Special services and equipment

A permanently, totally disabled worker may be approved to receive an environmental control unit to meet their vocationalThe equipment is required for re-employment.  The equipment is required for re-employment.and avocationalThe equipment is recommended for activities un-related to employment.  The equipment is recommended for activities un-related to employment.needs. The type of unit purchased may be a battery driven stand-alone unit or require a separate computer unit for operation. The type of unit is determined by the worker's assessed capabilities and needs.

Refer the worker for an assistive technology needs assessment with an authorized Assistive Technology Service provider.

Note: When a worker requests a referral to a service provider not contracted with WCB, contact the designated health care consultant to obtain approval.

This assessment may be completed in conjunction with the computer resource assessment. The provider will submit a report and recommendations may given in areas such as:

• Computers and adaptations, hardware, and software
• Augmentative communication devices
• Adapted electronic toys
• Micro switches
• Environmental controls
• Other technical aids

Review the service providers assessment findings and recommendations including the type of equipment recommended, cost for the equipment and the training requirements. Participate in the assessment case conference and approve the care plan in a timely manner. The decision maker requests approval from the appropriate level of authority when the cost exceeds their authority level (see the Levels of Authority Manual). 

Note:  The provider cannot proceed with the care plan until the decision maker approves the recommendations. 

When the computer and assistive technology services are approved, the service provider will:

• Make recommendations about which computer technology and technical aids are suitable for the worker's needs.
• Loan the worker equipment for a period of up to one-month to determine the suitability.
• Order all approved equipment, supplies and/or services.
• Coordinate implementation and monitor the work.
• Assist with preparing and setting up the equipment for both the assessment and training.
• Provide training on the use of the adaptive equipment.
• Provide a written assessment of the worker's skill and ability to operate the computer equipment, software, and technical aids.
• Follow-up with the worker to assist with troubleshooting and further training on the use of any equipment in the worker's home environment.

Note: Approve up to a maximum of three-months of rental costs for all approved computer peripherals, software and devices per worker.

The provider is pre-approved for up to eight hours of in-home or worksite troubleshooting and extra equipment and software training. Any requests beyond eight hours of service provider support require approval. 
 

Voice recognition technology

Voice recognition technology (VRT) is a software product that enables the user to operate a computer by voice, eliminating the need to use a keyboard or mouse. This tool can be customized to work with most software applications. 

VRT allows an injured worker to operate a computer hands-free and can help a worker recover from a repetitive strain injury by alleviating symptoms.  VRT may increase a worker's job options for re-employment, increase self-esteem and support the worker to remain in control of their environment.

The assistive technology service provider will: 

• Assess, recommend and acquire the most appropriate software at the best market price. 
• Test devices to recommend the most appropriate one for the worker's needs. 
• Deliver customized voice software training to the worker.
• Assist the employer and worker with integrating the technology into the workplace, if appropriate.
• Follow up with the worker to ensure the effective usage and sustainability in the workplace/home.

Repairs

Maintenance and repairs of computers purchased solely for the workplace are the worker's responsibility.

For other assistive technology equipment purchased by the WCB, the provider may provide maintenance or repair on an emergency basis to address health and safety issues up to a maximum of $1000.  Costs over $1000 require approval from the decision maker.

Note:  Review the worker's personal care allowance when the adaptive devices increase their independence. 

A worker may require one or more bathroom aids, to promote safety in bathroom.

The provision of bathroom aids should be based on recommendations from an occupational therapist or community health nurse.   

 Recommended bathroom items may include:

• Bathtub lifts
• Shower commodes
• Bath seats or stools
• Commodes
• Grab bars
• Raised toilet seats
• Telephone showers
• Toilet arm rests
• Shower trolleys  

All recommended bathroom aids must be approved by the decision maker prior to purchase. The decision maker reviews and approves the request based on individual need (e.g., a worker who requires a raised toilet seat following discharge from the hospital).

The special needs coordinator will arrange for purchase and delivery of the recommended equipment.  Some equipment may be rented when it is required on a temporary basis and not available in storage.  

Repairs to bathroom aids may be approved and arranged by the special needs coordinator.

Workers who are incontinent, bedridden long-term and regularly bathed in bed, such as a worker who is quadriplegic and/or uses a respirator as a result of a work-related accident or condition may receive bed linens or towels.  

Approval guidelines

• White bed linens and towels that can be bleached should be considered for purchase.
• Bed linens may be authorized up to a maximum of $150 per year.
• Towels may be authorized up to a maximum of $100 per year.

The approval amounts are a guideline.  If the cost exceeds this amount, consider the reason(s) for the excess cost when making and documenting the decision to approve the purchase of additional bed linens or towels.   

Decrease the number of bed linens and towels accordingly when the worker's need reduces with treatment or time. 

Workers who are immobile for prolonged periods of time and at risk for skin breakdown (e.g., paraplegics, quadriplegics, wheelchair confined or other severely injuredA worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care. workers) may be eligible to receive a bed, mattress, recliner or easy lift chair when medically recommended by the worker's treatment provider or through an assessing clinician or nurse.

