Medical testing, referrals and program support

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 and/or work restrictions.

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 has been referred to a surgeon or community specialist and the appointment is more than four weeks from time of assessment.
• The worker has experienced recent and significant changes in their medical status.
• All diagnostics are on file.

In some cases, a repeat exam can take place as necessary or as medically indicated. Such as when the examiner requests a reassessment or there is a new and substantial change in medical status.

• Back injury program - Worker Fact Sheet 
• Back injury program - Employer Fact Sheet 

When a worker has a suspected brain injury, they are referred for a brain injury medical exam. The results of the exam will determine whether additional assessments should be done. Specialized assessments require approval from Health Care Strategy.

Moderate to severe brain injuries are assigned to the Special Care Services (SCS) team who may refer a worker for any combination of neurological and psychological assessments to determine the barriers a worker may experience going forward.

A Brain Injury Program can only be recommended following a brain injury assessment, including at a minimum both a brain injury medical exam and a traumatic brain injury assessment.

Brain injury functional capacity exam (BI-FCE)

A brain injury functional capacity exam compares critical activities to the worker’s expected job tasks and work conditions to determine their sustainable abilities and includes a functional cognitive screen based on the conclusions.

Brain injury basic functional capacity exam

When the exam is done in the early stages of a claim, it establishes a baseline to determine a worker’s physical and functional abilities, cognitive abilities and identify further rehabilitation to support the worker’s recovery.

Brain injury complex functional capacity exam

The exam can be done in the later stages of a claim when the worker has reached a plateau in their recovery and the exam supports the return-to-work process. The two-day exam evaluates a worker’s physical functional and cognitive abilities to identify any work restrictions based on the expected job tasks and working environment.

Brain injury medical status examination (BI-MSE)

A brain injury medical status examination is conducted by a physician and is used to determine the current medical condition, diagnosis, work restrictions as well identify any other medical conditions that may impact rehabilitation and successful return to work.

Based on the results, the examining physician may recommend further brain injury assessments as appropriate following the results.

Brain injury return-to-work planning meeting (BI-RTWPM)

A return-to-work planning meeting includes the worker, employer and the treatment provider.

The meeting is required for a worker who has experienced a brain injury, to clarify the worker’s pre-accident job demands and identify suitable modified duties and return-to-work opportunities.

Eligibility:

• The worker is not working.
• The employer is having difficulty identifying modified duties.
• The worker is performing modified duties, but there is no plan to progress to full duties.
• The worker or employer has concerns about the return to work.

Neurological vestibular assessment

A neurological vestibular assessment is performed by a physiotherapist who has received specialized training.

The assessment is used to confirm diagnosis and treatment recommendations when the worker presents with symptoms of dizziness and is not already referred to a contracted physiotherapy provider with ability to complete this specialized assessment.

The brain injury service provider arranges the neurological vestibular assessment in conjunction with the brain injury program. However, a family physician or community physiotherapist may make the recommendation, or a decision maker may consult with a physical therapy consultant to confirm this referral is appropriate.

Traumatic brain injury (TBI)

A traumatic brain injury intake assessment is done by a psychologist or neuropsychologist who reviews the worker’s current symptoms, their accident history and any treatment or services they’ve received.

The information is used to outline any additional assessments, a treatment plan going forward and to educate the worker about expectations for recovery and return to work.

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.

This assessment can be combined with a neuropsychological assessment and/or a psycho-vocational assessment. Consult a psychological assistant to discuss if it is appropriate, and/or to determine the best timing. Please see the psycho-vocational assessment section below for criteria.

The comprehensive psychological assessment 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.
• There is a need to clarify or confirm the connection between the diagnosis and the work injury.
• There is a need to confirm fitness for work and temporary or permanent work restrictions.
• The worker has psychosocial issues posing significant barriers to returning to work.

Potential invalid exam

Should the assessor note any concerns about the validityThe findings of the examination may not be an accurate reflection of the true situation which may be due to a number of factors. of the exam results, contact the psychological assistant or consultant for clarification, or the assessor if needed. 

The assessor may still be able to comment on fitness, based on a combination of the file information and history, the interview and examination and their expertise in the field.

When the examiner is unable to provide the requested information, reach out to the psychological assistant or consultant as necessary to discuss the results, recommendations and to clarify when to repeat the assessment.

