Independent Internal Review or Incompetency This is not a decision of the established appeal system but the appalling result of a WCB experiment. We have recently been involved in an appeal of a decision of the Workers Compensation Board arising out of the results of the internal review pilot project. If this is to be the standard of review and decision making the results are astounding. In this case the worker reported that her usual work was the cause of the development of CTS and she pointed to a three year time period. The medical evidence was that the worker was of an age for developing this condition regardless of any activity, she had an underlying condition which could be causative of CTS and was overweight. Two EMG studies, conducted three years apart, showed little if any change in the condition and the first study, which was at the beginning of the three year period referred to by the worker, showed bilateral problems, severe on one side. An ergonomic study was undertaken which was non-committal. On the basis of that medical evidence the adjudicator determined that the worker’s condition was not compensable. The worker appealed to the Workers Compensation Review Board. When the worker filed Part 2 of her appeal giving a submission why the decision should be overturned and attaching an advocacy opinion from her attending physician the claim was drawn into the internal review process. In the course of that process the employer was asked to submit any new evidence but was not given access to the submission and advocacy opinion. Since the employer was unaware of the case they had to answer they had no evidence or counter opinion to submit. The internal reviewer who was not a Manager but a claims manager, as was the original decision maker, decided that the worker’s submission and the advocacy opinion constituted significant new evidence which cast doubt, as it was intended to do by way of argument, on the original decision and directed the original decision maker to reverse his decision. In the mean time that adjudicator had reviewed new medical evidenced submitted by the attending physician by way of a direct report to the WCB and concluded that the new evidence did not alter the original decision. Nevertheless he complied with the direction of the reviewer and reversed his decision.The reviewer, in our view, made significant errors which call into question the validity of the whole process. He did not seek a medical opinion to determine whether the advocacy opinion contained any new medical evidence versus simply arguing the old evidence, he did not seek a medical opinion from the Board Medical Adviser as to the relative significance of the underlying condition, the worker’s age and BMI. He did not reveal to the employer the existence and content of the submission from the worker to the Review Board or the advocacy medical opinion. All of which put the respondent, in this case the employer, at a disadvantage. The adjudicator then did not stand up to the reviewer and support his original decision, which he had already confirmed on the medical evidence before him, and demand from the reviewer full reasons why that original decision should be reversed. He failed to seek the necessary medical opinions that the reviewer had failed to obtain and simply complied with the direction. This does not bode well for the system if this is to be the standard of practice in an internal review process.