The decision maker reviews the recommendation and determines if the non-specialty or specialty bed, recliner or easy lift chair and/or related equipment (e.g., mattresses, mattress overlay, heat, massage or upgraded fabric optionsIn some circumstances, upgrade to a leather-like fabric such as Brisa fabric may be recommended by the occupational therapist for incontinence issues. etc.) is approved or not approved.  Approvals must remain consistent with the existing levels of authority.

Non specialty beds

Non specialty beds (e.g. hospital type beds) may be authorized for paraplegic, quadriplegic and severely injuredA worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care. workers who require special features in a bed as a result of the work-related injury.  Non- specialty beds require a written request from the worker's treating practitioner prior to approval.  An occupational therapy assessment can provide recommendations for non-specialty beds or other supports to reduce skin breakdown.  Prior to purchasing a non-specialty bed, the decision maker may explore other options to alleviate a worker's symptoms (i.e., wedge pillow to elevate the head to relieve breathing issues).

Specialty treatment beds

Specialty treatment beds are for paraplegics, quadriplegics or anyone immobile for prolonged periods of time and at risk for skin breakdown.  Assessment by a wound care nurse or occupational therapist is required prior to approving specialty treatment beds.  

Recliner and easy lift chairs

An occupational therapy assessment can provide recommendations for recliner or easy lift chairs including proper size and fit.  Include a request for a seating assessment on the referral.

Purchase, delivery and set up is arranged by the special needs coordinator. The special needs coordinator works with the vendor to determine the product that will best meet the worker's needs. 

If the cost exceeds the decision maker's authority level, approval is requested from the supervisor.  See the Levels of Authority manual.

The special needs coordinator arranges for the items that meet the worker's prescribed needs to be delivered from storage. If the items are not available in storage, they will order the items from a vendor.

Once the purchase is delivered and in place, contact the wound care nurse or the occupational therapist to arrange a follow-up approximately four-weeks after installation.

Note: Residential modifications may be required to accommodate an oversized bed. Contact the health care consultant responsible for support surfaces for any questions.

Workers may be eligible for a clothing allowance when a worker uses a prosthesis, appliance or a wheelchair as a result of their compensable work injury.  WCB may pay the allowance, on application by the worker, to help replace clothing worn or damaged as a consequence.  See Policy 04-07, Part II, Application 4: Self-Care.

There are three categories of clothing allowance:

• Upper extremity
• Lower extremity 
• Wheelchair 

Determine which category applies based on the prosthesis, appliance, or wheelchair that the worker uses and what clothing has excessive wear and tear. 

In exceptional circumstances, the worker may receive allowances for both the wheelchair and the upper extremity. For example, when the worker is partially confined to a wheelchair and partially able to walk but requires constant use of crutches/forearm crutches to do so. 

Notes:

• The provision of custom-made shoes alone does not qualify the worker for a clothing allowance, unless the worker also meets that criterion, such as a worker who has a brace or prosthesis.
• Consider the worker's gender identification, and any work-related position, when determining the payable clothing allowance amounts. 
• When an annual clothing allowance is payable on a pension or economic loss payment claim, all arrears must be paid before referring the file to the Medical Aid Department.

See Policy 04-07, Part II - Addendum A for clothing allowance rates.

The clothing allowance is paid yearly, usually on the anniversary of the date the prosthesis or appliance was first fitted or the wheelchair supplied. The allowance continues uninterrupted, unless the worker no longer uses the prosthesis, appliance or wheelchair. 

Review yearly for ongoing eligibility.  When no further claim management is required by the decision maker, transfer the claim for monitoring and yearly reviews.

When the clothing allowance is no longer payable, notify the worker and send a letter. Notify the Medical Aid Department to stop the allowance.  See Policy 04-07, Part II, Application 4 - Self-Care to review the criteria for stopping a clothing allowance.

Workers with severe injuriesA worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care. may be at risk for dental problems. Damage or deterioration of a worker's teeth may result from the work-related accident, receiving emergency medical treatment, or the medication prescribed for the compensable injury/condition. 

The WCB pays for dental assessment and cleaning following discharge from hospital or when medically related to the compensable injury/condition. Discuss the results of the assessment with the dental consultant to determine WCB's long-term responsibility. See the 1-1 Initial entitlement decision procedure. 

Note:  WCB may pay for additional travel costs (for dental care unrelated to the claim) if a worker must travel an extra distance to attend the nearest wheelchair accessible dentist.

A worker who does not receive a personal care allowance and, as a result of the workplace injury or condition, is unable to maintain their own personal foot care may be authorized to receive a maximum of up to six visits per-year to a skin care facility. 

If the worker requires more than six visits per year, consider the reasons why more visits are required, and determine whether to authorize additional visits. 

The service provider hired must be appropriate for the service required.  For example, nail care must be done by a podiatrist, a licensed practical nurse (LPN) or a registered nurse (RN) with foot care training. 

A severely injuredA worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care. worker, such as those with spinal cord injuries may benefit from fitness equipment and supervised fitness programs, when it is medically recommended to support their recovery. 

