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WCB Procedures

  • Initial entitlement decision
    • Detailed business procedure
    • Injury-specific IED
    • Supporting references
  • Medical testing and exam referrals
    • Detailed business procedure
    • Types of medical testing and exams
    • Supporting references
  • Opioid management
    • Scenarios
    • Supporting references
  • Rate setting
    • Section 56 rate
    • Concurrent rate
    • Additional rates
    • Communication
    • Supporting references
  • Re-employment services
    • Refer the worker
    • Supporting references
    • Additional RE services

Medical testing and exam referrals

Procedure summary

Purpose To accept the request or recommendation for a test or exam, make arrangements for the worker to attend their appointment, and share the results with all parties once it is complete.
Description

The decision maker reviews the request to ensure that it will meet the needs of the worker and will contribute to their recovery and return to work. They will collect additional information about the worker’s injury and recovery progress as needed.

The decision maker seeks out appropriate options and treatment providers (if available) and discusses the options with the worker. Together they decide the best course of action and the decision maker strives to remove any barriers that may prevent the worker from attending their appointment.

Once the chosen testing or examination is booked, the decision maker ensures the appointment information is communicated to all parties and that additional arrangements are made such as wage loss replacement, accommodations or interpreters.

Results of the test or exam are then shared with the worker and their general practitioner and other specialists, either through the treatment provider or through the decision maker.

Key information

Medical testing and exams can be beneficial when the worker’s recovery is not progressing as expected or there are barriers preventing their return to work.

They are used to assess a worker’s injury, make a diagnosis, recommend a treatment plan or expedite surgery or treatment.

Requests for testing and exam referrals are usually submitted through the worker’s specialist, community health care provider, general practitioner or their employer. In some cases, a WCB decision maker can request a referral when they recognize the need for an assessment and their worker meets the criteria. In some cases, WCB departments such as Medical Services or Millard Health and Healthcare Strategy may be involved in facilitating referrals.

Detailed business procedure

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1. Review the worker's file for indicators and eligibility


Review the worker’s entitlement information and injury details and ensure they reasonably correspond with the criteria for the test or exam.

Additional questions to consider:

  • Does the request meet policy?
  • What is the testing or examination meant to achieve?
  • What assessments has the worker already undergone for their injury?
  • Do they require any additional testing prior to the requested referral?
  • Is all of the diagnostic and other relevant medical information on file?
2. Contact the worker, employer and treatment provider(s)


Contact the worker, employer and treatment provider(s) to discuss the request for referral. Ask questions about how the worker’s injury and recovery are progressing, answer their questions and provide additional information such as related fact sheets or web links.

Communicate all eligible testing and examination options to the worker and explain what to expect from each of the options. Discuss the available providers and their locations and then help the worker decide the best location for the assessment.

Once the worker has agreed to the recommended course of action, confirm their availability to attend. Ask the worker about their travel and accommodation requirements, and whether they require language interpretation services.

Outline the next steps with the worker, such as who will book the appointment and who will call them back to confirm the appointment date and time (either the chosen provider will contact the decision maker with this information or call the worker directly to confirm).

3. Confirm a course of action and book the test or exam


Send the referralRefer to the administrative tasks for each test or exam listed below for more information. to the chosen provider, who will then book the test or exam.

Make any necessary arrangements for travel and other requirements such as accommodation or interpreter services.

4. Review and communicate the results


Share the testing or exam results with a medical consultant, clinical consultant, psychological consultant or Visiting Specialist Clinic provider for review and clarification if required.

Communicate the recommendations and next steps with all partiesIn some cases, employers may need to submit an access to information request to receive a copy of the worker’s results. and ensure the results/reports have been shared with the general practitioner and other specialists or treatment providers. (In some cases, the chosen provider will review the results directly with the worker and then forward the information to the decision maker).

5. Implement the recommendations


This can be a(n)

  • Referral to a surgical facility, rehabilitation facility or community program.
  • Recommendation to undergo further testing or assessments.
  • New, continued or adjusted treatment program or plan.
  • Initial or change to entitlement to benefits and/or services.

Send the appropriate letter to the worker confirming their results, outcomes and next steps, and any changes to their entitlement to benefits.

Types of medical testing and exams

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Back medical exam


A back medical examination (BME) is a medical assessment performed by a physician who has received specialized training.

A back medical exam can be used to:

  • Establish or confirm the worker’s diagnosis
  • Determine the worker’s health status prior to return-to-work program.
  • Expedite a consultation, where possible, if there will be a long wait to see a surgeon (within 30 days of the referral).
  • Clarify the worker’s fitness to return to work.