Contact the worker to discuss the next steps. These may include a psychiatric independent medical exam, a case conference with the treating physician or a repeat assessment if a consensus cannot be met.

In the event an assessment has to be repeated, confirm the exam and ensure the worker understands the importance of their participation.

• Comprehensive psychological and psychological-vocational assessments - Worker Fact Sheet 

A concussion symptom assessment is an early brain injury medical assessment for workers who have suffered a mild head injury and is completed by a medical status exam physician.

Workers who have suffered moderate to severe brain injuries are assigned to the Special Care Services (SCS) team who may refer a worker to a neuropsychologist or psychologist who has experience working with head injuries.

When the worker has experienced a concussion or has ongoing symptoms and needs further services, a referral for a CSA should be completed. The examination must take place within 21 days following the date of accident. The referral can be sent by day 14.

The concussion symptom assessment includes three parts. 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, which may include a return to work as appropriate.

Indicators 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).
• Any symptoms like dizziness, headaches or tinnitus.
• 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.

If the results of the assessment determine the worker has sustained a more serious brain injury, consult a Special Care Service supervisor to determine whether the claim qualifies to be transferred.

A functional capacity evaluation is completed after a medical status exam and compares activities to the tasks a worker is expected to do as part of their job.

The assessment determines which work activities the worker can and cannot perform safely and how often they can do those activities given their injury. There are two types of functional capacity evaluations.

Basic functional capacity evaluation (BFCE)

A half-day assessment done early in the claim, often used with a medical status exam, to determine a baseline for the worker’s abilities, the need for any work modifications and identify if the worker requires rehabilitation treatment.

A comprehensive functional capacity evaluation (CFCE)

A two-day assessment of the worker’s performance, done later in the claim when a worker has reached a medical plateau. The exam determines the worker’s sustainable abilities and reasonable working conditions and outlines any restrictions in support of their return to work.

A gait assessment can provide specific recommendations for the provision of footwear, braces and other gait aids to help improve a worker’s comfort and function when the injury affects the lower extremity (hip, leg, ankle joint).

Testing is individualized to each worker, but may include any of the following:

• Evaluating the current footwear and/or walking aids.
• Evaluating any swelling or skin conditions.
• Functional test such as squatting and balancing.
• Testing mobility, strength, and/or stability.

There are two types of gait assessments.

Basic assessment

This type of gait assessment is recommended when the worker has a(n):

• Mild to moderate strain and/or chronic lower extremity swelling.
• Uncomplicated toe or mid-foot fracture not affecting the ankle joint.
• Gait assessment within the last six months without surgical intervention.
• Older claim requiring periodic follow-up.
• Spinal injury unaffected by a neurological involvement.
• Low back strain/sprain, impacting weight bearing tolerance.

Comprehensive gait assessment

This type of gait assessment is recommended when the worker has a:

• Strain that is severe on the lower extremity.
• Surgical intervention recently of the lower extremity.
• Fracture that is significant on the lower extremity.
• Neurological involvement (drop foot, complex regional pain syndrome (CRPS) etc.).
• Crush injury to the foot or other lower extremity.
• Burns to the foot and/or lower leg.

A gait assessment may be necessary when a worker requires the use of footwear, orthotics, braces or gait aids in order to continue activities comfortably in the following areas:

• Daily living
• Work

WCB does not fund gait devices for sporting activities.

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. The worker will be offered a choice of up to three available examiners, when possible, from a roster of physicians.

Further expert opinion is required for Customer Services to weigh the evidence when:

• The Appeals Commission Directs it.
• 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 and/or work restrictions.

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

• Primary diagnosis.
• Relationship between the injury/primary diagnosis and work duties.
• Complex medical issues.
• Appropriate medical treatment and/or investigation.
• Fitness to work and work restrictions.

An independent medical examination cannot proceed if:

• There are any missing relevant medical reports.
• The worker is under the care of a treating specialist for the issue(s) to be addressed by the IME.
• The worker is in active treatment or currently participating in a return-to-work program.
• All treating specialists/previous IME Physician’s recommendations have not been followed.

Potential invalid exam

Should the examiner note any concerns about the validityThe findings of the examination may not be an accurate reflection of the true situation which may be due to a number of factors. of the exam results, they will not answer any questions including fitness to work. 