Home exercise equipment

The purchase of home exercise equipment is restricted to paraplegic, quadriplegic, or severely injuredA worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care. workers.

Approval guidelines

Home fitness equipment may be considered for approval when the fitness equipment is: 

• Basic and there is no specialized fitness program within the worker's community.
• Required for a medically prescribed course of treatment.
• Purchased at a reasonable cost.
• Monitored by an individual approved by WCB (e.g., a physical therapist or exercise therapist). 

Supervised fitness and swim passes

A fitness or swim pass is approved initially for a three-month period, starting when the worker is coming to the end of the treatment program or upon discharge.  An extension beyond this period may be approved if it continues to be medically recommended as part of the treatment plan and the worker is using the pass on a consistent basis. The maximum length of time the pass can be extended to is one year. 

Approval guidelines

Fitness passes including swim passes may be considered when:

• The worker has a severe disability, either physical, psychological or both. 
• A medical practitioner recommends swimming or other fitness activities as part of a prescribed course of treatment. 
• The pass is for a swim or fitness facility that provides supervised activities, such as the Steadward Centre for Personal & Physical Achievement. 
• The worker is motivated to attend and has committed to using the fitness or swim pass at least three times per week.
• The pass is economical. 

If all of the above criteria are not met, the fitness or swim pass should not be approved.

A worker with a severe injuryA worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care.   A worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care. may receive a phone, intercom or home safety devices to support their independence for tasks that have become difficult as a result of their compensable injury and to improve their safety. See Policy 04-07, Part II, Application 1 - Communication.

Types of injuries where supports may be needed include:

• Spinal cord injuries resulting in reduced hand function (e.g. a voice activated cell phone supports their independence as they do not have the fine motor hand function to use a regular cell phone).
• A brain injury and the worker needs support with memory and organization.
• Hearing impaired workers may require an amplified or cordless phone.
• Severe vision impairment and the worker requires a device to provide lighting, scanning, magnifying lens. 

An occupational therapy assessment will assist in determining the type of communication aid and/or safety device that will best suit the worker's needs.

Home safety devices may include, but are not limited to:

• Phones such as voice activated cellular phones, cordless phones, or a LifelineA Lifeline is a medical alert system that allows a person to summon help in emergency situations, any time of the day at the press of a button, even if they can't speak.. When a Lifeline is recommended, a monthly plan for the Lifeline is covered. The worker is responsible to set up a monthly plan with the service provider and submit receipts for reimbursement.
• For workers with a compensable mobility issue:
  • Video doorbells or cameras for front and rear door visuals.
  • Intercoms that facilitate front and rear door communication.
• For workers with a compensable hearing impairment:
  • Special fire alarm systems, visual and electronic alarms for compensable hearing impairment
• For workers with a compensable visual impairment (e.g., blindness):
  • Intercoms that facilitate front and rear door communication.
  • Auditory signaling systems or alarms which provide cues to help a person map their environment. For example, emergency warning systems, talking thermostats that will allow the worker to change temperature settings. 
• For workers with a compensable brain injury:
  • A security system to ensure a worker who is prone to wandering away from home and at risk of getting lost (e.g., due to a brain injury, etc.) does not leave home. The home or property must be properly secured (e.g., doors, enclosed patio, fence). The system secures all exterior doors or gates when opened from the inside.  

Stand-alone units that require no major home renovations can be purchased once approved by the decision maker. When major home modifications are required to install the device, the costs and requests for installation must be documented in the home modification proposal. Supervisor approval is required if the costs exceed the decision makers level of authority.

Note: The WCB does not usually approve purchase of fire extinguishers or gas monitors.

Discuss the request with the worker and ask questions about the reason for the safety aid and what type of research they have already done. The type of device approved may vary depending on the compensable disability and need of each individual.

If approved, explain the expenses covered including:

• The cost for the communication aid or safety device. 
• Cellular phones are covered up to a maximum of $1300, including the phone case and screen protectors.
• Monthly phone plans are not included and become the worker's responsibility.
• Monthly LifelineA Lifeline is a medical alert system that allows a person to summon help in emergency situations, any time of the day at the press of a button, even if they can't speak. plans are covered.  The worker is responsible to set up monthly plan with a service provider and submit receipts for reimbursement.
• Home modifications, when required.

Repairs and Replacement

Additional costs covered by WCB include repairs, batteries for normal usage and replacement every 3 to 4 years, when it is still required by the worker. Review the request and the reason for replacing the device and approve, if appropriate. 

Valid reasons may include:

• The worker’s disability will be better addressed by new technology. 
• The worker's level of disability has changed, and a new device will better support them.
• The phone has an issue.

A worker may require one-or-more equipment or aids to promote independence and safety at home as a result of their compensable work injury.  Equipment and aids are recommended to support the worker's functional abilities to self-manage care and household responsibilities, where possible.

Support within the home should be based on recommendations from an occupational therapist or community health nurse.   All recommended equipment and aids must be approved by the decision maker prior to purchase. The decision maker reviews and approves the request based on individual need.

Kitchen, household aids and equipment

Housekeeping, kitchen or household aids, including gripping and adaptive aids, may be authorized by the decision maker when required to support a worker's functional needs. 

