HomeMy WebLinkAbout1992-1084.Manji.93-01-07
...
!\ "" -'~
ONTARIO EMPLOYES DE LA COURONNE
CROWN EMPLOYEES DE L'ONTARIO
1111 GRIEVANCE CpMMISSION DE
SETTLEMENT REGLEMENT
BOARD DES GRIEFS
180 DUNDAS STREET WEST SUITE 2100, TORONTO, ONTARIO. M5G IZ8 TELEPHONE;lTELEPHONE (416) 326-'388
180, RUE DUNDAS OUEST BUREAU 2100 TORONTO (ONTARIO) MSG lZ8
FACSIMILE /TELECOPIE (416) 326-1396
1084/92
IN THE MATTER OF AN ARBITRATION
Under
THE CROWN EMPLOYEES COLLECTIVE BARGAINING ACT
Before
THE GRIEVANCE SETTLEMENT BOARD
BETWEEN:
OPSEU (Manji)
Grievor
- and -
The Crown in Right of ontario
(Ministry of Government Services)
Employer
Before: J.H. Devlin, Vice chairperson
For the Grievor. N.A. Luczay
Grievance Officer
ontario Public Service Employees Union
For the Employer: Percival Toop
staff Relations Officer
Management Board Secretariat
Hearing. December 16, 1992
I
I
I
~
l~~~~ l
\
. \
i
1
In this case, the Grievor claims reimbursement for
orthodontic expenses in accordance with article 57.2 of the
collective agreement which provides as follows:
Effective February 3, 1992, the Employer agrees to pay one
hundred percent (100%) of the monthly premium for services
relating to orthodontics, to apply only to dependent
unmarried children of the employee between the ages of six
(6) and eighteen (18), with benefits equivalent to Rider 3
of the ontario Blue Cross Plan on the basis of fifty
percent/fifty percent (50/50%) co-insurance, in accordance
with the current ontario Dental Association Schedule of
Fees, up to a lifetime maximum benefit of three thousand
dollars ($3000.00) for each such dependent unmarried child.
A similar provision appeared in the prior agreement although,
under that agreement, the maximum lifetime benefit was $2000.00.
The expenses which are in issue were incurred by the
Grievor on behalf of her son during the period from July of 1989
to March of 1991 and were submitted for reimbursement in February
of 1992. The Grievor explained that it was only at that time
that she became aware of her entitlement to orthodontic benefits.
The insurance carrier allowed the Grievor's claim in respect of
expenses incurred in 1991 but declined to reimburse the Grievor
for expenses incurred in 1989 and 1990 on the basis that the
insurance plan provides that claims must be submitted by the end
of the calendar year following the year in which the expenses are
incurred.
I
~
~ ~~. i
.
2
It was the position of the Union that the time limit
relied upon by the carrier is not binding as it does not form
part of the collective agreement. The Union further submitted
that the Grievor acted promptly when she became aware of her
rights and that the Employer had not objected to the grievance on
the ground of timeliness It was the position of the Employer,
however, that the time limit relied upon by the carrier is
standard in benefit plans of this sort. The Employer further
maintained that given the delay in submitting her claim, the
Grievor should be disentitled to relief based upon the doctrine
~
of laches. Moreover, the Employer pointed out that the time
limit for submitting claims is clearly set out in an information
booklet concerning employee benefits which the Employer is
required to make available to employees in accordance with
article 44.6 of the collective agreement. The Grievor indicated,
however, that she was not provided with the booklet by the
Employer.
While the collective agreement makes no reference to a I
time limit for the submission of claims for orthodontic benefits,
the agreement contemplates that such benefits will be provided
through the vehicle of an insurance plan. A standard plan will
commonly specify a time limit for the submission of claims and,
under this collective agreement, it is the obligation of the
Employer to make available to employees an information booklet.
Presumably, the purpose of the booklet is to bring to the
, ~,...:':---: "='16'~'" r i t
,\
\
3
attention of employees the particular features of benefit
coverage. Accordingly, it is my view that if the Employer
intends to rely upon a particular feature of coverage, such as a
time limit for submitting claims for orthodontic benefits, then
it must be demonstrated that there has been compliance with the
obligation set out in article 44.6 to make an information booklet
available to employees.
In this case, although there was a dispute concerning
compliance with article 44.6, the parties agreed that it was not
practical to resolve this dispute in the limited time available
on a day when a number of other cases were also scheduled for
hearing under the expedited arbitration procedure. Accordingly,
I ..
provided both parties agree, additional time shall be set aside
under the expedited procedure for purposes of resolving this
dispute. Failing agreement to proceed in this manner, the
dispute shall be referred to a panel of the Board for hearing in
the normal course.
DATED AT TORONTO, this 7th day of January, 1993.
0
iCu~,-8 bbl L
vice Chairperson
./