If the examiner is unable to provide the requested information, consider if any decisions can be made based on the information on the file. If not, reach out to the medical consultant to discuss ideas to move the plan forward, if needed. An exam may be repeated if appropriate and approved.

Any specialist exam that is arranged by a third party is considered a Specialist Consultation and will only be considered and covered if deemed relevant to the claim. When an employer is requesting an independent medical exam be done, they may be expected to cover any associated cost.

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.

A medical status exam can also be used to:

• Expedite a consultation, where possible, if the wait to see a surgeon is more than 30 days from the referral.
• Clarify the worker’s fitness to return to work and/or work restrictions.

Once a treatment provider receives a referral for assessment, the provider uses the worker’s information to determine if the assessment is appropriate.

Eligibility:

• The worker has not seen a physician within the last three months (non-surgical cases). 
• A work readiness report is not on file within the last three months (surgical cases). ,
• The worker is in or has completed a community acute care program and is not progressing as expected.
• The worker’s treatment provider requests an assessment.
• The worker's diagnosis needs to be confirmed and/or an entitlement decision is pending, there is a lack of medical consensus on the claim, or the worker requires expedited diagnostics, injections or consultations.
• Chronic pain, pain that does not proportionate to the injury or there are non-compensable red flags/barriers (e.g., blood pressure, cardiac concerns).

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)
• Ultrasound (US)

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 when an exam cannot be booked within the timelines noted below: 

• MRI: one week
• CT scan: one week
• EMG/NGS: three weeks
• US: one week

Eligibility:

• There is a requisition from a physician who has assessed the worker. In some cases, the practitioner or physician may arrange the exam.
• The request corresponds with the worker’s diagnostic history and entitlement information on their claim.

Medical Services will contact the worker and arrange the exam and any needed translators and travel -- unless there are special requirements or an extended stay.

Note: All lumbar MRI requests made by a family physician must have a lumbar spine imaging screening record completed by the physician, in addition to the standard MRI requisition form, before the MRI can be expedited. The lumbar spine imaging screening record is located on the Alberta Health Services (AHS) website: Diagnostic Imaging | Alberta Health Services.

Note: All shoulder MRI requests made by a family physician or general practitioner are reviewed by a medical consultant to determine if there is enough information to support the procedure being expedited or if a shoulder medical exam (SME) is required. A task will be sent by the medical consultant to the decision maker and booking expeditor advising if the MRI has been approved.

Invoices or expedited referrals from a non-contracted provider are covered when the test is confirmed to be related to the accepted work injury.

The provider is to reimburse the worker for any testing paid out of pocket and resubmit billing to WCB under Section 86 of the Workers' Compensation Act.

When there are questions about a referral, call or refer to the medical consultant who will assist when a decision cannot be made about whether to accept it.

A neuropsychological assessment is an independent assessment completed by a registered psychologist or a return-to-work provider. It is requested when the worker has suffered a head injury, concussion or compromised cognitive function such as stroke or other neurological effects as part of their workplace injury.

A neuropsychological assessment can be combined with a comprehensive psychological assessment and/or psycho-vocational assessment. In some case when the worker may be experiencing a barrier related to a cognitive or psychological deficit resulting from a traumatic brain injury, stroke, epilepsy, or any other neurological injury. These assessments can also be completed by a community provider or as part of a return-to-work center assessment.

A neuropsychological assessment 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 behaviour or personality.

The recommendations in the neuropsychological assessment report are reviewed to address any outstanding issues.

Potential invalid exam

Should the assessor note any concerns about the validity of the exam results, contact the psychological assistant or consultant for clarification, or the assessor if needed.

The assessor may still comment on fitness, based on a combination of the file information and history, the interview and examination and their expertise in the field.

When the examiner is unable to provide the requested information, reach out to the psychological assistant or consultant as necessary to determine the next steps.

If a repeat assessment is appropriate, it can take place six months after the initial assessment for the following reasons:

• Recommended based on results of previous testing.
• Evidence of a brain injury, despite an inconsistent outcome in a previous assessment.
• To confirm cognitive fitness to return to work.
• To determine the level of permanent clinical impairment related to a brain injury (24 months post-date-of-accident).

Make referrals for any repeat neuropsychological assessments to the original authorized psychologist. When the results of the previous assessment noted validityThe findings of the examination are inconsistent or incomplete and are not a trustworthy representation of the true situation. concerns, refer the worker to a different psychologist.