Examples:

A worker may receive a long handled reacher to assist them when they cannot bend or reach high or low levels, as a result of the work-related injury or condition.

A worker may receive adaptive devices for eating, such as specialty cutlery, cups, dishes, matting, bibs, etc., when they require assistance holding and/or manipulating utensils.

Dressing aids

Dressing aids can improve a worker's independence for dressing themselves and reducing support required from a caregiver. There are many different types of dressing aids including dressing sticks, sock aids and long handled shoehorns, button hooks, zip pullers, reaching and grabbing tools.

Once approved, the specialist needs coordinator will arrange for purchase and delivery of the recommended aids and/or equipment. When a worker has purchased items on their own, the decision maker documents whether the item is approved or not approved. The medical aid team will reimburse the worker based on the receipts received.

Repairs to kitchen and household aids may be approved and arranged by the special needs coordinator.

Note:  Recommended aids and equipment may improve the worker's ability to manage activities of daily living and reduce the personal care allowance (PCA) level.  Decision makers should review the PCA level following receipt of equipment and aids.

Meals on Wheels is a program that delivers meals to individuals at home. A worker may be approved to receive meal service when they are unable prepare and cook meals for themselves due to a work-related injury.

To determine the worker's eligibility for a meal delivery program, the decision maker will consider whether the worker is in receipt of a personal care allowance level that covers meal preparation.  When the worker is not in receipt of this allowance, the decision maker will consider authorizing this service.

The WCB provides a worker with medical supplies, such as those required for bowel routines, catheterization, etc., in a reasonable quantity to ensure the health and safety of the worker.

Supplies may include include:

• Incontinence supplies
• Laryngeal supplies
• Meal replacement supplements
   

Consider the unique needs of each individual worker to determine what is considered a reasonable quantity. Lifetime authorization can be provided

Paraplegic, quadriplegic and severely injuredA worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care. workers may receive miscellaneous items to support their independence and quality of life. Consider each circumstance on an individual basis before authorizing the purchase. These items must be medically recommended through the worker's treatment provider or through an assessment (e.g. occupational therapist). 

Items include:

• Pressure relief equipment, such as heel and elbow pads.
• Specialized mattress to replace a regular mattress. 
• Electric toothbrush or waterpick, etc. 
• Lift chairs.
• Portable patient lifts.
• Transfer aids, such as a trapeze, sask-a-poles or transfer boards.
• Alternate power source, such as a generator for respirators, airbeds or ceiling lifts.

The WCB will not be responsible for:

• Community association membership fees that are common to the general population and are unrelated to the disability. 
• Baby-sitting services while the worker engages in recreational activities.
• Insurance premiums for home, vehicle, life, Alberta Health, Blue Cross, etc.
• Education or health costs for the worker's children unless eligible due to fatality adjudication (a parent was fatally injured at work and the child qualifies for education and health costs under the claim).

The worker's treating physician may recommend non-prescription drugs or substances. Discuss the request to cover these costs with the medical consultant.  

A car seat support increases the worker's comfort and ability to function. In most cases the worker should be using the car seat support for both personal and work use. 

The written or verbal request for a car seat support may come from the insured, employer, worker or treating practitioner. 

Approve the request before the purchase can be made. For workers who do not live in Edmonton or the surrounding area, consider the most cost-effective way to purchase the car seat support.

The special needs coordinator will arrange purchase and delivery, once approved.

In most cases the seat is provided on a one-time-only basis. Send a letter advising the worker of the conditions for authorizing the car seat support and that they are responsible for the repair, maintenance and replacement. 

The worker may receive items, equipment and supports to assist with the treatment of a psychological injury when recommended by their treating psychologist or a clinician from a psychological injury treatment program. 

Recommended items may include grounding tools such as thera-tappers and fidgets, noise cancelling headphones and weighted blankets.  

The treating psychologist or clinician may also recommend a heart rate monitor, such as a Fitbit or other brand of fitness tracker, to a worker during exposure therapy for traumatic psychological injury. Heart rate monitors add objective and measurable evidence of what the worker is physiologically experiencing during exposure therapy.

Approval Guidelines

• No formal documentation is needed from the provider and only verbal approval is required from the decision maker.
• Items and equipment purchases are approved on a one-time basis. 
• Noise-cancelling headphones may be reimbursed up to a $100 maximum.
• Weighted blankets may be reimbursed up to a $150 maximum.
• Fitbit monitors (or other brand of fitness tracker) must include a heart rate monitor and may be reimbursed up to a $300 maximum.  A member from the treatment team may purchase the monitor and submit the invoice for billing or the worker can submit a receipt for reimbursement.
• Grounding tools, such as thera-tappers and fidgets, should be cost effective. 
• WCB is not responsible for repairs, replacements, etc.

A receipt is required to confirm that the worker purchased the recommended item(s). Originals are not required.

Self Defense Course

A self-defense course or program may be recommended by the treating psychologist or clinician to assist a worker in their recovery from a psychological injury if the injury resulted from being physically assaulted or threatened.

