This three-step process is used when there is disagreement or concern with OAC’s administration of the Plan terms – including eligibility for a benefit.
The process allows for a concern to be escalated, although almost all concerns are resolved at Step 1.
STEP 1: Staff Review
You may request that OAC review a concern or case about the interpretation of the Plan terms or a benefit entitlement. To request a Staff Review, contact OMERS Member Services. As part of this Staff Review, you may be asked for additional documentation*, such as employment information, medical information or proof of spousal status.
How long the Staff Review takes can vary depending on the fact-finding process and the level of review of Plan terms and administration that may be required. Once complete, you will receive a written response that summarizes the outcome of the Staff Review.
*By providing OAC with this information, you are representing to OAC that you and whomever the information is about consent to the collection, use, and disclosure of that information by OAC for the purposes of the Dispute Resolution Process. In particular, you and whomever the information is about understand that the information may be shared with other parties and with OAC employees, management, and the OAC Board of Directors (OAC Board). This applies to information submitted at all steps of the Dispute Resolution Process.
STEP 2: President’s Determination
If you disagree with the outcome of the Staff Review, you may request that OAC’s President review the decision. This is called a President’s Determination.
Any party who could be impacted by a President’s Determination can submit additional documentation for consideration. Each party is permitted to review the documentation submitted by any other party and to make further submissions. (This process may take several months.)
Once all documents are submitted, the President, or their delegate, will review and respond in approximately four weeks.
STEP 3: Appeal to the OAC Board of Directors
If you are not satisfied with the President’s Determination, you can appeal the decision to the OAC Board. An appeal must be requested in writing within 30 days after the President’s Determination, by submitting the Request for Hearing Form to the Staff Designate.
If you are not the party appealing the President’s Determination, but you wish to actively participate as a party in an appeal, you must submit the Application for Party Status Form to the Staff Designate. The Appeals Committee will then decide whether party status will be granted.
The documents governing appeals are By-law No. 4 – Appeals Process and Rules Respecting Practice and Procedure for Appeals. These documents allow OMERS to conduct appeals in accordance with a streamlined process that is efficient, transparent and fair.
Three members of the OAC Board’s Appeals Committee (the “Panel”) will act as a panel to consider the appeal afresh. The Panel is an impartial adjudicator that will fully review the issues put before it. It has independent legal counsel to advise on matters such as procedural fairness. The Panel has no jurisdiction to award damages.
The rules of procedural fairness are followed during the appeals process, which means:
- Once an appeal is initiated, you will be provided with information on how the appeals process works, including any timing requirements for submissions and new documentation.
- Copies of all documents and submissions provided to the Panel will be shared with all parties, and you will have an opportunity to reply to claims made by an opposing party.
Usually, the Panel conducts hearings in writing. If you would prefer to have an oral hearing, you must submit the Request for Oral Hearing Form to the Staff Designate. You must satisfy the Panel that there is a good reason to hold an oral hearing – for example, if you have reason to believe that a party’s credibility is an issue. The Panel may also decide on its own that it is appropriate to hold an oral hearing.
After the hearing, the Panel will prepare a written decision which will include reasons. You will receive a copy of the Panel’s decision. The decision of the Panel, acting on behalf of the OAC Board, is final. If you wish to review prior decisions rendered by the OAC Board since 2005, these decisions are available here. These decisions are redacted (i.e., personal and sensitive information have been removed for privacy purposes) and are referenced by the year of the decision and the appeal subject matter.