Collaborative care planning

Review the relevant information on the claim file:

• Details of the injury, diagnosis and the injuries accepted.  Ensure all diagnoses have been adjudicated or investigated. If not, consider what information is needed to determine entitlement for unadjudicated diagnoses (e.g., gathering additional information from the worker or treatment provider).  
• Current treatment plan
• Return-to-work status
• Details of the pre-accident job
• Modified work opportunity
• eCO alerts

Try to determine the possible outcome for the worker. Are they likely to:

• Be fit for their pre-accident job duties?
• Be fit for modified work?
• Have long-term temporary or permanent work restrictions?

Consider treatment protocol timeframes and anticipated recovery from the compensable injury to determine an estimated return-to-work goal date. Consider work restrictions to assist in forecasting a recovery goal date or return to suitable modified duties. Consider a referral to an internal consultant for a medical opinion, if needed, to clarify recovery time for the compensable injury.

Determine (through discussions with the worker, employer and the treatment provider) whether the modified duties available are suitable based on:

• Anticipated work restrictions
• The modified work being meaningful, safe, productive and promoting a successful return to work

Take time to get to know the worker. Ask mindful questions to build a trusting partnership and encourage them to include trusted treatment providers in their care plan.

Ask the worker about:

Their injury:

• How has it impacted them?
• How are they managing at home?
• What supports do they and their family need?
• Ask open-ended questions about the accident and what injuries were sustained?

Their job:

• What are their duties, and do they have a job description.
• What duties can they do now?
• If return to work is a possibility, when will they be ready to return to work?
• What other jobs may be available with the date-of-accident employer and what training is required?

Their relationship with their employer:

• When were they last in touch?
• How do they plan to stay connected to their work?
• How do they like to communicate and how often?
• What modified duties has the employer offered?

General needs and claim information:

• Is there anything important that hasn’t been asked about or discussed?
• Other information they need or assistance with their recovery?

Clarify the pre-accident job demands with the worker and educate them about WCB expectations of them, including their active participation in treatment, duty to work with their employer to find suitable modified duties as quickly as possible, and the return-to-work process. Ask if the worker has any questions about their plan, benefits or additional supports.

Collaborate with the worker to establish recovery and return-to-work goals. Confirm their understanding of the plan moving forward.

Take time to get to know the worker’s employer and their plans to support the worker in their return to work.

Educate the employer about the return-to-work process.

Ask the employer about:

• The pre-accident job duties.
• Their relationship with the worker.
• How they prefer to communicate and how often.
• Modified work opportunities that are available. Consider asking:
  • What other positions are available or what positions will you be hiring for in the near future? What type of training is required for these positions?
  • If you had an extra set of hands right now, what would you have that person do?
  • If I gave you a worker for free, what could they do for you?
  • What can I do to help you in identifying modified work opportunities?
• Whether they will keep the worker’s job available.
• Their plan to keep the worker engaged with the workplace while recovering.
• Their expectations for the worker’s return to work.
• How they think WCB can help with the worker’s return to work.

Clarify the pre-accident job demands with the employer and educate them about WCB expectations of them, including their duty to work with the worker to find suitable modified duties as quickly as possible, and the return-to-work process. Ask if the employer has any questions about the plan or additional supports, and request they submit a physical demands analysis if one is not already on file.

Explain that a worker may become fit for work at different points of their recovery; attempt to pre negotiate modified work for when the worker achieves an anticipated fitness level. Continue to negotiate modified work throughout the worker’s recovery.

Call the treatment provider(s).

Discuss the worker’s fitness level, progress and next steps in treatment:

• Share relevant medical information.
• Gather any missing information.
• Confirm next steps in the treatment plan.

Ask the treatment provider(s):

• If treatment is progressing as expected. If not, find out what is preventing progress.
• If there are challenges that WCB can help resolve.

If there are concerns that cannot be resolved through one-on-one conversations, facilitate a collaborative conversation between the worker and their treatment provider.

Make additional referrals if needed, such as an internal consultant referral if the worker is not progressing with their current treatment.

Contact the worker and review the proposed care plan (including the treatment plan and forecasted recovery or return-to-work goal date); involve care providers as appropriate. Consider what other benefits, supports and services the worker may require (for example, assistance with home care, short-term home assistance, etc.).

Contact the employer and review the proposed care plan and return-to-work goal date.

Use these conversations to establish an agreement on a collaborative care plan that is focused on the worker’s unique needs and recovery. Consider arranging a case conference to have all parties involved in the development of the worker’s treatment and return-to-work goals.

