatever it may mean, an asterisk (in ink) appears at the left margin of the words "out-of-province Clerk to deputize - 35 - for the Group Leader" and on the right (also in ink) is a scrawl which appears to be initialling by Mr. Delaney. It is not clear whether he wished to emphasize the point or question it. 371 Allout-of-province Clerks have input regarding'the review, correction and revision of Cut-of-Province forms and documents in order to provide a more efficient flow of information. There was a comment in pencil beside the a~bove paragraph: "not necessarily," but it has been struck out in ink. Ms. Peters then wrote in ink: "This would apply to all elms elks if requested." A further inked comment in different.hand-writing was "worked as a group for new payment letter used throughout Dist. office." 38) Clerks Within the O&of-Province Group may be required to work in any of the other claims processing~groups during peak workload periods; the reverse dces not hold true. The las~t words above --- "the reverse does not hold true” --- were struck out in pencil, but beside them appear in pencil "can be.” Above that comment it appears that Ms. Peters .* or an associate wrote in ink: "We believe the reverse can happen but the incumbent does not agree fully i.e. hospital claims." The point at issue here is whether in-province clerks are qualified to process OOP claims without a period of "training" or "donversion". Ms. Peters does not think so and Mr. - 36 - Ferris, the Group Leader failed to contradict her. explanation is in the next paragraph. 39) Skills and Knowledge - The out-of-province Claims Clerk undergoes three months of training to reach the full working level of an Cut-of-Province Claims Clerk however, the incumbent interviewed and the Group Leader indicated that this training period is premised on a clerk being fully trained @one of the other Claims Processing Groups (Pay-Physician, Pay-Subscriber); previous experience Of this nature provides the background knowledge of the OHIP Fee Schedule, International Classification of Diseases, Health Insurance Act, medical and computer terminology plus the overall policies and procedures related to claims processing trhich provides a basis for the more flexible treatment of claims in the Out-of-Province area; training in the position would then involve interpreting unfamiliar medical terminology in order to relate services/procedures performed to equivalents within the OHIP Schedule of Benefits; learning to deal with ~claims involving foreign ianguages and currencies and devel- oping a sound working knowledge of the policies and procedures governing out-of-provi~nce claims in order to respond effectively to a variety of inquiries. The In the above paragraph the words -II training" and "full" have been struck out i,n pencil (probably by Mr. Delaney pencilled replacement "a period of conversion," below Peters wrote "except agreed training for hospital".. with the which Ms. The word "training" when used again was struck out and replaced by "convers'ion." A pencilled comment (again probably by Mr. Delaney) was "could take a elk off the street and take the usual 22-24 months training O.K." after which an unidentifiable, commentator wrote: "This holds true any position (not realistic)" - 3-l - 40) ,The Out-of-Province Claims Clerks acting as direct representatives of the Ministry of Health in their daily interaction with the public must ensure gccd public relations are maintained: in order to be effective in this regard the Out-of-Province Clerks must not only have an extensive knowledge of theOHIPSchedule of Benefits, Health Insurance Act, etc. but also be conversant with International Laws pertaining to collection, assignment of rights and a variety of other Health Insurance Plans eg. Medicare, Blue Cross, etc. The words "direct representatives" has been circled in ink and "the Ministry of Health" has been amended in ink to read "OHIP." On the right Ms. Peters seems to have written "applies to all elms processing clerk." On the left, half-way down the paragraph is another mysterious asterisk. In the last clause "International laws" is amended to read "International payment policy," apparently initialed by Mr. Delaney. In a different hand, the words added at the end of the paragraph are: “Social Service Benefits of other countries Medical Plans." On the right areseveral illegible words written in ink by an unknown person. 