Consider the recommendation on a case-by-case basis. In most cases, the treatment provider will recommend a specific course.

Therapies that improve an injured worker's quality of life and activities, such as massage, life coaching, art, etc., may be considered for severe injuries and diseasesA worker is considered severely injured when: a) because of the compensable injury, the worker has severe and prolonged functional limitations; and b) because of those functional limitations, needs temporary or permanent assistance with communication, mobility, or self-care. , such as a significant brain injury, spinal cord injuries, severe burns and cancers.

Therapy must be medically recommended through a treatment provider or an assessment (e.g., an occupational therapy assessment, brain injury assessment, etc.).

The decision maker must approve the therapy before it is purchased.

TENS is a modality used to control pain by applying electrical stimulation via skin electrodes over or around the painful body part.

The TENS program is cancelled for new clients effective July 1, 2007. The TENS program is only available for workers who were using a WCB provided TENS machine prior to or on June 30, 2007.The WCB continues to pay for TENS supplies for these workers, as required.

The decision maker may authorize ongoing operational TENS supplies (electrodes, gel, wires, etc.) beyond those originally approved by the provider without further assessment. Review the provider's report for the recommended frequency for supplies (e.g., six months, one year, two years, lifetime).

Unit replacements may be considered. In these cases, arrange for the worker to be reassessed to determine if the response to a unit remains favorable. Send the referral for the re-assessment to Millard Health. 

Wheelchairs may be approved for temporary or permanent use. Permanent wheelchairs are only approved for paraplegic, quadriplegic and seriously injuredSerious injuries may result in temporary or permanent disability. Examples of serious injuries may include: rotator cuff tears, ruptured discs, serious ankle/wrist fractures, serious knee injuries (e.g., torn ACL), and any other injuries of similar seriousness. It would not include most soft tissue injuries unless it is of unusual severity (e.g., bilateral severe epicondylitis, multiple hernia surgeries, etc.). workers.

The type of wheelchair or scooter must be consistent with the worker's specific needs. A referral to a seating specialist is necessary to make recommendations on seating needs, balance, mobility needs, terrain and storage of equipment. The health care consultant responsible for occupational therapy can assist in choosing a consultant to assess the worker's seating needs.

Contact the special needs coordinator before arranging a rental wheelchair or purchasing a wheelchair.  The special needs coordinator will select a wheelchair or scooter that meets the worker's prescribed needs and may use wheelchairs and scooters currently in storage for temporary use.
 

Note: The WCB does not pay for wheelchair deposits on rental chairs.

Approval guidelines

• One wheelchair is generally purchased while the worker is still in the hospital and a second wheelchair or scooter is purchased within the first 6 months of the injury. The purchase of the second wheelchair is to provide mobility at all times.
• Eligibility for a scooter is dependent on the need of an electric wheelchair for terrain, seating needs, etc.  Upgrades to scooters are not approved.
• A cover for the outdoor wheelchair or scooter is payable. Storage buildingsA storage building may be considered in some circumstance (i.e., to prevent batteries from freezing up/draining in the winter). are not normally approved but may be considered on a case by case basis. 
• All durable medical equipment remain the property of the WCB. The special needs coordinator repairs and maintains all durable medical equipment, including wheelchairs and scooters. Approval for repairs is not required from the decision maker.
• Payment requests over $5000 requires supervisor approval.
• Repairs may require a cost breakdown before the payment is authorized.  Vendors selling the equipment complete the repairs (e.g. replacing tires, tubes, upholstery, etc.).
• Replacement wheelchairs or scooters requires approval. The special needs coordinator notifies the decision maker when there is a request to replace a wheelchair or scooter.

Special needs coordinator documents the wheelchair or scooter specifications on the claim file, arranges for delivery, and monitors all maintenance and repairs to the wheelchairs or scooters. 

Special needs coordinator consults with the decision maker in all cases where the worker is not happy with the style, model or specifications of the wheelchair or scooter.

Note:  Advise the residential modification consultant the worker will be receiving a wheelchair in order to coordinate any needed modifications to the worker's home. 

Wheelchair and scooter aids

When the worker requires aids to assist with the use and operation of their wheelchair or scooter, the following items may be approved:  

• Arm rests
• Cushions
• Trays
• Vehicle liftsA vehicle lift helps load a mobility aid (wheelchair or scooter) independently into a vehicle when a worker is unable to do so on their own. or trailers for scooters supplied in place of wheelchairs 

The special needs coordinator arranges for the purchase and delivery of the above items. 

Vehicle Assessment 

A vehicle assessment should be considered for workers approved for a permanent wheelchair or scooter.  A vehicle assessment is completed by an occupational therapist to determine:

• The worker's ability to transfer independently by manual wheelchair (at least four transfers)
• Need for a power wheelchair.
• Whether vehicle modifications are recommended for safe transfers or whether a new vehicle purchase would better suit the worker's needs.

Contact the health care consultant responsible for Occupational Therapy when there are questions about vehicle modifications needed to accommodate a worker's wheelchair. 