A repeat assessment is not required when no brain injury is identified in the original assessment.

Neuropsychological Screen (NPS)

A neuropsychologist may complete a neuropsychological screen (NPS) when a worker is experiencing potential cognitive difficulties that may impact their recovery and return to work.

The screen will clarify the worker's diagnosis, outline the current cognitive status, outline potential exams and treatments, and comment on the prognosis in order to determine the supports the worker will need going forward.

A neuropsychological screen is done when it has been less than eight weeks since the acute hospital or inpatient rehabilitation phases. After eight weeks, a neuropsychological assessment is done.

• Neuropsychological assessment - Worker Fact Sheet 

Occupational therapists are an injured worker’s solution to the challenges they face. With the help of an occupational therapist, workers can increase their ability to take care of themselves, be productive, and enjoy what their homes and communities have to offer.

There are a number of assessments occupational therapists do to identify a worker’s current abilities and provide solutions to help them improve their independence with managing activities of daily living, including self-care. Solutions may include assistive devices, new ways to complete tasks and self-care, changes to the home set-up and community supports.

The following assessments are available through occupational therapy providers:

• Home maintenance assessment
• Housekeeping assessment
• Personal care allowance assessment
• Home equipment assessment
• Combined personal care allowance and home equipment assessment
• Home modifications assessment
• Wheelchair assessment
• Seating/pressure mapping assessment
• Scooter assessment
• Palliative care assessment
• New vehicle modifications assessment
• Driving assessment
• Pre- and post-accident profile assessment
• Ergonomic assessment
• Exposure therapy
• Cognitive therapy
• Hand assessment/therapy
• Splinting assessment
• General assessment

Contact Health Care Strategy (HCS) prior to making a referral for a specific occupational therapist. HCS will consider the request only if there is a clinical need, the occupational therapist is the next available and they are located within the appropriate geographical area. A previous assessment completed by a specific occupational therapist does not demonstrate a clinical need for the same occupational therapist to complete another assessment for the same client. An example of clinical need is that the specific occupational therapist is the only one who has the clinical training to complete a service. 

This exam supports a worker’s diagnosis and treatment in the case of an injury that requires orthopedic expertise.

It is considered a diagnostic and treatment consultation (DTC) when an external community physician completes a Diagnostic and Treatment Consultation Referral form in the RapidReportRapidReport is the electronic injury reporting system that is used by employers and providers. system initiating the exam. A separate form is required for each referral to WCB to ensure effective tracking.

When the consultation is initiated internally by the decision maker or is recommended by the medical consultant it is considered an expedited specialist consult (ESC).

Eligibility:

• It has been less than eight weeks since the date of accident and the worker is not already in the care of an orthopedic specialist.
• The injury is exclusively orthopedic (no secondary psychological or neurological effects) and does not affect the back or shoulder.
• There is complex medical evidence that surgery is unlikely to be successful, such as multiple or age-related issues, conflicting or ambiguous diagnoses.
• The worker would benefit from an in-person assessment.

The exam takes place in either Edmonton or Calgary and is performed in person by an orthopedic specialist also capable of performing independent medical examinations. The examiner provides a report with recommendations for diagnosis and treatment that excludes an opinion about causation.

Contact the initiating physician who will carry out the recommendations for treatment to offer support if necessary.

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 and can be done simultaneously with an independent medical examination for multiple issues or questions.

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. In some cases, when there are sufficient records, the permanent clinical impairment evaluation can be completed by reviewing the documents on file, and the physical and/or psychological examination and discussion with the worker are not necessary.

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.

Potential invalid exam

Should the assessor note any concerns about the validityThe findings of the examination may not be an accurate reflection of the true situation which may be due to a number of factors. of the examination results, contact the appropriate internal consultant, if needed.

The assessor may still comment based on a combination of the file information and history, the interview and examination and their expertise in the field.

When the results of a permanent clinical impairment examination are invalidThe findings of the examination may not be an accurate reflection of the true situation which may be due to a number of factors., a further assessment can be arranged 6 – 12 months later. If the results of the second examination are also compromised, no reassessments will be arranged.

Effective July 2024, the PSA service is no longer available. 

If assistance or clarification about the worker's fitness-for-work abilities is required, discuss them directly with the clinician who provided the restrictions (e.g., CFCE assessor, primary therapist on RTW program).

