Document name

Continuum of Care

Document number

POL 03/2024

Continuum of Care Model means a framework for the efficient and coordinated planning and provision of health care and return-to-work plans appropriate to each stage of a worker’s injury and recovery.

Medical aid, also referred to as health care, means “the provision of medical and surgical aid, of hospital and professional nursing services, of chiropractic and other treatment and of prosthetics or apparatus” (Section 2(1)(v) of The Workers’ Compensation Act, 2013 (the “Act”).

1. Under Section 19(1) of the Act, the Workers’ Compensation Board (WCB) has a duty to:
   1. Arrange the provision of any health care or treatment that may be needed because of a work injury.
   2. Arrange to provide rehabilitation to injured workers.
   3. Consult and cooperate with injured workers in the development of rehabilitation plans intended to return them to positions of independence in suitable productive employment.
2. Workers have a legislated responsibility to take all reasonable action to lessen earnings loss resulting from an injury and to co-operate with the WCB in a rehabilitation plan to return the worker to a position of independence in suitable productive employment (Section 51).
3. An employer must co-operate with the WCB and the worker to achieve the worker’s early and safe return to work (Section 53).
4. Saskatchewan human rights legislation requires that all employers make every reasonable effort, short of undue hardship, to accommodate injured workers, and allow them to return to work as soon as medically safe. The Saskatchewan Employment Act also provides job protection to certain employees who are absent from work due to a work injury and outlines employer responsibility to accommodate modified or alternative work duties. 
5. Health care providers examining or treating workers are expected to furnish any reports respecting the examination or treatment of a worker relevant to a work injury that the WCB may require, including recovery and return to work progress reports (Sections 55 and 56).
6. The Early Intervention Program (EIP) model was implemented by the WCB in 1996. The program intended to ensure a worker’s optimal recovery and resumption of normal activities, including work, in the most appropriate, timely and safe manner. The program was renamed Continuum of Care to better reflect the progressive levels of assessment and treatment available to workers.

General Principles

1. The WCB has adopted an integrated partnership model of recovery and return to work with open communication between all partners – the employer, health care providers, the worker, union representative (by the worker’s request) and the WCB. This includes an awareness of the role each plays in achieving the most appropriate, timely and safe return to work.
2. The WCB supports the functional rehabilitation model, including supportive care, that recognizes the importance of returning the worker to functional activities relevant to their life, including return to work, during the recovery period. The functional rehabilitation model encourages health care providers and workers to recognize that successful long-term recovery is associated with return to function, even in the presence of increasing subjective symptoms where there are no objective signs of harm.
3. There are three levels of assessment and treatment in the Continuum of Care model – Level I (primary), Level II (secondary), and Level III (tertiary). The levels graduate towards increased program complexity, scope and resources, depending on the needs of the worker. The goal of the model is to ensure that workers receive the right care at the right time.

Level I Assessment and Treatment (Primary)

4. Level I assessment and treatment begins with the initial diagnosis and medical management by the primary health care provider.
5. Workers choose their primary health care provider and may also choose to see other care providers, with whom the WCB has a relationship agreement, consecutively or concurrently. A referral from a licensed health care provider is required if the other provider is not licensed (e.g., an exercise therapist or massage therapist). POL 18/2016 and PRO 18/2016, Health Care Services, establish the guidelines for the provision of health care services to workers.
6. Where requested by the primary health care provider, the WCB will arrange diagnostic tests, specialist appointments, surgical consultations or treatment interventions, as needed. Where a waiting list exists, the WCB may arrange expedited appointments to ensure timely access to treatment. In-province services will be used unless unavailable within a reasonable period of time (i.e., based on usual treatment availably or specific worker needs).
7. Return to work should be integrated into the treatment plan as soon as possible, preferably with the worker’s first visit to the primary health care provider. POL 08/96, Return-to-Work Plans, applies.
8. The primary health care provider will assess the worker’s condition and may refer the worker to another primary discipline (e.g., occupational or physical therapist) to assist with the development of a list of functional restrictions resulting from the work injury. This list is to be shared with the employer and updated as the worker’s condition changes.
9. A physician, chiropractor, physical therapist, occupational therapist, mental health care provider or nurse practitioner may arrange a functional ability assessment and monitor the worker’s return to work, with the cooperation of the primary health care provider. Where this occurs, progress reports must also be provided to the primary health care provider.
10. Where a work injury results in restrictions that impair a worker’s ability to perform their pre-injury duties, whether or not the employer has a return to work (RTW) program, the WCB will assist the worker and employer with a RTW program that will, to the extent possible, enable a return to suitable productive employment.

Level II (Secondary) and Level III (Tertiary) – Advanced Assessment

11. At any time during treatment, the primary health care provider or WCB may request an advanced assessment when:
    1. There is no active treatment plan.
    2. The worker is not working and has no confirmed RTW date.
    3. Significant risk factors for chronic disability have been identified (see Appendix A).
    4. The expected recovery date has passed (see Appendix B).
    5. The worker continues to work in employment but has not returned to full duties and/or full hours of work after the work as initially anticipated.
12. Assessment teams accredited by the WCB bring together a number of health disciplines to perform an advanced assessment of a worker’s medical, physical, functional and psychosocial condition.
13. The WCB will select the appropriate assessment team based on the length of time the worker has been away from regular job duties or the presence of psychosocial and pain management issues. Additional specialists may be added to the assessment team at the discretion of the WCB. Other assessments requested (e.g., psychological or psychiatric), may be added, as required.
14. The assessment team will confirm a diagnosis and recommend a plan of treatment to assist the health care provider(s). The required reports and recommendation for assessment teams are set out in PRO 14/2023, Health Care Services – Assessment Teams.

Level II (Secondary) and Level III (Tertiary) – Advanced Treatment

15. When the primary health care provider approves the assessment team’s treatment recommendations, they may make a direct referral to a WCB approved treatment centre.
16. To prevent an actual or potential conflict of interest, treatment centres must disclose with the worker any relationships that exist between the care provider(s) and the employer. Treatment centres are required to disclose to the WCB actual or potential conflicts that exist between a care provider, worker and/or employer.
17. Once referred to the treatment centre, the primary care provider will continue to see the worker and monitor progress throughout the treatment program. Other Level I therapies will stop and the recommended treatment will be provided by the Level II or Level III treatment centre.
18. The treatment centre will provide all recommended components of treatment to ensure cohesive health care and re-employment management. When a component of the treatment is not available in the centre (e.g., specialist or vocational services), the WCB will locate an alternate provider for assistance.
19. Workers expected to make a full recovery from the injury and regain the ability to perform the pre-injury job will be referred to Level II treatment. Programs may include: biomechanical treatment, regional conditioning, global conditioning, work simulation, work hardening, psychosocial counselling, ergonomic consultation, education related to the injury and a monitored return to work. Suitable duties and tasks may be arranged with the employer while the worker attends the program.  
20. Workers expected to make a full recovery from the injury but needing more extensive therapy, as well as those with permanent functional restrictions, will be directed to Level III programming. In addition to the physical conditioning at Level II, Level III treatment involves chronic pain management, lifestyle adjustment and stress management. Suitable duties and tasks may be arranged with the employer while the worker attends the program.
21. The worker will be expected to attend Level II or Level III programs up to five days per week. Where the worksite may be used to make functional progressions, less treatment time may be needed.
22. Accreditation, practice standards of care for Level II and Level III clinics are outlined under PRO 13/2023, Health Care Services – Secondary and Tertiary Treatment.