Service dogs are considered a type of medical aid to help workers following their workplace injury do tasks they are unable to do because of their compensable disability.  Disability types include mobility limitations, psychological injuries, hearing impairments, etc. 

For workers with a psychological injury, a service dog can orient them into the present moment using tactile stimulation, alert the worker if their level of anxiety increases, or wake them up if they are having nightmares.

Effective January 1, 2019, the WCB may cover the costs of a service dog when the worker meets the criteria, and the dog is certified by the Government of Alberta (GOA).  This date does not apply to guide dogsGuide dogs (also known as "seeing-eye dogs") are specially trained to help people who are sight impaired. .

For sight impaired workers, entitlement for a guide (i.e., seeing eye) dog is considered under Policy 04-07, Application 4 - Communication. For these workers, the CNIB (if involved) may connect them with a guide dog provider. 

The decision of whether a dog is qualified to be a service dog is not made by the decision maker; it is made by the GOA's Service Dog Licensing department.  The decision maker determines if the worker needs a service dog because of their compensable injury and whether the costs for the service dog will be paid for by the WCB.

Service dogs will generally be approved by the Special Care Services teams. All reviews to consider a service dog must have a consultation with a Psychological Injury Coach before proceeding.

Criteria for coverage of a service dog

For WCB to consider paying the costs of a service dog, the following criteria must be met: 

• The worker has a work-related condition, which has led to a disability that requires a service dog to help with tasks related to that disability. 
• There is a confirmed medical requirement and recommendation indicating a need for a service dog due to their compensable condition and disability. This medical recommendation must be submitted in writing by the worker's family physician, psychiatrist or psychologist. 
• The dog meets the conditions outlined in Alberta's Service Dogs Qualification Regulations, section 1(1).
   

A worker may obtain a service dog by either:

• Purchasing a pre-qualified service dog from an approved service dog organization, or
• Having their dog (or a dog they have bought from an organization not recognized in Alberta) undergo a Service Dog Qualification Assessment.  When a dog is not purchased from an approved service dog provider, payment is not issued until the dog is granted an Alberta Service Dog Identification card. 

In some cases, an accredited out-of-province or out-of-country dog provider organization may be the best option, based on availability or specialized training needed.

If a service dog is pre-qualified in Nova Scotia or British Columbia these dogs would meet the conditions outlined in Alberta’s Service Dogs Qualification Regulations. As noted on the GOA website, both of these provinces training standards are equivalent to the Alberta Training Standards and are accepted in Alberta. An Alberta Service Dog Identification card would not be required, if they have a similar card issued by the government in either of these provinces. Payment would not be made until the dog is granted the identification card by that province. 

Notes:

• Emotional support and therapy dogs are not considered service dogs under Alberta's Service Dogs Act and Regulations.
• For non-sight-impaired workers, coverage for service dogs is considered a type of medical aid given under Policy 04-06, Application 1 - Heath Care. 

Guide Dogs

Guide dogs are specially trained to help people who are sight impaired. The Government of Alberta (GOA) requires that both types of dogs qualify under Alberta Legislation.  

For sight impaired workers, entitlement for a guide (i.e., seeing eye) dog is considered under Policy 04-07, Application 4 - Communication. For these workers, the CNIB (if involved) may connect them with a guide dog provider. 

The decision maker determines if the worker meets the policy criteria for a guide dog and must ensure the provider is accredited before approving (see Alberta's Guide Dogs Qualification Regulation). The coverage of costs is generally the same as for service dogs. Costs exceeding the amounts listed, may be paid depending on the reasons (e.g., guide dogs require more training). 

Call the worker to discuss the request and the process for approving a service dog.

Discuss the following information:

• The criteria that must be met to qualify for coverage of a service dog. Refer to the key information section for eligibility criteria.
• The worker is responsible to apply to have the service dog licensed through the Government of Alberta (or British Columbia or of Nova Scotia) (Family and Social Supports/ People with Disabilities/Service Dog program). 
• WCB does not participate in or guide any part of the training or certification process. Refer the worker to the GOA's website for information and a list of accredited service dog provider organizations.  This applies to a pre-qualified dog, their own dog or a dog purchased from an organization not recognized in Alberta.
• Confirm where the worker is in the application process. The process for obtaining a service dog can take up to 2 years.
• If the worker's physician or psychologist has completed a Government of Alberta medical recommendation for a service dog they can submit a copy of it for the written medical recommendation.
• Explain the expenses that are covered and that the process for obtaining a service dog can take up to two years. See Expenses Covered below. 

Covered expenses 

If a service dog is approved for the worker, the initial cost to purchase a licensed service dog up to a maximum of $35,000 is covered.  

Note:   If an existing dog fails to achieve certification, expenses related to that dog will not be covered. 

Effective January 1, 2024, annual maintenance costs are paid at a rate of $2000 to cover expenses such as food, routine veterinarian care, etc. This amount is based on the Calgary Humane Society's estimate (excluding vacation costs) for 2 weeks of dog care and is based on how much it costs to own a dog in Alberta.

Note:  For service dogs purchased prior to January 1, 2024, yearly maintenance costs are covered to a maximum rate of $1400.