The Post-covid rehabilitation triage is an initial assessment and is used to determine the best treatment plan to support a worker’s recovery from COVID-19.

The results of the assessment identify whether there’s a need for further medical referrals, and whether the worker would benefit from community supports or admission to the Post-Covid Recovery Program.

Covid-19 and Return to Work  

A psychological injury screen is a triage tool to determine the best treatment to facilitate recovery and return to work when the worker suffers a psychological injury caused by either a single traumatic event or cumulative exposure to a series of traumatic incidents or chronic psychological stress, like harassment.

The screen outlines factors that may affect the worker’s recovery and return to work planning and determines any requirements for further assessments and/or treatment, such as a psychological injury program.

A psychological injury screen is considered when,

• A psychological injury is accepted as compensable (diagnosis and causation have been determined).
• The worker has participated in community counselling (minimum 10 to 12 sessions) and is not progressing with their return-to-work goals. The barriers they face cannot be resolved through alternative strategies such as collaborative discussions, exposure therapy, adjusting modified duties, etc.
• The worker has not completed a CPAComprehensive Psychological Assessment , NPANeuropsychological Assessment, or PIMEPsychological Independent Medical Examination or the assessment did not provide further treatment recommendations
• The worker is program ready and does not have barriers present that would hinder participation in a return-to-work program.

The nature of the injury determines which program is recommended.

(1) A worker has experienced chronic psychological stress in the workplace caused by one or more of the following types of incidents over time:

• Bullying
• Harassment or sexual harassment
• Ongoing stress

They may require treatment through a cumulative psychological injury (CPI) program.

(2) A worker has experienced a single traumatic work-related incident. This might include, but is not limited to, one of the following types of incidents.

• Assault, robbery or sexual violence
• Disaster, either man-made or natural
• Disfigurement, crush injury or significant burn
• Fall from a significant height or other life-threatening injury
• Motor vehicle accident
• Physical disfigurement or dismemberment
• Repeated traumatic emergency response calls

These injuries may require treatment through a traumatic psychological injury program.

The screen is completed by a registered psychologist who interviews the worker and completes several evaluations with them. In rare circumstances this may be done by a community provider.

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

• Educating the worker on how to manage their injury or symptoms.
• Further assessments.
• A rehabilitation program, such as the Traumatic Psychological Injury or Cumulative Psychological Injury Program.
• A recommendation to extend treatment with a community provider that includes counselling.

Eligibility:

• A psychological injury is accepted as compensable and work-related.
• The primary cause of the injury or ongoing disability is consistent with a traumatic incident and the injury is not acutely physical.
• The treating community psychologist confirms the worker has not seen significant progress or it has plateaued and there is no return to work planned within the next six weeks.
• The return-to-work plan is not progressing, and the barriers cannot be addressed through other means (collaborative conversations, exposure therapy, adjustment of modified duties, etc.).
• Generally, a psychological injury screen is more suitable for a worker who has no significant pre-existing psychological conditions or substance abuse issues.

A psycho-vocational assessment includes the primary components of a comprehensive psychological assessment or of a neuropsychological assessment and also identifies a worker’s vocational barriers affecting their return to work.

Consider a psycho-vocational assessment when a worker has compensable or non-compensable psychosocial or cognitive barriers to determining a suitable or academic path during re-employment planning, confirm a job is psychologically suitable, or there is a need to identify new job options to match a worker’s psychological profile.

Combine a psycho-vocational assessment with a comprehensive psychological assessment request when the psychological diagnosis includes, but is not limited to, one of the following:

• Post-traumatic stress disorder (PTSD),
• Major Depressive Disorder,
• Chronic Adjustment Disorder,
• Personality disorder or learning disability such as ADHD or dyslexia (suspected or confirmed).

Include a psycho-vocational assessment with a neuropsychological assessment request when there is a vocational barrier related to a cognitive or psychological deficit resulting from any of the following:

• Traumatic brain injury
• Stroke
• Epilepsy
• Neurological injury

If the assessment is needed, discuss the benefit with the worker and make the necessary arrangements. In some cases, this assessment can be completed virtually.

Review the recommendations in the psycho-vocational report and address anything outstanding.

Potential invalid exam

Should the assessor note any concerns about the validity of the exam results, contact the psychological assistant or consultant for clarification, or the assessor if needed. Consider whether repeating the exam is appropriate.