A back medical exam includes:

  • A comprehensive history and physical examination.
  • Coordination of any required diagnostics or further medical services.
  • Education for the worker about their injury and the return-to-work process.
  • Contact with the treating physician to obtain treatment consensus.
  • Development of a medical treatment plan.

The back examiner can also request a spinal surgery review (SSR), where an independent orthopedic specialist provides an opinion on whether the worker requires back surgery.

Eligibility:

  • The worker’s primary injury is their back or neck and all other injuries have been resolved.
  • The worker needs to be assessed prior to entering a return-to-work program.
  • The worker requires a surgical consult through the Visiting Specialist Clinic.
  • The worker’s relevant medical reporting is on their file (medical history, diagnostic imaging, physical therapy).

In some cases, a repeat exam can take place within 30 calendar days of the initial exam.

  • Back injury program worker fact sheet
  • Back injury program employer fact sheet

Administrative tasks

Use the eCO referral script to make the referral.

Basic functional capacity evaluation


A basic functional capacity evaluation is a half-day assessment, often used with a medical status exam, to determine if the worker requires rehabilitation treatment.

The assessment determines which activities the worker can and cannot perform given their injury and compares them to the tasks they are expected to do as part of their job.

Administrative tasks

Use the eCO referral script to make the referral.

Comprehensive functional capacity evaluation


A comprehensive functional capacity evaluation is a two-day assessment that identifies what work activities the worker can perform safely and how often they can do them.

The clinician compares the worker’s performance between the first and second day in order to determine their sustainable abilities and work conditions. A comprehensive functional capacity evaluation also outlines any work restrictions.

Administrative tasks

Use the eCO referral script to make the referral.

Comprehensive psychological assessment


A comprehensive psychological assessment can help assess the psychological impact of the worker’s injuryIf more than one year has passed since the worker’s date of accident, refer the file to a clinical consultant to review and identify any missing medical information. and recommend a treatment plan.

It is conducted by an experienced, independent psychologist over one to two days and determines the relationship between the worker’s workplace accident and their psychological diagnosis. It can also assess their fitness for work.

The assessment involves a review of the worker’s relevant medical history and a series of psychological tests and clinical interviews to assess the worker’s symptoms.

It is recommended when:

  • The worker has a medically indicated psychological condition without a confirmed psychological or psychiatric diagnosis as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
  • The worker’s DSM diagnosis needs to be clarified.
  • The worker has a pre-existing psychological condition, and it is unclear if it was aggravated by their work duties.
  • Comprehensive psychological and psychological-vocational assessments worker fact sheet

Administrative tasks

Psychological medical information package (PIP) (C1077)

Confirm CPA referral letter (CL026P)

CPA referral presumptive PTSD letter (SP026)

CPA ref non presumptive letter (SP026B)

CPA ref non presumptive letter (SP026B)

CPA trauma Post Apr 1 letter (SP026M)

Psych-chronic stress assess/referral (SP026D)

DSM confirmation physician letter (SP026J)

DSM confirmation psychologist letter (SP026K)

Independent medical examination (IME)


An independent medical exam is performed by a specialist that has not been involved in the worker’s care and will not be actively involved after. Its main purpose is to provide impartial answers to specific medical questions about a work-related injury or illness. An independent medical examination may be requested when:

  • There is a need to weigh medical evidence.
  • There is a difference of opinion between medical providers.
  • There are concerns with the worker’s treatment.

An independent medical examination is used to assess or determine a worker’s:

  • Fitness to work.
  • Work restrictions.
  • Diagnosis.
  • Appropriate medical treatment/investigation.
  • Complex medical issues.
  • Relationship between the injury and work duties.
  • Difference in medical opinions web page

Administrative tasks

Use the service selection tool to determine whether an independent medical examination is the most appropriate option.

Medical Services offers the worker a choice of up to three available examiners from a roster of physicians.

Medical Services communicates the appointment details in writing to the worker, makes any needed travel arrangements and facilitates the booking of any needed translators.

Advise of appointment – IME letter (CL023l)

Medical status examination


A medical status examination determines the worker’s current medical condition including diagnosis and work restrictions. It also identifies other health concerns prior to any additional consultations, assessments or treatment.

A medical status exam is usually completed prior to a functional capacity evaluation to ensure appropriate medical screening.

Administrative tasks

Use the eCO referral script to make the referral.

