Medical panel

Procedure summary

Published On

May 13, 2025
Purpose

To assess whether a referral for a medical panel is needed to resolve a complex medical issue(s) and/or a difference of opinion and to initiate the referral.
Description

The decision maker evaluates whether a complex medical issue(s) and/or a difference of medical opinion exists and considers if there is an alternate way to achieve a resolution. When attempts to resolve the issue have been unsuccessful, the decision maker discusses the issue(s) and/or difference of opinion with the medical services manager including all avenues attempted to achieve resolution (e.g., consultation with the worker's treating physician or an independent medical exam).

Following the discussion, the decision maker refers the claim to the medical services manager for a preliminary review. Following the preliminary review, the medical service manager notifies the decision maker as to whether the medical panel request:

  • is warranted,
  • may be considered once additional information is obtained, or
  • whether they will proceed with a formal review for panel consideration.

Based on the outcome of the preliminary review, the decision maker actions the claim as appropriate. When a medical panel request will be considered, the medical services manager completes a formal review and documents their decision to approve or not approve the request for medical panel.  If approved, they make the referral to the medical panel commissionerThe medical panel commissioner is an independent physician appointed by the Minister, who has no role in WCB claims and whose independence is subject to review by the Auditor General..

The decision maker continues to monitor the claim for the medical panel report and actions the decision, as appropriate. When the medical panel was requested by the Appeals Commission (AC), the decision maker awaits the AC decision memo and actions the claim based on direction from the AC.
Key information

A medical panel provides the Worker's Compensation Board (WCB) of Alberta and the Appeals Commission with an impartial, independent process for resolving complex medical issues that may affect a worker's right to compensation. Refer to Policy 03-01, Part II, Application 1, Question 3 and Sections 46.2 and 46.3 of the Worker's Compensation Act (WCA).

Medical panels are considered when:

  • The WCB determines there is a “difference of medical” opinion that cannot be resolved through other means such as consultation with the treating physician or an independent medical exam (IME), which may be completed by one or multiple IME specialists, if required.
  • The WCB or the Appeals commission recommends a referral for a medical panel to clarify a significant medical issue.
Assembling the medical panel

Medical panels are assembled by the medical panel commissioner who is responsible for the overall operation of the medical panel process. The medical panel commissioner identifies a list of eligible physicians. Physicians where there may be a potential conflict of interest (e.g., a worker's treating physician or one who has consulted with the worker, a physician who provides medical services to the employer, etc.) are not eligible to participate in the medical panel. Eligible physicians must:

  • Have expertise with the worker's medical issue under review.
  • Be registered with the College of Physicians and Surgeons of Alberta.
  • Be available and willing to participate on the medical panel.

Once the list of eligible physicians has been compiled, the injured worker, employer, and the WCB are given the opportunity to choose their order of preference of physicians to participate in the medical panel.  The medical panel commissioner then selects the panel members and the panel chair. 

Medical panel process

The medical panel reviews the medical information on the claim and:

  • Interviews and examines the injured worker.
  • Requests additional investigation or consultation, if required.

The goal of the medical panel is to achieve consensus from all three practitioners for the issue under review. Once a consensus has been reached, the medical panel issues a written decision.  Medical panel decisions are final and binding; they are not open to question or review in any court.

For additional information, refer to the worker and employer fact sheets in the Supporting References (General tab) at the bottom of this procedure.

Detailed business procedure

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1. Review the claim and determine the issue

Administrative tasks

 

Follow the appropriate procedure:
2. Discuss and make a referral to the medical services manager

Administrative tasks

Update the Injury Details in eCO.

Document the discussion in a file note (Contact/Other).

Send a file note (Medical) to the medical services manager with the description line “please review for possible medical panel.”

Refer to the 11-2C Medical issues handled by the medical services manager or designates (Sept 2024) document in the Resource Library.

The medical services manager sends a file note to the decision maker documenting the outcome of their preliminary review.
3. Call the worker to discuss the outcome of the medical service manager's review

Administrative tasks

Document the discussion in a file note (Contact/Worker).

Send the appropriate letter outlining the next steps:

  • Claimant Custom letter (CL000A) to the worker
  • Insured Custom letter (IN000A) to the employer

 

To refer for a formal medical panel review, complete and send the Request for medical panel form (M-215) form to the medical services manager.
4. Communicate the decision

Administrative tasks

Document the discussion in a file note (Worker/Contact) and (Employer/Contact).

When not approved, send the appropriate letter outlining next steps:

  • Claimant Custom letter (CL000A) to the worker
  • Insured Custom letter (IN000A) to the employer

When approved, send the Independent Medical Panel (CL047E) letter to the worker and a copy to the employer.
5. Monitor for the medical panel outcome

Administrative tasks

Document the discussion in a file note (Contact/Worker) and (Contact/Employer).

 

Send the appropriate letter outlining the information used to make the decision:

  • Claimant Custom letter (CL000A) to the worker
  • Insured Custom letter (IN000A) to the employer

Supporting references

Workers’ Compensation Act

Applicable sections

  • 46.2 Medical panels comissioner
  • 46.3 Medical panels

General Regulation

Applicable sections

Related Legislation

Applicable sections