Comprehensive psychological and psychological-vocational assessments 

A Return-to-work planning meeting (RTWPM) assists workers, employers and claim owners in developing a safe, suitable and sustainable return-to-work (RTW) plan. Collaboration between all involved parties is the fundamental basis for a successful RTWPM service. 

The meeting will,

• Educate the employer about to the return-to-work process.
• Confirm the physical demands of the worker’s pre-accident job.
• Identify possible modified work opportunities.
• Discuss and address any barriers the worker might face with recovery and/or their return to work.
• Educate the worker on injury prevention, directed at how to avoid re-aggravating their injury.
• Create a return-to-work plan that supports the worker’s recovery and return to work.
• Confirm the worker's English-speaking ability.

The results of the meeting are documented and used to monitor and support the worker’s progress.

The effectiveness of the RTWPM can be influenced by the method of delivery.

The RTWPM can be delivered in-person, if

• There are major discrepancies between the physical demands analysis (PDA) and the worker's description.
• The employer has not provided a PDA and the pre-accident critical job demands (CJDs) need to be confirmed.
• The referral requires physical measurements of pre-accident CJDs.
• The claim is complex (e.g., multiple physical injuries, RTW barriers are present)
• There were previous unsuccessful RTW attempts or the compensable condition(s) requires more detailed assessment (e.g., psychological or cognitive injuries).
• A worker is appealing the suitability of modified work.
• Concerns exist with the employer-employee relationship (e.g., existing conflict, notable tension between both parties).

The RTWPM can be delivered virtually, if

• The date-of-accident worksite location is remote or if it is difficult to arrange because of logistical challenges.
• The goal is to develop or progress an existing RTW plan and the compensable condition(s) is not complex (e.g., single physical injury, lack of RTW barriers present).
• The DOA employer has declined an in-person meeting or the RTWPM was previously completed in-person.

Return-to-work planning discussion (RTWPD)

A return-to-work planning discussion is held when a formal return-to-work planning meeting cannot be held.

The meeting includes the employer, worker and the treatment provider and is held as either a phone conversation or in person at the treatment provider’s site.

There are criteria that have to be met before scheduling a return-to-work planning discussion:

• The decision maker has confirmed a discussion is adequate when a meeting cannot be arranged.
• There is a physical demands analysis for the worker’s pre-accident job.
• There are confirmation and documentation of modified duties, if any.

In cases when a clinician’s involvement is not needed, a referral to an industry specialist can be made in place of a return-to-work planning discussion.

Microprocessor (knee) or myoelectric device (upper extremity)

The return-to-work planning meeting for a worker who is requesting a Microprocessor Knee or a Myoelectric Device includes an additional assessment and report.

The evaluations in the report confirm:

• There is a medical need.
• The device is functional.
• The device is appropriate for the work environment.
• The device meets safety requirements.

The results compare the operation of the microprocessor (knee) or myoelectric device (upper extremity) to the work environment to confirm the device is safe for use.

A shoulder medical evaluation 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.
• Community physical therapy.
• Further diagnostic imaging.
• Non-surgical rehabilitation.
• Return-to-work services.
• eConsult (if the SME physician would like a specialist opinion on treatment recommendations (i.e., surgical vs. conservative measures) a documentary review will be completed by an orthopedic specialist.
• Surgical consultation at a Visiting Specialist Clinic.

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 as necessary or as medically indicated.

• Shoulder injury assessment - Worker Fact Sheet 
• Shoulder injury assessment - Employer Fact Sheet 

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:

• Orthopedic Back 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.

Surgical consult (SC)

Eligibility:

• The worker does not have a referral to a surgeon or they are waiting for surgery or a consult by a public physician.
• The worker has previously had a back medical exam or a shoulder medical exam when the injury affects that part of body.
• The worker’s booked surgeryThe 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, medical status examination, shoulder medical examination, eConsult or spinal surgery review.
• There is a documented physician on the claim and an adjudicator or case manager has been assigned to the claim.

Non-surgical consult (NSC)

Eligibility:

• The worker requires a non-surgical referral, and it has been more than eight weeks since the date-of-accident. If it is fewer than eight weeks, see diagnostic treatment consultation or expedited specialist consultation.
• The worker has previously had a back medical exam or a shoulder medical exam when the injury affects that part of body.
• The worker’s diagnosis and next steps in the treatment plan need to be determined.