Medical testing


Medical testing includes various methods of diagnostic testing such as:

  • Computerized tomography (CT) scan
  • Electromyography (EMG) / nerve conduction studiesA written request from the worker's treating physician can also be accepted for a referral.
  • Magnetic resonance imaging (MRI)Workers with back or shoulder injuries must undergo a back medical exam or shoulder medical exam prior to an MRI referral.
  • Ultrasound
  • X-ray

Medical tests are ordered to establish or confirm the worker’s diagnosis. In some instances, the testing can be expedited through health care providers that WCB has partnered with.

Eligibility:

  • There is a requisition from a physician who has assessed the worker.
  • The request corresponds with the worker’s diagnostic history and entitlement information on their claim.

Administrative tasks

Referrals for medical testing are sent by the medical department. Send a request to the appropriate team desk:

  • MRI - Edmonton
  • MRI - Calgary
  • MRI - other
  • Test - diagnostic (CT scan, ultrasound, bone scan)
  • PRI (EMG / nerve conduction studies and others)
Mild traumatic brain injury (concussion) assessment


A mild traumatic brain injury assessment is completed by a neuropsychologist or psychologist with experience working with head injuries.

The assessor reviews the worker’s accident history and current symptoms, as well as treatment to date. They also educate the worker about their recovery expectations and treatment recommendations.

IndicatorsAs per the American Congress of Rehabilitation Medicine (ACRM). of a mild traumatic brain injury can be:

  • Any period of loss of consciousness.
  • Any loss of memory for events immediately before or after the incident.
  • Any alteration in mental state at the time of the accident (e.g. feeling dazed, disoriented or confused).
  • Focal neurological deficit(s) (weakness, loss of balance, change in vision, dyspraxia paresis/plegia [paralysis], sensory loss, aphasia, etc.) which may or may not be temporary.

Administrative tasks

Use the eCO referral script to make the referral.

Neuropsychological assessment


A neuropsychological assessment is requested when the worker has suffered a head injury or concussion as part of their workplace injury. It can confirm or rule out a brain injury when the worker is experiencing a psychological condition. The assessment can also provide treatment recommendations.

In most cases, the neuropsychological assessment is done within two to six months after the date of accident. However, it can be conducted at any time once a brain injury is suspected.

The assessment is scheduled over a one to three day period and is used to examine the worker’s:

  • Cognitive ability (memory, problem-solving skills, attention, concentration and intelligence).
  • Social and emotional functioning.
  • Motor skills.
  • Personality.

The worker may require a neuropsychological assessment if:

  • There is medical information on their file that suggests a head injury such as bruising of the head, skull and/or facial fractures or bleeding on the brain.
  • Loss of or change in consciousness at the time of their injury.
  • They experience amnesia after the accident.
  • There are signs of cognitive defects such as memory loss, concentration difficulties, fatigue or changes to behavior or personality.

In some cases, a repeat assessment can take place six months after the initial assessment.

  • Neuropsychological assessment worker fact sheet

Administrative tasks

Use the eCO referral script to make the referral.

Psychological medical information package (PIP) form (C1077)

Neuropsychological assessment letter (SP021E)

Permanent clinical impairment evaluation


A permanent clinical impairment evaluation measures the worker’s physical and/or psychological function and determines whether their injury has resulted in a lasting functional impairment. The evaluation can be completed by a trained WCB specialist or general practitioner examiner.

A permanent clinical impairment evaluation typically takes place 24 monthsSome examinations can occur earlier than 24 months post-injury such as amputations and discectomies. after the worker’s date of accident or most recent surgery to ensure that adequate time has passed to allow the worker to reach their maximum medical recovery.

The evaluation involves a review of the worker’s medical file, a physical and/or psychological examination and a discussion with the worker about their injury.

Eligibility:

  • The worker suffered a loss of a body part.
  • The worker lost the use of a body part, system or function, or
  • The worker experienced a change or disfigurement of any body part, system or function.
  • Permanent clinical impairment (PCI) worker fact sheet

Administrative tasks

Send task to PCI pure desk.

Shoulder medical exam


A shoulder medical evaluation (SME) is a medical assessment performed by a physician who has received specialized training from a shoulder surgeon.

As part of the shoulder medical exam, the physician will examine how the worker's shoulder moves and the strength in their shoulder muscles. They will then determine which treatment stream the worker should be triaged into.

In most cases, recommended treatment could be a combination of the following:

  • Educating the worker on how to manage their injury or symptoms.
  • Return-to-work services.
  • Community physical therapy.
  • Further diagnostic imaging.
  • Non-surgical rehabilitation.
  • A shoulder surgical review (if surgery through the Visiting Specialist Clinic may be required).