Coverage for pet health insurance may be considered when:

• The dog is pre-qualified or has an Alberta Service Identification Card. 
• The worker submits 3 quotes for the insurance cost and provides receipts for reimbursement.
   

Send a letter confirming the discussion and that payment cannot be issued until all the criteria are met. 

 Determine whether the worker meets the eligibility criteria.  Refer to the key information section for eligibility criteria.

Review the Anderson Service Dog Prescriber Guidelines 2.0 (bcandalbertaguidedogs.com) for assistance in determining if a service dog is required for the worker's compensable injury and to determine if the worker has any contraindications for owning a dog (e.g. substance abuse, history of abusive behavior, active psychosis, inability to interact with a dog using humane methods, etc.)

Once the information is confirmed, consult with a Psychological Injury Coach prior to approving a service dog.  When the service dog is not being approved, consultation is not required.  End this procedure.

Note:  Refer to Policy 04-07, Application 4 - Communication and the 1-1 Initial entitlement decision procedure to determine entitlement for a guide (seeing-eye) dog.

Send the recommendation and rationale to the supervisor for approval or pre-approval of the service dog.

For pre-qualified dogs include the status of the application process (applied or approved).

For a worker's own dog or one bought from an organization not recognized in Alberta, request pre-approval for the service dog.  The claim will need to be reviewed by the supervisor for final approval once the Service Dog Identification Card is received.

Review the supervisor's recommendations and contact the worker to discuss the decision (approval, pre-approval, or not approved).  Explain the facts and reason for the decision. Communicate the decision in writing.

Monitor the claim for the worker to obtain the service dog or for receipt of the Alberta Service Dog Identification Card.  When no further claim management is required by the decision maker transfer the claim to a case assistant and request that they monitor:

• Where the worker is in the process of obtaining a service dog or having their own dog or a dog from an organization not recognized in Alberta assessed.  
• For the worker to submit three quotes for Pet Health Insurance, just prior to obtaining the service dog or submitting the Alberta Service Dog Identification Card
   

When the worker is approved, determine how they will be acquiring the dog. 

Acquiring the service dog

The worker can:

1. Purchase a pre-qualified service dog from an approved service dog organization.
    
2. The worker can have their own dog or a dog they have bought from an organization not recognized in Alberta undergo a Service Dog Qualification Assessment.

When the worker wants their own dog certified, they must apply to the Government of Alberta's Service Dog Licensing department for a decision about whether a dog is qualified to be a service dog. 

The worker receives reimbursement only after the dog undergoes the assessment is granted an Alberta Service Dog Identification Card. 

In some cases, an accredited out-of-province or out-of-country dog provider organization may be the best option, based on availability or specialized training needed. 

Note: If the worker's own dog or dog they bought from an organization not recognized in Alberta fails to achieve certification, WCB cannot reimburse for the costs related to that animal.

When the worker is not approved, share the outcome, explaining any facts or rationale that led to the decision and whether they may be approved in the future. Send the appropriate letter outlining the details of the discussion. 

Once the service dog is received, action the claim as appropriate based on the type of approval process the service dog underwent.

Pre-qualified service dog

When the service dog comes from an approved provider the provider requires the money up front to proceed with the purchase and training of a service dog.  

Notify medical aid to pay for the quotes or receipts received including service dog purchase and training, pet health insurance, and the annual dog maintenance payment for the remainder of that year (if purchased in the middle of year, the annual payment is pro-rated).   

Worker's dog or a dog purchased from an organization not recognized in Alberta

When the worker has the dog successfully certified by the Government of Alberta, British Columbia or Nova Scotia and the Service Dog Identification Card is received, obtain final approval for the service dog from to the supervisor. 

Once final approval is received, notify medical aid to pay for the cost of the dog or certification, pet health insurance (quotes and receipt on file) and annual dog maintenance payment for the remainder of that year.

When no further claim management is required, transfer the claim for annual reviews.  At the annual review date, call the worker to ensure everything is going well with the service dog.  Address any issues/concerns reported by the worker. Continue to pay annual maintenance costs and reimbursement for pet health insurance (when receipt is submitted).

A worker may be eligible for home oxygen approval when it is medically prescribed by a requesting physician or nurse practitioner and the need for supplemental oxygen relates to the worker's compensable injury/condition.

Review the prescription submitted by the physician or a nurse practitioner for supplemental home oxygen and determine if the worker's need for oxygen is related to the compensable injury or medical condition.  

Consider a referral to a medical consultant for a medical opinion if assistance is required to determine if the need for oxygen is due to the accepted injury or medical condition.

Note:  If the request comes from a source other than the requesting physician or nurse practitioner (e.g. respiratory therapist, authorized nurse, treating physician, the worker, etc.), advise that the request cannot be approved until a written prescription is received. When the service provider has a copy of the prescription, request it be submitted to the claim for consideration.

Determine if the oxygen is approved or not approved.

When oxygen is not approved, call the worker to discuss the decision and rationale.  Communicate the decision in writing.

When oxygen is approved, call the service provider to arrange a referral for a respiratory assessment, if not already completed.  

