WCB Procedures

Employer-requested medical examination

Procedure summary

Published On

Aug 26, 2025

Purpose

To determine whether it is necessary for an injured worker to undergo a medical examination when it is requested by an employer, and to arrange the exam when it is determined as an appropriate part of managing the claim.

Description

The decision maker reviews the request and contacts the employer to understand their reasons for requesting the worker undergo a medical examination.

After reviewing the worker's medical information to determine whether the request is appropriate the decision maker contacts the employer to share the decision. When the examination proceeds, the decision maker contacts the worker to notify them of the decision.

The decision maker refers the worker for the appropriate medical examination and after reviewing the results, contacts both the worker and employer to discuss the results of the examination and any impact they have on the claim.

Key information

A medical examination includes any examination or assessment completed by a physician or person licensed or authorized under the Health Professions Act to practice any of the healing arts in Alberta; Section 1(1)(v) of the Workers' Compensation Act. Types of medical examinations may include independent medical examinations (IME), comprehensive psychological assessments (CPA), diagnostic tests necessary to complete a medical examination, etc. Refer to the 4-1 Medical, testing, referrals and program support procedure for the types of medical exams or tests to consider.

Detailed business procedure

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1. Review the request and contact the employer When an employer submits a written request for a worker to undergo a medical examination, review the request and call the employer to discuss their reasons. During the conversation consider the purpose of the examination, seek to understand the employer's issues or concerns and what they expect to be clarified. Advise the employer their request will be reviewed along with available medical information to determine if the medical examination is warranted. Note: If the employer makes a verbal request for an examination during a phone conversation, advise the employer to submit the request in writing as outlined in Section 39 of the Workers' Compensation Act.	Administrative tasks Send the Insured Custom (IN000A) letter to acknowledge the employer's request in writing. Ensure the letter includes review and appeal information.
2. Review the worker's medical information and make a decision Review the medical information available on the claim, including any completed medical examinations, such as an IME, CPA, diagnostic tests, etc. Consider the employer's reasons for the request and determine whether: The medical examination is necessary as a regular part of managing the claim. The employer's issue or concern has already been addressed on the claim and if so, what was done. There is an alternative resolution to address the employer's issue or concern that has not already been addressed. The employer's reason for requesting the examination is to alter a decision that was previously reviewed by the Dispute Resolution and Decision Review Body (DRDRB) or the Appeals Commission (AC). Make a decision about whether the employer's request should proceed. Note: The decision to proceed with an examination is at the discretion of the decision maker. If the request for a medical examination is deemed unnecessary, WCB is not obligated to fulfill the employer's request.	Administrative tasks There are no administrative tasks for this step.
3. Share the decision Call the employer to advise whether the medical examination will proceed. Clearly explain the rationale for the decision. Examination will proceed Advise the employer the examination will proceed, as it has been determined to be appropriate for managing the claim. Clarify that in this instance, the employer is not required to pay for the costs associated with the examination. Contact the worker to advise them that they are required to undergo a medical examination. Provide them with the reason(s) the employer is requesting the examination. Continue to step 4. Note: If the worker refuses to undergo a medical examination, discuss their duty to cooperate and that compensation benefits may be suspended. Examination will not proceed Advise the employer the examination will not be arranged when: The exam is not necessary for managing the claim. The employer's issue or concern has already been addressed on the claim. There is an alternative resolution to address the employer's issue or concern. The reason for requesting the examination is to alter a decision that was previously reviewed by the Dispute Resolution and Decision Review Body (DRDRB) or the Appeals Commission (AC). Discuss why, from a case management perspective, the examination is not required. This may include helping them understand the results of previously completed medical examinations and why, the additional examination is not required. Discuss the current status of the claim and any proposed plan of action. If the employer disagrees with the decision, work to understand their concern and achieve a resolution. Negotiate an alternate plan of action, when it is appropriate. Note: If the employer requests information regarding the review and appeal process, advise the employer there is a one-year time limit from the date of the decision.	Administrative tasks Send the Claimant Custom Letter (CL000A) to the worker outlining the conversation. Document the conversation with the worker in a file note (Contact, Claimant Contact). Refer to: 3-3 Duty to cooperate 3-4 Egregious conduct Document the conversation with the employer (Contact, Insured Contact), indicating whether the examination request is approved or not.
4. Refer for the appropriate medical examination and review the results Refer the worker for the appropriate medical examination based on the employer's request. Following the medical examination, review the results and determine if the information impacts the status of the claim or the worker's entitlement to further benefits and services (e.g., Temporary total disability benefits (TTD), re-employment services, fitness for work).	Administrative tasks Follow the appropriate procedure: 4-1 Medical testing, referrals and program support procedure. 3-2 Collaborative case planning 1-8 Fitness-for-work decision
5. Contact the worker and employer to discuss the results Contact the worker and employer to discuss the results of the exam and any impact they have on the claim. Follow up by sending a letter confirming the conversation.	Administrative tasks Document each conversation in a file note (Contact, Claimant Contact and Contact, Employer Contact). Send the worker appropriate letter based on the outcome of the examination and resulting decision(s) with a copy to the employer. Confirm the results of the exam and any impact these results have on the claim.

Supporting references

Workers’ Compensation Act

Applicable Sections

Section 39 (1), (2), (3), (4) - Employer may require medical examinations
Section 1(1)(v) - Interpretation
Section 54 - Reduction or suspension of compensation

Workers' Compensation Regulation

Applicable Sections

Compatibility Warning

WCB Procedures

Employer-requested medical examination

Procedure summary

Detailed business procedure

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Supporting references

Workers’ Compensation Act

Workers' Compensation Regulation

Related Legislation