Fitness-for-work decision

Monitor and review incoming medical reports to confirm if the worker has medical clearance to return to work. Determine if the available medical information supports they can return to their pre-accident job or if they are cleared for modified work. 

To determine if the worker is fit for full or modified duties, review the worker's work capabilities and work restrictions as identified in the medical report and compare them to the worker's pre-accident job duties (e.g., job description and physical demands analysis; social and cognitive requirements when applicable) if available or obtain clarification of the job requirements. Refer to the Classification of work capabilities section below.

Identify other relevant details to support a return-to-work plan. Consider:

• When the work restrictions are likely to resolve and any recommended treatment to help the worker fully recover.
• Previous modified work discussions, if the worker is capable of returning to lighter duties.
• Whether return-to-work barriers were previously identified (e.g., transportation issues, limited or no modified work available based on prior discussions).

If the medical reporting is unclear on the worker's fitness for work, request clarification by contacting the treatment provider and send the appropriate letter. 

If required, send a referral to the medical consultant for an opinion on the worker's work capabilities and restrictions. Review the medical consultant's opinion and action recommendations, as appropriate. If the worker's fitness for work is still unclear, consider what additional information or further medical evaluation is needed to determine fitness for work and/or work restrictions (e.g., a return-to-work planning meeting, comprehensive functional capacity evaluation, independent medical exam, etc.).

Note: If the worker is under the care of a surgeon, clearance is required prior to referring for medical assessments such as a functional capacity evaluation.

If there is a conflict of medical opinion regarding the worker's fitness for work, follow the 1-9 Conflict of medical / psychological opinion procedure. Once addressed, return to this procedure to make a fitness-for-work decision.

Prepare for the fitness-for-work or job-readiness discussion

If the worker's fitness for work is clear, prepare to discuss the fitness-for-work decision with the worker and the employer, and the benefit type that may be payable. The type of benefit payable depends on the worker's fitness-for-work level and the outcome of the conversation.  

Prepare to discuss that:

• Temporary total disability (TD01) benefits will end if the worker is fit for their full duties.
• Temporary partial disability (TD02) benefits may be payable if worker is fit for modified work, but they are earning less than their pre-accident salary while working modified duties with the date-of-accident employer. These benefits are payable until the worker is earning equal to or greater than their pre-accident earnings.  

If the worker has a fitness level but the date-of-accident employer is not able to provide suitable modified work, determine if the worker is ready to participate in re-employment services.

A worker is not ready to participate in re-employment services if they are in the acute phase of recovery (less than six weeks from the date of accident), they are participating in a return-to-work program, or significant improvement is expected. 

A worker is ready to participate in re-employment services when treatment is completed, or the worker is still in treatment, but their fitness level is not expected to improve for 8 to 12 weeks, or the worker has reached the best level of function expected (a medical plateau) and no further improvement is expected. In this circumstance, prepare to discuss a referral for re-employment services and the change to re-employment benefits.

Call the worker and the employer to discuss the medical evidence that supports the worker's fitness for work, the work restrictions identified, and whether these restrictions are expected to be temporary or permanent. Depending on the claim circumstance, explain if wage replacement benefits will end or change.

If the worker is fit to return to their pre-accident job, explain that because they have been cleared to return to full duties their wage replacement benefits will end (Wage replacement TD01 or TD02 benefits are typically paid up to and including the date the decision is initially communicated. The decision, and rationale for the decision, can be communicated verbally and before the medical reporting comes to file.). Go to step 4 to communicate the decision in writing.

If the worker is fit for work with work restrictions, and modified work with the date-of-accident employer was previously negotiated and is available, confirm the date the worker will return to modified duties and whether partial wage replacement (TD02) benefits are payable. Refer to Policy 04-02, Part II, Application 1 - General. 

If the worker is fit for work with work restrictions and modified work is not available with the date-of-accident employer but may be available at a later date, determine if the worker is ready to participate in re-employment services.

