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Medical Review Panels

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(POL 15/2024)

1. The Workers’ Compensation Act, 2013 (the Act) establishes a Medical Review Panel (MRP) as the forum by which injured workers or the deceased worker’s dependants may resolve disputes regarding medical questions related to an injury claim that has been accepted by WCB (Section 59). When possible, a worker or deceased worker’s dependant will be referred to as the applicant in this policy and corresponding procedure.
2. The Workers’ Compensation Board (WCB) has the exclusive jurisdiction to make adjudicative decisions (Section 20). As such, only medical questions related to an accepted area of a work-related injury claim can proceed to an MRP.
3. An MRP is an examination of a worker or a deceased worker’s medical documents which is completed by health care providers who are independent from the WCB.
4. An applicant may request an MRP if they have a genuine medical question regarding a greater debilitating effect of an accepted area of a work-related injury than has been acknowledged by the WCB, and they have exhausted their rights to appeal regarding that same area of injury. The Act sets specific requirements for applicants when requesting an MRP (Section 59).
5. The Act outlines the requirements for the appointment of two chairpersons who are physicians and the selection of specialists or chiropractors for the MRP. (Sections 60(1)(2), 61 and 62).
6. The Act provides the WCB authority to appoint another person as an alternate chairperson when neither of the appointed chairpersons are able or willing to act as the chairperson for an MRP. The alternate chairperson must be appointed in consultation with the Saskatchewan Medical Association and the WCB Board Members interpret this to mean that this person must also be a physician (Section 60(3)).
7. The final certificate of the MRP is binding on the WCB and the applicant who has requested the examination (Sections 63 and 64).
8. The Act recognizes the authority of the Board Members to develop policy directives (Sections 18 and 23).

1. An applicant can request an MRP in relation to an accepted area of a work-related injury claim when they have:
   1. A genuine medical question regarding the greater debilitating effect of the area of a work-related injury than has been accepted by the WCB. The medical question must have arisen from the position taken by the Tribunal in their decision, and
   2. Represented that they:
      1. Suffered a greater functional impairment or limitation in working capacity than that decided by the WCB,
      2. Should be granted compensation for a longer period than allowed by the WCB, or
      3. Received a WCB decision based on an inaccurate or incomplete medical report, and
   3. Exhausted their rights to reconsideration or review of a decision made by the WCB and they have already received a written decision related to a medical question from the Board Appeal Tribunal (Tribunal).
2. Adjudicative issues (i.e., claim acceptance or denial) cannot proceed to an MRP as the WCB has the exclusive jurisdiction to make adjudicative decisions on all injury claims.

Enabling Certificate

3. All requests for an MRP must be completed by a worker or a deceased worker’s dependant or an authorized representative for either party. The request must be made in writing and must specify whether the worker requests the MRP examination be held in Regina or Saskatoon.
4. An enabling certificate completed by a health care provider, either a physician or chiropractor, must accompany the request for an MRP.
5. The health care provider must identify the following in the enabling certificate:
   1. The medical position taken by the WCB that they disagree with,
   2. The specifics about the medical question in the Tribunal’s decision they disagree with, and
   3. The sufficient particulars to define the issue meaning the medical evidence that supports their position.
6. The Tribunal will review the request and the enabling certificate to determine if the legislated requirements for an MRP have been met.
7. The Tribunal will provide a written decision to the applicant outlining whether the MRP examination can proceed. The Tribunal will provide the applicant with an explanation when they have determined an MRP examination cannot proceed.
8. If the Tribunal has determined the MRP can proceed, the pre-injury employer will be notified of the pending MRP.

MRP Chairperson

9. In consultation with the Saskatchewan Medical Association, the WCB will appoint two physicians engaged in the practice of medicine to be chairpersons for MRP examinations. Either appointed physician can be selected as the chairperson when an MRP has been established.
10. The MRP chairpersons hold office for a term of three years and until a successor has been appointed; however, they will also be eligible for reappointment.
11. The WCB, in consultation with the Saskatchewan Medical Association, appoints another physician (an alternate) to act as chairperson when both appointed chairpersons are unable or unwilling to act as chairperson of an MRP. Board Services will ask an alternate chairperson who has been appointed to act as chairperson when neither chairperson can sit on the MRP.

MRP Member Selection

12. In addition to the chairperson, the MRP will be comprised of two health care providers, either two specialists or a specialist and a chiropractor.
13. Board Services will provide the applicant a list or lists of health care providers. The composition of the MRP will be chosen by the applicant based on the list(s) provided.
14. A health care provider with a potential conflict of interest may not be eligible to be a member of the MRP considering the principles of natural justice (i.e., the rule against bias or the perception of bias, and the right to a fair decision). This includes a health care provider who has:
    1. Provided the enabling certificate,
    2. Provided a recorded opinion regarding the medical question stated in the enabling certificate, or
    3. Examined or treated the worker or acted as a consultant in the treatment of the worker.
15. If there is a conflict of interest or a perceived conflict of interest, the Tribunal will make a decision regarding a health care provider’s eligibility as a panel member and ability to perform the assessment without bias or the perception of bias.
16. A health care provider who has repeatedly refused or failed to respond to requests to sit on an MRP may also be excluded from the list(s) provided to the applicant.

Medical Examination

17. The WCB will provide the worker with travel expenses to attend the MRP, if appropriate (POL 05/2023, Travel Expenses – General).

MRP Final Certificate

18. The MRP chairperson will provide WCB with the final certificate as soon as possible after the examination, which outlines:
    1. The condition of the worker,
    2. The fitness of the worker for employment,
    3. Where the worker has been found unfit to work, the cause of that inability to work,
    4. The nature and degree of any limitation in the worker’s capacity to work caused by the work-related injury (e.g., part-time, or full-time, partial, or full duties),
    5. The extent of any permanent functional impairment of the worker caused by the work-related injury based on the American Medical Association Guides to the Evaluation of Permanent Impairment (AMA Guides), and
    6. Any further medical matters that any member of the MRP considers to be relevant to the claim.
19. If the Tribunal determines that the MRP’s final certificate fails to address all of the above stated issues, Board Services will return the certificate to the MRP chairperson for clarification.
20. A complete final certificate is binding on both the applicant and the WCB.
21. The Tribunal will not be bound by opinions or recommendations made in the MRP final certificate that are outside the scope of the disputed medical question that was provided to the health care providers who participated in the MRP (i.e., opinions provided on an area of injury that has not been accepted by the WCB will not be considered by the Tribunal).
22. Within 10 days after Board Services receives the final certificate from the MRP, the Tribunal will provide the applicant a written decision with respect to the matters set out in the final certificate.