Special considerations:

• When the worker is under the care of a general practitioner or a community specialist (non-VSC surgeon), written confirmation releasing the worker from care must be obtained before a referral can be accepted.
• When a Visiting Specialist Clinic doctor requests a worker they are seeing in their public practice be transferred to the care of the Visiting Specialist Clinic, the decision maker is responsible for determining entitlement, providing approval and completing the referral.

In both cases, before making any changes to a worker’s treatment plan, ensure the worker agrees to the change in appointment and/or specialist. Also, inform the worker they may be able to get an earlier appointment if they would be willing to travel to another location.

Discuss timelines and expectations with the worker. 

• Explain the process can be quick and surgery may be scheduled for soon after the surgical consult (as soon as one week). If the worker is unable to be ready at that time, delay making the referral until they are ready.
• Discuss the arrangements that need to be made for after surgery. The worker needs to have a ride home (not with a taxi) and a responsible adult to stay with them for a minimum of 24 hours after the surgery. If the worker does not have a ride and someone to stay with them, arrange for home health services in advance. Without this support, the surgery will be cancelled.

If reporting from the Visiting Specialist Clinic is unclear, or if a case conference with a surgeon and decision maker is needed, complete an Assistance Request (AR) form. To confirm diagnosis or procedure, discuss concerns with the clinical or medical consultant.

Confirm if surgery is authorized and send the appropriate letter.

A worker requires a new referral and recent injury diagnostics for all follow-ups six months after they have seen the surgeon and/or have been discharged from the surgeon's care.

Return-to-work program services support a worker to reintegrate into the worksite and job demands.

This may begin by organizing a return-to-work planning meeting or discussion.

The program is designed to provide support to an individual worker’s specific injury-related needs and circumstances:

• Negotiating ergonomic or job-duty modifications.
• Simulating work-related activities to increase work tolerance.
• Physical conditioning interventions (musculoskeletal condition), which may include physical therapy, exercise therapy, occupational therapy.
• Psychosocial interventions, which may include the psychology treatment such as counselling, cognitive behavioural therapy, etc.
• Re-employment service interventions, which may include resume services, job search workshops and job planning services.
• Worksite treatment.

This might also include mediating worker and employer discussions to resolve challenges and progression planning to resolve them and move the plan forward.

The Traumatic psychological injury program has three levels of treatment and helps facilitate safe, sustainable return to work when a worker has psychological, medical, functional, cognitive and re-employment needs for workers with a traumatic psychological injury.

The standard treatment duration is ten weeks. Extensions between 11 and 30 weeks can be approved by the decision maker when appropriate. Extensions beyond 31 weeks require approval by a health care consultant.

The treatment duration for post-traumatic stress disorder (PTSD) is 12 weeks. Extensions between 13 and 30 weeks can be approved by the decision maker when necessary. Extensions beyond 30 weeks require approval by a health care consultant.

TPI services (level 1) - stand alone - psychological services only:

TPI Services (level 1) is the primary treatment intervention for workers who may be off work due to a traumatic psychological injury and can reach pre-accident employment through therapy. Most workers will return to work following this type of treatment.

Recommended treatments may include:

• Cognitive behavioral therapy
• Cognitive processing therapy
• Eye movement desensitization and reprocessing (EMDR)
• In-vivo systematic desensitization
• Prolonged exposure therapy

TPI services (level 2) - psychological services combined with occupational therapy:

TPI Services (level 2) provides the same services provided by a psychologist as outlined above in level 1, combined with additional treatment by an occupational therapist, which may include:

• In-vivo exposure – supported by psychological counseling if the worker is exposed to a fearful situation, object or activities.
• Work site reintegration. Provision of support and job coaching as worker is returning to work.

TPI program (level 3) - interdisciplinary service interventions:

The TPI program (level 3) is a full interdisciplinary care service for a worker who has multiple barriers to returning to work, such as,

• Multiple physical injuries and/or functional limitations.
• Fear and avoidance issues, significant anxiety or depression.
• Withdrawal or isolation.
• Not responding to or progressing with single service psychology.

A functional status exam must be completed prior to admission to this program.

There are two levels of the interdisciplinary brain injury program to assist workers with recovery and enhancing their quality of life.