To determine if the worker is ready to participate in re-employment services, review the treatment plan and consider if their fitness level is:

• Expected to improve in the next 8 to 12 weeks - the worker is not ready. Continue to pay TD01 benefits and negotiate modified work with the employer as the worker' progresses in their recovery and their fitness level improves.
• Is not expected to improve in the next 8 to 12 weeks - the worker is ready. Discuss a referral for referral for re-employment services and explain their wage replacement benefits will change to re-employment (VR) benefits. Explain that these services will focus on supports (i.e., skilling-up services may open up more modified work options with the date-of-accident employer) that will enhance their employability. These services will help to prepare them for a return to work, either with their date-of-accident employer or with a new employer if permanent work restrictions are identified and the date-of-accident employer cannot offer an alternate suitable job. Continue to negotiate modified work with the date-of-accident employer as the worker progresses in their recovery and their fitness level improves.
• At a medical plateau (i.e., significant functional gains are not anticipated) and there is no suitable job available with the date-of-accident employer - the worker is ready.  Review the permanent work restrictions with the worker and confirm they understand that they have reached their best fitness level. Explain that they will be referred for re-employment services to help them look for alternate suitable work and their wage replacement benefits will change to re-employment benefits. 
• Not at a medical plateau - the worker is not ready. Continue to pay TD01 benefits and negotiate modified work with the date-of-accident employer as the worker progresses in their recovery or until a medical plateau is reached and re-employment services are appropriate.

If the worker or the employer are not cooperating in the return-to-work process, discuss their duty to cooperate.

In some circumstances, a worker's injury results in a permanent disability that impacts their earning capacity. When the worker's condition stabilizes, WCB determines the impairment (loss) of earning capacity by assessing the impact the permanent compensable work restrictions will have on the worker's ability to earn in any suitable employment. Refer to Policy 04-04, Part II, Application 1 - Determining Impairment of Earning Capacity. 

Go to step 4 to communicate the decision in writing or if the worker or employer disagrees with fitness-for-work decision or barriers are identified, go to the next step.

Identify any barriers that prevent the worker from returning to work (e.g., transportation or childcare issues) and discuss solutions to resolve the barrier. For example, if transportation is a concern, consider how the worker got to work prior to the injury. Is carpooling or public transportation is an option?

When the worker or employer disagrees with the fitness-for-work decision, work together to resolve their concerns. Consider what assistance is available to resolve the disagreement and/or clarify the worker's work capabilities. Work together to develop a plan to obtain consensus about returning to work or to resolve the issue. 

Consider the following available supports to address the issue:

• Telephone contact with the treatment provider to clarify the worker's fitness level, work restrictions or whether modified duties are suitable. 
• A referral to an internal consultant to review the available medical reports or to call the treatment provider to gain consensus on the worker's fitness level.
• A referral for a return-to-work planning meeting to confirm the physical demands of the date-of-accident job and identify opportunities for modified work or for assistance in developing a gradual return-to-work plan.
• A referral for a comprehensive functional capacity evaluation to confirm work restrictions (i.e., pushing/pulling and lifting capabilities, ladder climbing, etc.)
• An independent medical exam to confirm work restrictions.
• Referral for a psychological assessment or cognitive assessment for psychological injuries or brain injuries. 

Call the worker and the employer to discuss the outcome of the referral including clarification of the worker's fitness for work and work restrictions and if wage replacement benefits will end or change. Refer to step 2. 

Send the appropriate letter to communicate the fitness-for-work decision in writing. Include the following information in the letter:

• The medical information used to make the decision including the report date and treatment provider's name. The decision, and rationale for the decision, can be communicated verbally and before the medical reporting comes to file. The decision is formalized in writing once the medical report is on file and the decision maker confirms the facts on that report.
• Specific work restrictions.
• Details of modified duties performed or offered.
• The gradual return to work plan, if applicable.
• Details about benefits changing or ending. Refer to Policy 04-02, Part II, Application 1 - General. 
• The goal date for return to full duties if the worker is returning to modified work.  
• Any update to the care plan including continued treatment plan or additional medical assessments.
• Any referrals required such as for re-employment services.

Note: In most circumstances, the medical information referenced in the discussion with the worker is already on the claim file. If the medical report referenced in the decision discussion comes to the file after the conversation, review the information when the report is received to confirm the decision is correct and aligns with the information communicated. Then send the appropriate decision letter to formally communicate the fit for work decision.  

When the worker is fit with restrictions or requires permanent accommodation, continue to negotiate modified work if a return-to-work date has not been confirmed.  

Send a referral for re-employment services, if required, and as discussed with the worker and employer.