Communicate the care plan in writing so all parties clearly understand the plan and their responsibilities in the worker’s recovery. Send the appropriate letter to the worker and employer.

Make additional referrals if needed, such as an internal consultant referral if the worker is not progressing with their current treatment.

Monitor the worker’s recovery and progress towards their return-to-work goal by assessing medical reporting as it is received. Communicate with the worker biweekly to review their recovery progress and address any concerns regarding their treatment and recovery. Regularly communicate with the employer (at least every 6 weeks or as there are changes to the care plan).

Ensure the care plan remains on track and the worker is likely to achieve their goal.

A plan is on track when:

• Diagnosis and treatment are consistent with claim entitlement.
• The worker is actively engaged and attending appointments regularly.
• There is improvement in the worker's function and abilities
• There is a decrease in symptoms and/or work restrictions.
• Medical information supports an estimated return-to-work date is reasonably expected within the time period outlined in the care plan.  
• The date the worker estimates that they will return to work within the time period outlined in the care plan.
• Modified work opportunities have been fully explored.
• No barriers have been identified by the healthcare provider.

A plan is not on track when:

• Additional investigations or consultations are recommended by the healthcare provider.
• Diagnosis does not match claim entitlement, it has changed or it is not consistent between all healthcare providers.
• The return-to-work date changes and is no longer within the expected care plan timeframe.
• The worker is not making any improvement in their function and abilities, work restrictions, symptoms or pain.
• The worker does not estimate that they will return to work within the expected time period outlined in the care plan.
• Modified work opportunities have not been fully explored.
• There are concerns with worker or employer cooperation.
• The healthcare provider does not have a clear understanding of the date-of-accident physical job demands.
• Barriers have been identified by the healthcare provider.

Addressing barriers

Determine entitlement if any new diagnosis is identified.  

Address any identified barriers and develop a plan to help overcome them. Identify the supports or referrals needed to help get the plan back on track. Consider:

• A case conference to have a collaborative discussion about return to work with the worker, employer and healthcare provider.
• Whether the healthcare providers have all the information to support the plan and return-to-work goal (e.g., job description, physical demands analysis, etc.). 
• A referral to an internal consultant (e.g., medical consultant, physiotherapy consultant, psychological consultant etc.) to obtain clarity about the worker's expected recovery for the injury, if a new diagnosis is identified.
• Referrals for additional investigations or consultations, as appropriate [e.g., medical status exam, independent medical exam, psychological assessments, visiting specialist clinic (VSC) for surgical consult, non-surgical consultation (NSC), or diagnostic tests such an MRI, ultrasound, etc.]
• A return-to-work program or psychological counselling if there are social or cognitive barriers 
• A return-to-work planning meeting (RTWPM) or a referral to an industry specialist if there are employment barriers (i.e., difficulty identifying modified work options, relationship issues between the worker and the employer).
• A referral for re-employment services when:
  • the worker's job with the date-of-accident employer is no longer available, or
  • the worker has or will have permanent work restrictions and the employer confirms permanent accommodation is not available.

There may be a unique circumstance delaying the worker's recovery and/or return to work such as the worker is awaiting admission to hospital. Consider the reason for the delay in recovery or return to work and determine what compensation benefits or services the worker is eligible for. Refer to the Compensation pending hospital admission section below.

When the worker or employer are not cooperating, consider applying duty to cooperate.

Adjust the care plan as needed, focusing on the worker’s goals for medical recovery and return to work. This will vary depending on the worker’s circumstances. Respond to unexpected events that may occur and collaborate with the worker and employer to resolve any interruptions or obstacles to the care plan.

If there is a significant change to the care plan, communicate those changes in writing.

Continue to monitor the worker’s progress and recovery until they are able to return to full duties or find suitable alternate employment.

When medical reporting supports a fitness level, collaborate with the worker, employer and treatment provider to develop a return-to-work plan. Depending on the claim circumstance, a return-to-work plan could involve:

• Return to full duties.
• Return to modified duties or hours.
• A graduated return to full duties or hours.
• Suitable alternate employment.

Refer to the 1-8 Fitness for work decision procedure to make and communicate the fitness-for-work decision and address any barriers. The decision and rationale regarding fitness for work can be communicated verbally before the medical report is received to file. The fitness for work decision is formalized in writing after the medical report is filed and the decision maker verifies the details within that report.

Determine if the worker's injury will or is likely to result in a permanent clinical impairment (PCI). If yes, discuss the PCI review process with worker including when the review will take place.