Medical testing and exam referrals

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.