Call the worker to discuss the decision and the referral for a respiratory assessment. Explain that the assessment will include assessing vital signs, breathing patterns and how well the lungs are working.  Following the assessment, the respiratory therapist will provide recommendations for supplemental oxygen.  

Note: In some cases, the worker may already have been referred to a service provider by their treatment provider.

Review the respiratory assessment results along with their recommendation for oxygen equipment, supplies, and the estimated cost of services.  A medical consultant can assist with interpreting respiratory assessment results and recommendations.

Refer to the Alberta Aids to Daily Living (AADL) guidelines when determining reasonable costs for respiratory equipment.

Send a letter to the oxygen service provider outlining the following:

• The approved oxygen equipment, supplies, and the duration for coverage. Recommended equipment and supplies may include:
  • Stationary concentrator
  • Portable concentrator
  • Nasal cannula and tubing
  • Face mask
  • Humidifier
  • Nasal lubricants
• Who is responsible for repairs, replacement and maintenance of the oxygen and related equipment.  

Note:  The oxygen provider is responsible for repairs, replacement and maintenance of all rented oxygen equipment.  Purchased equipment would be the responsibility of the WCB.  The decision maker considers the option that is most cost effective when determining approval.

Call the worker 4-6 weeks after receiving the equipment and confirm if they have any questions or concerns.  Arrange a follow-up assessment with the provider, is required.

Transfer the claim to a case assistant for monitoring when no further claim management is required by the decision maker.  The case assistant will monitor the invoices for oxygen to confirm they remain consistent and the worker's oxygen needs have not changed.  

The case assistant will arrange for yearly reviews or follow-up sooner, if required.

Assign the claim back to the decision maker when:

• The worker's oxygen levels, or equipment needs have changed.
• There are concerns with the invoices (e.g. inconsistency in the billed amounts)
• The worker has been hospitalized.
• The worker is travelling out of province and requires supplemental oxygen in another province.

When the oxygen needs have changed, the decision maker determines if the changes are related to the worker injury/condition.  Consider obtaining an opinion from a medical consultant or arranging further assessment, if not already done.  Return to step 2.

Monitoring continues until the worker no longer requires supplemental oxygen.

When a worker is receiving supplemental home oxygen and is hospitalized, the decision maker determines whether to temporarily or permanently discontinue oxygen delivery.

When a worker is admitted to a hospital on a temporary basis, determine whether the oxygen delivery should be temporarily stopped. For stays that extend beyond a four-week period, oxygen delivery is to be temporarily stopped (either the Case Manager or the designated family member can stop the service).

To determine whether oxygen should continue or end, consider the following:

• When a worker is confined to a hospital/institution on a permanent basis, discontinue the approval for oxygen. 
• When a worker is admitted to a hospital on a temporary basis, determine whether the oxygen delivery should be temporarily stopped. For stays that extend beyond a four-week period, oxygen delivery is to be temporarily stopped (either the decision maker or the designated family member can stop the service). Once a discharge date is confirmed, WCB must ensure that oxygen delivery is reinstated.

Once oxygen is reinstated, return to step 3.

Oxygen for Out of Province Travel

When the worker advises that they will be leaving the province, review their request for oxygen at a second out-of-province residence. 

Obtain details about their travel:

• The reason for the trip, such as a death in the family, board directed appointment, vacation, etc.
• The length of the trip.
• The date the worker is leaving and returning.
• The worker has obtained medical clearance from their treating doctor confirming travel is medically approved and there are no health risks with travel, such as flying. 

If the travel period is not approved, notify the worker, explaining the reasons for the decision and send a letter outlining the conversation. End this procedure.

When the trip is reasonable, determine the length of time the worker will be gone and contact them to share the decision. Send a letter to the worker and the Alberta oxygen provider and include the following information based on the length of time the worker will be travelling. 

Travel less than two months:  

• The worker will continue to receive oxygen in Alberta. 
• The equivalent Alberta monthly rate (to be determined by contacting the Alberta provider) will be issued directly to the worker to cover the costs in the second residence.
• The worker will be responsible for setting up oxygen services at the secondary location.
• The worker is responsible for any amount over the Alberta average monthly rate for oxygen and supplies.

Arrange for the worker to receive a monthly payment directly for oxygen and supplies for the period of travel. Specify the date the payment is released. 

Contact the Alberta oxygen vendor two weeks prior to the worker's return and arrange services to start again when the worker's travel is less than two-months. Return to step 3 to continue monitoring.

Travel greater than two months:

• The Alberta rental equipment will be cancelled for the period that the worker is away.
• The average Alberta monthly rate (to be determined by contacting the Alberta provider) will be issued directly to the worker.
• The worker is responsible for setting up oxygen services at the secondary location.
• The worker is responsible for any amount for oxygen and supplies over the Alberta average monthly rate.  
• The worker will be responsible for calling to have services started again prior to returning to Alberta.
• The worker is travelling with a portable unit and additional batteries may be required, when necessary due to the length and mode of travel. Typically, the worker needs up to a maximum of four batteries.

Return to step 3 to continue monitoring.