The assessment allows for timely transfer into the shoulder surgical review process (ShSR) for those workers who are considered potential surgical candidates.

The shoulder surgical review (ShSR) examination includes an assessment with an orthopedic surgeon with special interest in shoulders and a shoulder surgical review physical therapist.

Eligibility:

  • The worker’s predominant injury is their shoulder.
  • The worker needs to be assessed prior to entering a return-to-work program.
  • The worker may potentially require a surgical consult through the Visiting Specialist Clinic.
  • The worker’s relevant medical reporting is on their file (medical history, diagnostic imaging, physical therapy).

In some cases, a repeat exam can take place within 30 calendar days of the initial exam.

  • Shoulder injury assessment worker fact sheet
  • Shoulder injury assessment employer fact sheet

Administrative tasks

Use the eCO referral script to make the referral.

Traumatic psychological injury assessment


A traumatic psychological injury assessment may be requested if the worker suffers a psychological injury or stress due to a single traumatic work-related incident or a cumulative series of traumatic incidents.

A traumatic psychological injury assessment is used to determine the worker’s requirements for further assessments and/or treatment.

The assessment is completed by a registered psychologist who interviews the worker and completes several checklists with them.

Eligibility:

  • A referral should be completed within four weeks of the accident.
  • Generally, a traumatic psychological injury assessment is more suitable for a worker who has no significant pre-existing psychological conditions or substance abuse issues.
  • Traumatic psychological injury worker fact sheet
  • Psychological injuries employer fact sheet

Administrative tasks

Use the eCO referral script to make the referral.

Medical package cover sheet (FM001A)

Psychological medical information package (PIP) form (C1077)

Confirm TPI referral letter (CL026O)

Traumatic assess/tx pre Apr 1 letter (SP026A)

Traumatic assess/tx post Apr 1 letter (SP026L)

Visiting Specialist Clinic (VSC) referral


A Visiting Specialist Clinic is a facility that WCB has partnered with to ensure the worker’s timely access to specialist consultations and surgical procedures.

The Visiting Specialist Clinic also provides non-surgical consultations that can provide specialists opinions regarding the worker’s diagnosis and ongoing treatment needs.

In most cases, the specialist that performs the assessment will also provide the treatment or procedure, if required.

Available specialties include:

  • OrthopedicBack and shoulder injuries must have completed a BSE or SME prior to referral. - foot/ankle, knee, hip, spine, shoulder, elbow, hand/wrist.
  • Plastics - hand/wrist and carpal tunnel syndrome.
  • General surgery - hernia.

Eligibility:

  • There is a wait time of over four weeks for a consultation that was arranged by their treating physician.
  • The worker is under the care of a general practitioner but there has not been a referral to a surgeon or the consultation is more than four weeks away.
  • The worker’s booked surgery The worker’s current specialist must sign a release of care form before the worker can be referred to the Visiting Specialist Clinic for surgery. wait time is more than eight weeks.
  • The worker was identified for surgery through an independent medical examination (IME), medical status examination, shoulder surgery review examination or spinal surgery review.

Administrative tasks

Whenever possible, offer the worker a choice of available providers.

Surgical coordinator VSC referral (FM235D)

VSC assistance request (FM235E)

VSC - release of care (SP235F)

VSC - GP approval (SP235G)

Surgery authorization (SP235B)

Surgical claim denial (SP235C)

Surgical denial (SP235D)

Supporting references

Policies

  • 03-01, Part I, General
  • 03-01, Part II, Application 6: Psychiatric or Psychological Injury
  • 03-02, Part I, Aggravation of a Pre-existing Condition
  • 03-02, Part II, Application 2: Rehabilitation Surgery Program
  • 04-02, Part I, Temporary Benefits
  • 04-05, Part I, Return-to-Work Services
  • 04-05, Part II, Application 1: General
  • 04-06, Part I, Health Care

Statutes ( Workers’ Compensation Act )

Applicable sections

  • Section 24 (1) - Eligibility for compensation
  • Section 34 (5) - Report by physician
  • Section 38 - Medical examination and investigation
  • Section 54 - Reduction or suspension of compensation
  • Sections 78 (1) (2) - Provision of medical aid
  • Section 80 - Amount of medical aid
  • Section 86 - No charge for medical aid
  • Section 89 - Board to provide vocational and rehabilitation services
  • Section 137 (1) - Programs

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