41) The Out-of-Province Clerks must maintain harmonious relationships with out-of-province service providers to ensure that future patients will not be denied access to health services. - . . :,.. On the right someone has written in ink "too dramatic" followed by two question.marks and the words "covered above.” Further comment by an unknown hand is i llegible except for'the last two words-:. "processed promptly." - 38 - 42) The position also requires the ability to function effectively in a group/teamwork setting and the ability to process assigned claims while dealing with a fluctuating volume of telephone inquiries from a variety of sources. There were no comments on this paragraph but an asterisk appears to the left of the word “abi lity." In the foregoing revie.w o: E the -Job Audit all legible comments (under the heading "Corrections /Additions") have been reproduced verbatim. Most are not of great importance and reveal no serious differences as between the incumbent and management. It is fair to conclude that the text of the Job Audit, subject to very few exceptions, represents ag~reement by the parties as to the duties, responsibilities and requirements of.the position. These are the facts to be tested against the language of the standards for Clerk 3 General-and Clerk 4 General. It is necessary to compare certain words in the Clerk 3 General Standard with the corresponding words in the Clerk 4 General Standard. Such words represent an atte,mpt to provide indices whereby the two Standards may be distinguished from each; other. It must be kept in mind, however, that & certain amount of "overlapping" is inevit&Qe because some of the essential requirements are found in both. It is also obvious that there may be room for legitimate differences of opinion in assessing a posit,ion. For example, any job has its "duties" and its "responsibilities" --- which may or may not have equal weight. The value of a "duty" is easier to judge. The value of a "responsibility" may vary with the nature of a particular position. It is clear that some jobs --- whatever the skills required --- carry much more "responsibility" than others, although the difference is not always recognized in a "Position Specification and Class Allocation." It may be useful to re-read the first paragraphs of the two standards, side by side and thereafter compare the key words or indices: Class 3 Bnployees in positions allocated to this class, as "journeyman clerks", pefonn routine clerical work~of some complexity according to established procedures requiring a background knowledge of specific regulations, statutes or local practices. Decision-making involves some judge- ment in the selection of alternatives within a conprehensive framework of guidelines. Initiative is in the form of following up errors or anis- sions and in making corrections as necessary. Doubtful matters not covered by precedent are referred to supervisors. Much of the work is re- viewed only pericdically, principally for adherence to policy and procedures. Class 4 Fmployees in positions allocated to this class perform a variety of responsible clerical tasks requiring a good background knowledge of specific regulations, statutes or local practices. Dscisionmaking involves judgment in dealing with variations fron established guidelines or standards. Normally, employees receive specific instructions only on unusual or special problems as the work is performed under conditions that permit little opportunity for direct supervision by others. Matters involving decision5 thatdepart radically from established practices are referred to supervisors. class 3 Class 4 "routine clerical work of sore "a variety of responsible clerical complexity according to established tasks” procedures" - 40 - It can be argued of course that both versions fit the nature of the work performed. Nevertheless, on all the evidence before us, we think the Class 3 version does not fit the OOP job and the Class 4 version does. We reach this conclusion princi- pally for two reasons. The word "routine" is in our opinion inappropriate and inapplicable. Secondly, the evidence estab- lishes that there are indeed procedures set out in various regulations, bulletins and memoranda --- scattered widely: ,. throughout scores of hand-written, typed and printed documents --- which are subject to variation and frequent revisions. Thus, there do not exist "established procedures" in the proper sense . . of that term. More important are weighty reference books such as the "OHIP Schedule of Benefits Codes," Exhibit 9, listing code numbers for hundreds of medical procedures together with the "OHIP Schedule of Benefits" which (after a lengthy explanatory preamble) specifies the amounts payable for each of the numerous and varied kinds .of services performed by physicians, all coded for computerization. Attached are also schedules of benefits recognized by OHIP for Laboratory Medicine, Chiropodists, Podia- trists, Chiropractors, Osteopaths and Physiotherapists. All these are bound together as Exhibit 9 andformthebasic scale of OHIP bqnefits in Ontario, which, however, are modified to some extent in respect of services rendered abroad. Another volume of importance to OOP clerks is the "CPT" or "Physicians' Current Procedural Terminology", published by the American Medical ., - 41 - Association. It specifies the U.S. code numbers for a great variety of medical services, using terms which are often differ- ent from the terms recognized by the profession in Canada --- and by OHIP. It is understood that physicians and hospitals render- ing accounts from off ices in the U.S.A. would not know the OHIP codes or terminology --- or the benefits payable. Their language and their codes must be translated from one system to the other; a function of the OOP clerk which certainly cannot be described as I1routine." Another text quoted in Exhibit 25 is the "Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death" published at Geneva by the World Health Organization, a United Nations Agency. On the other hand, we conclude that the applicable words in the Class 4 Standard do correspond to the real nature of the work: "responsible clerical tasks." In short the work is not .n routine" and it is both "responsible" and "clerical." ..