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Medical consultant
The medical consultant can assist the decision maker by: - Answering questions and providing an opinion with rationale about diagnosis, the relationship between the work-related accident and the injury or ongoing symptoms, or cause of death and other claim advice.
- Medical consultants provide causation opinions based on available medical evidence and references such as the AMA Guides to the Evaluation of Disease and Injury. They may also be asked to comment on research papers submitted to the WCB.
- Consulting when there is a conflict of medical opinion to support a resolution.
- Communication with community physicians through the CCOP (Calls to outside physicians) process.
- Identifying additional medical issues and/or pre-existing conditions that should be considered.
- Providing an opinion on whether treatment or medical aids relate to the injury (including medical treatment/medical aids not normally authorized).
- Providing an opinion on whether medications prescribed relate to the injury and opioid claim management reviews.
- Determining if any additional or special medical information is needed when the worker’s recovery is prolonged.
- Reviewing reports and making treatment recommendations on fitness for work, return to work or permanent clinical impairment.
- Reviewing treatment, surgery and prescribed appliance requests for podiatry claimsPolicy 04-06, Part II, Application 1: General [PDF, 0.22MB] (except for emergency situations and requests).
Note: The medical consultant will accept the history and non-medical facts as established and provided by the claim owner.
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Administrative tasks
For a list of medical consultants, refer to the Medical Services site on the internal Electronic Workplace. From the eCO Create Referral screen, select the type of referral and complete the form: - Medical Consultant Review – FM555C form
- MC Review – Fatality- FM555O form
- MC Review – Hearing Loss HL – FM555P form
- MC Review – Hearing Loss PCI – FM555R form
- Opioid Medical Consultant Review Referral – FM007A form (Follow the 4-7 Opioid management procedure)
- Permanent Clinical Impairment – FM555B form
- Case Conference with Outside Provider (CCOP) – FM555D form
For information on when to consider a CCOPCase Conferencing with an Outside Physician referral and Medical Services contact process, refer to Procedure Resource Library.
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Psychological consultant
Psychological assistants evaluate and assign all referrals sent for psychological consultation. Psychological assistants will provide support to claim owners directly to help resolve the referral or assign the referral question to a psychology consultant when needed. Psychological assistants can offer clinical support to review and interpret psychology reports and are available on a walk-in basis by phone. The psychological consultant can assist the decision maker by: - Reviewing and interpreting psychological assessments, including assessments that may be invalid, and providing clarification if needed.
- Providing a neutral opinion or answers with rationale to claim questions about:
- Diagnosis and its relationship to the mechanism of injury (MOI)This is how the injury occurred or was caused., ongoing symptoms, findings and the contribution to disability. They help the decision maker weigh the medical evidence and facts.
- Appropriate assessments and treatment to effectively manage psychological injuries.
- Medical evidence regarding pre-existing conditions and additional psychological issues.
- Referrals for marked life disruption and results following the assessment to help determine entitlement for chronic pain syndrome.
- Fitness for work, support with return-to-work and identifying any psychological barriers to returning to work.
- Whether a review of permanent clinical impairment (PCI) should be completed.
- Consulting with the treating psychologist to resolve issues related to psychological treatment or to reach consensus on a treatment plan as well as participating in case conferences with the service provider(s).
- Reviewing requests to extend psychological treatment and recommendations regarding the need for further treatment.
- Provide support to the decision maker during or after call escalation. The psychological consultant will guide the decision maker through risk assessment and provide recommendations to address the threat.
Note: WCB psychological consultants are subject to professional standards and provincial regulations limiting their ability to counsel workers directly. However, they can still provide advice to the decision maker on how to proceed or may assist by calling treating providers or the police to request a wellness check. Ensure the following information is included on the claim file before sending the referral: - Psychological reporting including psychometric measures and assessments (such as CPA, NPA, psycho-vocational assessments, psychological IME), and information on pre-existing psychological conditions.
- Investigation unit reporting.
- Relevant re-employment services reports, such as academic assessments.
- Risk incidents or relevant information that has been documented on the eCO Mental Health line.
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Administrative tasks
From the eCO Create Referral screen, select the type of referral and complete the form: - Psych – IED, Tx, Cost Relief –FM555M form
- Psych – Contact Treating Psych Referral – FM555N form
- Psych – Invalid CPA Referral – FM555L form
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Physiotherapy consultant
The physiotherapy consultant assists the decision maker by: - Discussing specific clinical details, including the worker’s recovery and their fitness for work based on physiotherapy reports.
- Answering questions or concerns about the worker’s recovery or a first request to extend treatment.
- Supporting a request to extend treatment of a soft tissue injury past nine weeks or the second extension for a surgical or fracture protocol injury.
- Identifying another physiotherapist who has expertise with specific injuries.
- Approving billing and treatment extensions for physiotherapy and acupuncture.
- Approving sundry items not on the physiotherapy sundry items list and is over twenty dollars.