Some workers may also participate in re-employment services tailored to their specific needs, although the program is not necessarily the same for return-to-work services.

A brain injury assessment will recommend whether a worker will benefit from this service.

Workers receive information and resources appropriate for their individual needs, learning pace, and level of education to support their rehabilitation.

Rehabilitation services may include,

• Education on the natural progression of recovery and symptom self-management
• Psychological services and cognitive retraining
• Specialized re-employment services
• Physical reconditioning/occupational rehabilitation
• Family support
• Optional professional services, like speech therapy and/or dietary services
• Determining what skills a worker needs to manage ongoing anxiety, pain, depression, and any other ongoing support

The worker may require follow-up services to ensure they continue to improve in both daily living and work. This may include ongoing rehabilitation and re-employment goals and services.

Extensions for these programs can be approved as necessary.

Group 1- Mild Brain Injury/ Concussion Group

The Group 1 - Mild Brain Injury/Concussion Group is typically eight weeks. The primary treatment intervention for workers who have reported a mild brain injury unconfirmed by medical evidence.

The workers in this group will likely return to work following this type of treatment.

Group 2- Mild Complicated, Moderate to Severe Brain Injury Group

The Group 2 – Mild Complicated, Moderate to Severe Brain Injury Group is typically 12 weeks and supports a worker who has sustained a more significant head injury confirmed by the medical evidence.

The provider-site based return-to-work program is appropriate for a worker who has more severe injuries.

The program activities are carried out in the treatment facility. They can also be done virtually, in the worker’s home or be delivered as a hybrid.

The worksite-based return-to-work program is carried out on the employer’s site, excluding the initial assessment, which is done at the treatment provider’s facility.

The recovery activities include modified duties and are determined based on the initial assessment, the results of the medical status exam, the basic functional capacity exam and the required job site responsibilities.

The hybrid-based return-to-work program is a combination of the provider-site based program and the worksite-based program. The worker’s plan includes a combination of modified duties on the job site and attending five treatment days at the treatment provider’s facility within a two-week time frame.

The post-Covid rehabilitation program is for a worker who is still experiencing residual symptoms Covid 19 after recovering from Covid.

Residual symptoms may include:

• Shortness of breath
• Coughing
• Ongoing fatigue
• Heart palpitations
• Joint pain
• Anxiety
• Loss of taste or smell
• “Brain Fog”

The program addresses specific challenges, such as:

• cognitive and psychological
• medical
• functional and musculoskeletal
• re-employment

The program supports the workers safe and sustainable return to work.

The complex return-to-work program is designed for workers who need pain management strategies.

A worker may be referred if their return-to-work barriers are effectively managed in the general program service stream, such as the worksite-based program, but are experiencing issues managing their injury-related pain.

The cumulative psychological injury program supports workers and employers during negotiations to facilitate a safe, sustainable return to work when the worker has experienced a psychological injury and has increased barriers as a result.

The program addresses the worker’s abilities and restrictions in the areas of:

• cognitive and psychological needs
• medical, functional and musculoskeletal status
• re-employment planning and discussions, reintegration and interventions, education, coaching and status review.

The results are used to outline and negotiate a modified work plan and the provision of workplace supports.

This program can be recommended based on a psychological injury screen or as part of the return-to-work referral. Request a medical status exam and/or a functional capacity exam to determine which program is appropriate.

Cumulative psychological injury (CPI) standard program

The cumulative psychological injury standard program is intended for a worker whose condition is acute, yet whose symptoms are mild to moderate and therefore do not require a daily program to support their successful return to work.

Program length

The program duration is up to eight weeks. Authorize extensions up to between nine and thirty weeks as appropriate to support the worker’s recovery and return to work. Refer to all extension requests of thirty-one weeks or more to the health care consultant for approval.

Cumulative psychological injury complex program

The cumulative psychological injury complex program is a full interdisciplinary program and supports a worker who has experienced a psychological injury that is having a more severe impact on their life and ability to return to work.

This might include a worker whose psychological injury is pre-existing or chronic, or a worker who is experiencing social withdrawal or isolation after having been off work for a significant length of time following a psychological injury.

Program length

Authorize up to twelve weeks of the complex program to support the worker’s return to work. Extensions to the program can be approved up to between thirteen and thirty weeks. Refer to all extension requests of thirty-one weeks or more to the health care consultant for approval.