>7-? Class 3 class 4 "requiring a background knowledge "requiring a gccd background kncxJledge of..." of..." -- We have no difficulty in arriving at a conclusion about this index. It is clear from the many documents put before,us -- and from the testimony of witnesses on both sides --- that the work requires not merely "a background knowledge" but rather "a - 42 - good background knowledge of specific regulations, statutes of local practices." Indeed, the knowledge of "practices" required is not really local but extends to practices in many different jurisdictions throughout the world and particularly the U.S.A., which does have insurance plans of various kinds both public and private, but nothing comparable to OHIP. Class 3 Qcision-making involves sane judZpnent in the selection of alternatives within a ccmprehen- sive framewrk of guidelines" Class 4 "Cecision making involves judgrrent in dealing with variations fmm established guidelines or standards." There is indeed a "comprehensive framework of guidelines", but --- as previously explained ---~ they are embodied in such a massive body of docu~mentation that they are encyclopaedic in scope. Moreover, some were framed in the Ontario context, while many others relate to special problems which arise in processing med,ical and hospital claims from any one of 50 Amer,ican states or from elsewhere in the world. Exceptions and variations abound, as for example in OHIP's special relationship with a hospital i-n fiichigaQ&nd with the Mayo clinic. Having regard to foreign termino'logy and foreign practices, which vary from'place to place, the judgment required is more than the "selection of alternatives." That term might .be applicable when processing claims from other Canadian provinces ~7.. (all o'f which are under t~he umbrella 6f'a federal statute, 6he - 43 - Medical Care Act) but it is not appropriate when dealing with claims from abroad. An attempt was made to show that there is no need for OOP clerks to exercise "judgment in dealing with variations." It was alleged that they have easy access to the Group'Leader and that difficult or doubtful problems can always be take.n up with the Medical Consultant. We are not persuaded that the allegat ,ion is well-founded. There would certainly be no access to the Group Leader whenhe is away. Whenthatoccurs, as it must from time to time, one of the Clerksbecomes acting supervisor of the unit, which suggests that they are all deemed capable of actin~g in that capacity, even if it be only temporary. As for access to the Medical Consultant, it occurs occasionally when a new or ., exceptional problem arises --- which may even be referred to OHIP ." headquarters at Kingston --- but it is clear that the Medical .Consultant's primary function is not to supervise processing clerks.. He is, as his title suggests, a consultant. .., . The crucial point is that "variations"~are inherent in the nature of claims submitted by subscribe.rs who have been served.by physicians, hospitals, clinics or laboratories 'abroad. Such claimsmust be supported by letterhead accounts of various kinds from medical offices and/or hospital accounts which some- - 44 - times include medical fees and other charges. These procedures are very different from those prevailing in Ontario, where both physicians and hospitals are familiar with OHIP requirements and render accounts on standard forms, so that "variations" ought to be minimal. Such uniformity cannot be expected of individuals in the U.S.A. or Europe or Asia, most of whom have never heard of OHIP. Finally, since OHIP has its own rules in respect of foreign claims as well as those from Ontario, the OOP clerk~,is constantly responsible for recognizing a "variation" when she sees one. This in itself requires considerable experience and judgment. Class 3 "Initiative is in the form of following up errors or anissions and in making corrections as necessary. Doubtful matters not covered by precedents are referred to supervisors." Under Class 3, the first sentence undoubtedly applies to _. Class 4 "Normally, employees receive specific instructions only on unusual or special problems as the mrk is performed under conditions that permit little opportun- ity for direct supervision by others." one~aspect of the Grievorsl work. Many claims are received with "errors or omissions", lacking the necessary supporting material. It then becomes necessary for the clerk to "follow up".by writing or telephoning the subscriber. It is often also necessary to contract a foreign doctor's..office or a hospital or clinic to .P clarify or supplement the information appearing on an account, - 45 - and thereafter decide whether such information meets OHIP requirements and whether the account is payable in whole or in part. It is not always true, however, that "doubtful matters not covered by precedent are referred to supervisors." The matter may be "doubtful" --- and often is --- and it may or may not be covered by precedent --- of which hundreds are referred to in bulletins and in notes maintained by the clerks for several years past. Not infrequently the clerks consult each other. The '.evidence shows that although there may not be a precedent exactly ' Jo; 'l.. in point, the clerks usually have sufficient knowledge and experience to understand what would be acceptable and what would -not be acceptable to OHIP. It is when differences of opinion .: arise that the clerks or the Group Leader would be most likely to .~"F;"*-:'refer the problem to the Medical Consultant. In the opinion of this Board the whole of the sentence under Class 4 above clearly applies to the OOP clerks. .* The nature of the work is such that "direct" or continuous supervision is obviously impossible. Medical claims in excess of $3,000 must be approved by the Group Leader and the Claims Production Manager, and unusually high fees are referred to the Medical Consultant for adjudication. The clerks process about 15 claims a day except during the busy period between - 46 - February and July when they process approximately 30 per day. When volume is that high and many steps must be .taken in dealing with each claim, it is possible for the Group Leader to observe the unit from his desk but clearly not.possible for him to follow what they are doing. His real function appears to be the approval of claims already processed; If direct supervision were actually required, he would need several deputies. However, in the words of the Class 4 standard, "the work is performed under conditions that permit little opportunity for direct supervision by others." Class 3 Class 4 "Much of the mrk is reviewed only "Matters involving decisions that depart periodically, principally for radically fran~established practices adherence to policy and procedures" are referred to supervisors." What is said under Class 3,above is consistent with "routine clerical work," done in accordance with well-established procedures, so that periodic reviews or "spot-checking~" is adequate to satisfy supervisors that all is well. In our view it does not correspond to conditions in the oOP unit. . On the other hand the statement under Class 4 above fairly describes. what happens in the OOP unit, It is only'when a claim raises the possibility of a radical departure from established practices under OHIP regulations or policies that the matter is referred to the Group Leader and/or the Medical illustrative, and therefore helpful. . . Class 3 Typical tasks at this level include the preparation of factual reports, statements or memoranda requiring sare judgment in the selection and presen- tation of data; assessment of the .accuracy of statements or eligibility of applicants, investigating discrep- ancies and securing further proof or dccmnentation as necessary; overseeing, as a Group Leader, the work of a small .subordinate staff by explaining pro- cedures, assigning and checking work. . . . . .~ - 47 - Consultant. Claims originating from abroad can raise a great variety of~questions, but the COP unit is expected to resolve most of them without resorting to supervision. EXAUPLBS The next paragraph in the Standards is of much less importance. The first paragraphs attempted (as precisely as possible) to define the class by d.escribing the a.ppropriate indices.. The second paragraphs, however, used the term "typical tasks," clearly signifying that the words following represent exam-, -- as counsel have recognized in many classification cases. "Typical tasks", being.only examp~les, are neither exclusive nor comprehensive. Nevertheless, they are Class 4 Tasks typical of this level include the evaluation or assessment of a variety of statements, applications, records or similar material to check for ccnformity with specific regula- tions, statutes or administrative orders, resolving points not clearly covered by these instructions, usually by authorizing adjustments or recommending payment or accept- ance; supervising a small group of "journey-man clerks" or a larger group of clerical assistants by explaining procedures, assigning and checking work and maintaining discipline. - 48 - Under Class 3 the first example given (down to the word "data") does not apply to the OOP unit, although clerks occas- ionally make recommendations or suggestio~ns~ for improving procedures. The reference to "assessment of... eligibility 'of applicants..." ,.,does apply to the OOP unit. Finally, the clerks do act as Group Leader temporarily when he is absent, but of course it is not a normal part of their work. Under Class 4, the examples given clearly apply to the OOP unit, at least down to the word "acceptance." Authorizing adjustments or recommending payment or acceptance are tasks at the core and centre of the positions occupied by the Grievors in this case. Supervision of course is minimal, although all clerks are qualified to substitute for the Group Leader when required. On the whole, the "typical tasks" mentioned in the second paragraphs of the two Class Standards demonstrate some ",overlapping," a not unusual phenomenon in a class series. Under the heading "Qualificafions," educational and other requirements are specified. It appears,, however, that these have now been "superseded" by "Staffing Standards" issued -by the Civil Service Commission almost 16 years ago.. In a memorandum issued to all Deputy Ministers on June 24, 1971 (Exhibit 68) Mr. W.A.B. Anderson, Chairman of the Commission, - 49 - referred to a new Manual which he said "contains staffing standards for the various classes in the Civil Service of Ontario which replace and supersede the qualifications sections in existing class standards." Finally, it may be noted that the Standards discussed hereinwerelastrevisedinDecember,1963, when the OOPunitdid not exist. A review of the class standards would not be complete without reference to the testimony of Dr. Peta Tancred-Sheriff and Mr. Bryan Neale, Regional Personnel Administrator with the Ministry of Health. Mr. Neale's experience (Exhibit 66) includes service with the Department. of Tourism and Information from 1965 to 1972 as a Personnel Officer, with the Ministry of.Colleges and Univer- sities; from 1972 to 1976 as Service Classification Officer, with the Civil Service Commission from 1976 to 1978 as a-classifica- tion Officer, then a Category Officer, then for two years as Standards Officer u~@'il 1982 as Category/Module Officer within the Civil Service Commission. He gave "general comments on Job Evaluation, Exhibit 67, in part as follows: Ihe purpose of any job evaluation system is to determine the relative worth of jobs within an organization. In the case of bargaining unit positions within the Ontario Public Service, the system in use to accomplish this task is - 50 - the "grade description" system. Briefly, this system groups together positions that are sufficiently similar in nature to enable relative worth comparisons, into "job families" or "class series." Levels or "grades" of whole job difficulty are narratively described ranging from the least demanding to the most difficult work. Each level of job complexity is described in a class standard and the process of evaluation requires a tihole job comparison to be made between.the total position and these descriptions of job difficulty. In job evaluation it is the requirements of the job that are considered and not the competence of the individual in the job. As a resulTone must always attempt toabstract the individual from the job, since it is the responsibilities demanded of the position that are being evaluated. . . . . . Ingradedescription systems, elements that contribute to relative job complexity are identified and described and it is these collective.'"compensable factor" descriptions within' the grade levels when considered against the, j.ob requirements as a whole, that determine the~approprfhte classification level. Although we can, and usually do, break down the standards into their compensable components for the purpose of analysis, we must finally relate the totality of the standard to the totality of the position since a whole comparison between the job.demands of the position and thelevelof job complexity described within the standard itself has to be made. This is an important point - because grade description systems consider the difficulty or complexity of a job as a whole, the individual compensable components are unweighted.,.. Thus different jobs at the same level may exhibit various strengths of one particular component. For example, while a job may be weaker in the knowledge component than another at the same level it may be stronger in the decision making component to the extent that on a whole job comparison basis they are still judged to be relatively equal. Referring to Classes 3 and,?4 Mr. Neale said:. In my opinion, it is significant in the context of the present position under consideration, that certain elements of possible job complexity are not identified as compensable factors within the Clerk General series. The existence of any such elements in this position cannot as a result be taken into account in assessing the position against these standards. - 5 l- It is difficult to accept the "opinion" expressed above. The plain language of the definitions for Classes 3 and 4 clearly '.identifies factors connoting the degree of complexity, not "possible complexity" but actual complexity. The only~reason for identifying such factors i'sto aid in evaluating the job. Indeed, the Class 3,definition uses the words "of,some complex- ity." Mr. Neale repeatedly used the term "compensable factors," but that term does not appear in the series. If the components identified in the definitions are not "compensable," what is the purpose of formulating any definition? Of course some of Mr. Neale’s remarks were said in the context of earlier testimony by Dr. Tancred-Sheriff who had referred to "undervalued and invisible skills", which she con- tends are often overlooked or ignored in,evaluating positions usually held by women. The crucial point, however, is whether such skills are required by the inherent nature of the components identified in a definition. For example, even if the'~ ability to read,~ write and make a coherent telephone call is not mentioned- in the definitions, such basic skills are so inherent in the nature of the components specified that-it must be assumed they are necessary, on which Mr. Neale's comment is: Yet if we examine the Clerk General series we find that it is not drafted in a fashion which addresses training time, rate of knowledge base change, range of information to be synthesized, or tension management and communication skills as elements in determining a position's relative worth - in fact it is not a skills oriented series. - 52 - Some.of the statements -quoted above are simply not consistent with the language of the standards. Mr. Neale said the Series, does not address "training time." Actually, the Standard for Clerk 1 General, says that job, the lowest in the series, "can be learned within a few hours." Mr. Neale said the Series does not address "rate of. knowledge base change." Actually, Class 3 requires "a background knowledge" and Class 4 re.quires "a good background knowledge." Similarly Class 3 and Class 4 recognize a difference in "the range of information to be synthesized." As for "tension management. and communication skills," other evidence makes clear they are essential due to the inherent nature of the work performed. The Board must find there is no support for the sweeping statement that the Clerk General series "is not.~a skills oriented series." Such a statement suggests that all clerks in the series .fall into the category of unskilled labour, a reductio fi ;.:.<:. iew of clerical work. absurdum re'vealing an unduly narrow v Incidentally, if the Clerk skills oriented series" (as Mr. General series "is not a Neale claimed) then an .* explanation-is due for the words appearing in~:large print as a :. paragraph heading in Exhibit 51, which is the form known as "Position Specification and Class Allocation FormrW authorized by the Civil Service Commission with which Mr. Neale served for six years. The heading is: "Skills and Knowledge Required to Perform .~ ,i - 53 - the Work." This seems to represent a more realistic approach to job analysis than that taken by Mr. Neale. Moreover, the answer given in Exhibit 51 by the then District Directory, Mr. J.M. Davis, and two other evaluators was as follows: Proven clerical experience; knowledge of Health Insurance Act and Regulations as applicable to claims functions: ability 'to communicate both orally and in writing: knowledge of medical terminology preferable. After his analysis of the language in the standards, Mr. Neale summarized his conclusions as follotrs: What emerges when we consider the 3 and 4 standards as a whole is: ~The Clerk 3 typifies a position where the work is of some difficulty, with decisions generally encompassed by guidelines and procedures, recourse to a supervisor is available for the referral and resolution of doubtful matters not covered by precedent or apparently necessitating variations from guidelines or procedures, whose work is checked, not regularly, but only periodically for adherence to procedures and policy. Whereas the Clerk 4 is performing the work where decisions are generally not governed by guidelines and procedures or precedent since it is regularly required they exercise discretion in dealing with variations from them, within an organizational environment where advice and consultation from a supervisor is provided only on unusual or special issues and to whom only those matters requiring a decision involving a radical departure from practice are referred. We share the view expressed by the majority of another panel of this Board in Goobie 240/84 (Verity and Craven) at page 31: - 54 - I Having reviewed the Grievance Settlement Board's existing jurisprudence, and after careful consideration, we find that we cannot accept Mr. Neale's characterization of the Clerk General Class Standards in terms of narrowly-construed "compensable factors" which exclude consideration of factors such as the exercise of communication and relational skills which we have found to be central to the Grievor's job. Dr. Tancred-Sheriff is Associate Professor of Sociology at