Before referring to a physiotherapy consultant, consider if a discussion with the treating physiotherapist might resolve the questions, especially as they relate to fitness for work. Send exceptional billing requests and invoices to the physiotherapy consultant for review and approval when the frequency exceeds the set number of visits. For example: - For specialized physiotherapy (e.g., vestibular assessmentAn assessment completed by a physiotherapy with specialized training to confirm diagnosis and treatment when a worker presents with symptoms of dizziness. and treatment, post-surgical hand treatment).
- For extended duration treatments that exceed seven visits.
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Administrative tasks
From the eCO Create Referral screen, select Physical Therapy Consultant and complete the FM555G form, or call the physical therapy consultant directly. Refer to the 4-2 Community treatment procedure for further information.
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Chiropractic consultant
The chiropractic consultant can assist the decision maker by: - Reviewing all requests for extensions of treatment, determining if the worker is making progress and commenting on their fitness for work based on the chiropractor’s report.
- Answering questions about the chiropractic treatment, including:
- The relationship to the work injury.
- The worker’s progress and recommendations for treatment or further investigation (i.e., referrals for further medical assessment), when indicated.
- Reviewing all cases for supportive chiropractic careSupportive chiropractic care may be necessary for patients who, despite rehabilitative exercises and other lifestyle modifications, are unable to sustain therapeutic gains after the conclusion of a standard course of chiropractic treatment. to determine the initial frequency and duration of treatment and annually to determine the ongoing need.
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Administrative tasks
Refer to the Medical Services site on the internal Electronic Workplace for chiropractic consultant information. From the eCO Create Referral screen, select Chiropractic Consultant and complete the FM555H form.
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Dental consultant
The dental consultant can assist the decision maker by: - Determining the relationship between the dental damage and the work-related accident for entitlement.
- Commenting on the worker’s oral hygiene needs and care.
- Answering questions and providing an opinion on the claim.
- Determining if there is anticipated ongoing dental treatment or care related to the injury.
- Recommending additional referrals or specialist consultation, if needed.
Ensure the following information is included on the file before sending the referral: - Relevant dental history, including dental exam reports, treatment reports, dental x-rays, photos and chart notes.
- Proposed treatment recommendations.
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Administrative tasks
Refer to the Medical Services site on the internal Electronic Workplace for dental consultant information. From the eCO Create Referral screen, select MC Review – Dental/Ophthalmology and complete the FM555Q form. Include additional information or questions not on the form, if needed.
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Ophthalmology consultant
The ophthalmology consultant can assist the decision maker by: - Determining the relationship between the eye injury and the work-related accident for entitlement.
- Answering questions and/or providing an opinion regarding an eye injury diagnosis and proposed treatment recommendations.
- Determining if there is anticipated severe or long-term damage as a result of the injury for ongoing and/or future entitlement.
- Providing an opinion regarding changes in vision, eyewear and/or recommended eye apparatus.
Ensure the following information is included on the claim file before sending the referral: - Medical reporting including eye exams, visual field tests, specialist consultation reports, surgical reports, proposed treatment and future vision care recommendations.
- Medical history including eye exam reports and prescriptions for eyewear prior to the work-related injury for comparison with worker’s current prescription.
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Administrative tasks
Refer to the Medical Services site on the internal Electronic Workplace for ophthalmology consultant information. From the eCO Create Referral screen, select MC Review – Dental/Ophthalmology and complete the FM555Q form. Include additional information or questions not on the form, if needed.
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Clinical consultant
The clinical consultant supports the decision maker by: - Managing examination referrals, including independent medical examinations and permanent clinical impairment evaluation.
- Providing general clinical advice and recommendations when there are questions about reports, assessments, concerns about medical issues or treatment for claim management, fitness for work, etc.
- Preparing consultation letters and/or medical information packages for external provider examinations.
- Assisting to determine whether there are conflicting medical opinions on the claim.
Note: If x-ray films are needed, the medical records clerk requests them.
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Administrative tasks
For a list of clinical consultants, refer to the Medical Services site on the internal Electronic Workplace. From the eCO Create Referral screen, select the type of referral and complete the form: - Independent Medical Exam – FM555A form
- Permanent Clinical Impairment – FM555B form
For other referral types that do not have a form, send a file note (medical and the appropriate standard text) to the Clinical Consultants, Team Desk.
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Medical services manager (or designate)
The medical services manager or designate supports the decision maker when: - There are unresolved concerns with permanent clinical impairment and non-economic loss payments and/or permanent partial disability awards.*
- There is an unresolved conflict of medical opinion.*
- A medical panel is recommended or being investigated as an option.*
- A complaint is received about a medical consultant or an independent medical examination (IME) physician.
- There is a failure or refusal by a physician to respond after three requests for medical information or records.*
*Note: The decision maker consults with the medical consultant to resolve the issue before they escalate it to the appropriate medical services manager or designate.
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Administrative tasks
Refer to the internal library to determine the Medical Services contact for specific medical concerns. Contact or send an email to the medical services manager or designate. In the email, indicate the claim number, reason for the referral and the steps taken to resolve the concern. Send a copy of the email to the file. When the issue is difficulty obtaining medical information or reports, follow direction outlined in the 11-1 Requesting medical reports procedure (step 5) instead.
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