McMaster University and an Editor of the Canadian Review of Sociology and Anthropology. She won a doctorate from the London School of Economics for her "Study of the British Civil Service against the background of French experience." She has also received several academic awards and authored several books and many papers on bureaucracy, career patterns and women's work. As .we understand her testimony, Dr. Tancred-Sheriff did not really mount an attack on the la.nguageof the class standards 'but rather on an unconscious male bias in the interpretation thereof. All society, she said, has "a tendency to diminish the value of skills brought to work by women." This was of special importance in the clerical series where (as Mr. Neale concedes) the vast majority of employees are women. In evaluating work, she uses five tools: .w (1) the knowledge required; (2) the degree of autonomy: (3) the degree of responsibility in the light of possible consequences; , - 55 - (4) the oral and written communication content of the job; (5) the level of "tension management required." 'L, j.'.., The witness mentioned the speed of technological change, pointing out that word-processors were not in use when the clerical standards were last revised in 1963. In this area of work, she believes, invisible skills such as tact in dealing with :>':., clients or the public are important but are "usually not taken into account." She remarked, however, that there are often "invisible skills" in jobs held by men. She discussed the words in the standards for Classes 3 and 4 and concluded by saying the difficulty is that "certain skills are taken for granted." Mr. zarudny, counsel for the Employer, had withdrawn his objection to Dr. Tancred-Sheriff's testimony, but argued there- after that it is not relevant. All that matters, he said were two tests: what the standards require and what are the actual duties of the position. In the view of this Board, .t-he points made by Dr. Tancred-Sheriff are not necessarily excluded by or inconsistent with the language of the standards. In practice and by tradition her points are sometimes disregarded by those charged with inter- pretation and application of the language in the standards. This I. phenomenon may,:be analogous to "the inarticulate major premise" - 56 - attributed to some other judges by the late Mr. Justice Oliver Wendell Holmes of the United States Supreme Court. Mr. James M. Delaney has been District Director at London since June, 1983, which was after the preparation of the Job Audit. He has served 28 years in the Ministry of Health, most of it with OHIP or its predecessor. For the assistance of the Board he had prepared Exhibit 63, a booklet entitled "An overview of the OHIP Administration London District Office Claims Services.' Much of it explains the organization of the District Office, but he also described "The OHIP Philosophy." He wrote that the OHIP Mission is "to facilitate access to a defined set of Health Services for all residents of Ontario." Among "Program Goals" he specified "assistance to client groups to obtain access to.-insured health care'services inside or outside Ontario," and "prompt, accurate payment for eligible health care services." _ .M.r. Neale had sought to show that communication skills are not part of the requirements of the OOP clerks' positions. By way of~contrast, Mr. Delaney~defined one of the "Divisional Objectives" as follows: &rvice: To provide prompt,~accurate, sensitive and courteous service to the public and to providers. - 57 - Another objective was defined on page A-2 of exhibit 63: To promote a favourable internal and external perception of OHIP. These seem to be examples of the so-called "invisible skills," inherent in the nature of the job, which Mr. Neale claimed cannot be taken into account. There might be something in his argument if the clerk were required to do only paper work at a desk, without ever speaking on the telephone or writing a letter or meeting a member of the public to answer an inquiry or explain a decision, but such is not the nature of the OOP clerks' positions. The requirements of their work, as set out in the Class Standards, make itessential for them to possess and use communication skills as well as completing their paper work. Mr. Delaney agreed that he had read the Audit Report and did n.ot dispute it except for certain corrections or additions. He said that as between himself and Mr. Ferris he "would prefer Ferris‘ account." As he had not heard most of the Ferris . . testimony, it can be assumed he had in mind that.he himself, being District 'Director, has not supervised the OOP clerks, as Mr. Ferris has for several years. However, he certainly had access to Mr. Ferris, the Claims Manager and the Medical Consultant when he signed the Job Audit. - 58 - During the course of hearings we were reminded by counsel of previous decisions in classification cases, with all of which we are familiar. Counsel for the Grievors cited the fo of this Board: llowing decisions Borges et al 21/84 (Verity) .: Lynch 43/77 (Adams) Knudson 248/80 (Samuels) Woodcock 564/81 (Samuels) Campbell et al 451/82 (Jolliffe), upheld on review. -- Brecht 171/81 (Roberts), upheld on review. . Parise et al 238/83 (Roberts) -- Beals et al 30/79 (Draper) -- Roy et al 174/81 (Jolliffe) Berry et al 217/83 (Samuels) Goobie et al 240/84 (Verity) at 25-34. -- i - 59 - Counsel for the Employer cited the fo llowing decisions of this Board. Pretty 64/77 (Swinton) Wheeler 166/78 (Swinton) McCourt 198/78 (Saltman) at 13. Montague 110/78 (Swinton) at 8. Parise et al 238/83 (Roberts) at -- Rae 289/83 (Verity) at 8-9. - Keown 387/83 (Verity] at 8-9. Ivan 755/84,(Verity) Watterworth et-al 1109/84 (Delis -- 9-10 .e) We do not think the conclusions stated hereafter are inconsistent with the principles established in the jurisprudence of this Board; which have not been successfully challenged on judicial review. Broadly speaking, there is no serious dispute about those,governing principles. Different cases have had different results by reason of the evidence relating to the facts, as they have been assessed by various panels of the Board. i - 60 - CONCLUSIONS In this decision we have attempted to expla in the nature of the work done by the OOP clerks at London: we have relied heavily on the Job Audit of February, 1983, because, with few exceptions, the facts stated therein were verified in writing by both Ms. Peters and the District Director: we have compared those facts with the indices setoutin the Standards for Classes 3 and 4; we have discussed the opinions and testimony of the Employer's principal.witnesses as well as the testimony of Ms. Peters: ,we have been obliged to consider numerous documents admitted into evidence and we have indicated what can be deduced from many aspects of the evidence. Finally, we have taken in'to account decisions made in the past by this Board. In our review of the evidence we have already indicated the inferences to be drawn from the foregoing sources. Notwithstanding the extraordinary length of testimony and the bulk of documentation we have been obliged to consider, we do not find substantial disagreement between the parties as to the facts so fu,lly stated in the Job Audit. The difference between the parties really arises from .differing interpretations of, the agreed facts when the applicable language in the Class Siandards is brought to bear. On balance, we find that the evidence supports the Union's interpretation. _ - 61 - ~. .- The Board is satisfied, for reasons hereinbefore stated, that these grievances succeed: the positions of the Grievors were in November, 1982, not correctly classified as Clerk 3 General, and the i Clerk 4 r positions ought to have been correctly classified as I General. Turning to the question of the appropriate remedy, we conclude that the Grievors are entitled to be paid at the Clerk 4 General level as and from the dates of their grievances. Ns. Peters’ grievance and those of six others were dated November .19, 1982, and that of Ms. Joanne Gatt was dated November 29, 1982. The Employer’s records will make it possible to ascertain the amounts actually paid to the Grievors at the level of Clerk 3 General, and also the amounts which would have been paid them at the Clerk 4 level. The difference down to the date . ..e .,.. _, they are reclassified will be due and owing to them. If any of the Grievers have ceased to be employed as OOP clerks, for whatever reason, on any date since 1982, entitlement in such event should be calculated down to that day. Counsel for the Union has requested the award of interest on the amounts payable to ~the Grievors since November, 1982. We shave given the request careful consideration. It is true that this Board has awarded interest where deemed ,pppropriate in a number of disciplinary cases and the Divisional .L‘ 5. - 62 - Court has recently upheld the power to do so in R. v. O.P.S.E.U. and the Grievance Settlements Board (Thibert et al) as yet unre- . ported, applying Section 19 of the Crown Employees Collective Bargaining Act. This, however, is a classification case, not a disciplinary matter. It appears to us that in classifying the Grievors incorrectly the Employer was not ~proceeding in an arbi- tratrary or discriminatory manner, but upon its understanding of the application and interpretation traditionally given to the clerical series standards. In these circumstances, and consis- tents with previous decisions of this Board, such as Goobie, supra, we are not persuaded that this is a case in which interest should be awarded. Nevertheless, if for-any reason, payment is not made to any griever on or before May 1, 1987, the amount due : shall bear interest thereafter at the cumulative rate of one per cent per month. We retain jurisdiction to hear. and determine at the <y.y, re,quest of either"party any problem encountered in implementing this decision, 3 --Y Dated at Rockwood this 5th ~day of March,.1987 Vice-Chairman ’ Member ,’ !!c,mbi!r