Document name
Medical Review Panels
Document number
POL 18/2010

Effective date: June 2, 2010

Application: All claimants

Policy subject: Reconsiderations and appeals

Purpose:

To establish guidelines for Medical Review Panels.

BACKGROUND

Policy section content
Section detail
  1. Section 60 of The Workers’ Compensation Act, 2013 (the “Act”) establishes a Medical Review Panel as the forum by which injured workers may resolve disputes on medical issues. Medical questions from injured workers will be determined by an independent body of medical practitioners once the internal Workers’ Compensation Board (WCB) appeals process has been exhausted.
  2. Section 59(1) of the Act states that “this section applies if:
    (a)    A worker who claims compensation has:
            (i)    represented to the board that:
                  (A)    the worker suffers a greater functional impairment than that decided by the board;
                  (B)    the worker suffers a greater limitation in working capacity than that decided by the board;
                  (C)    the worker should be granted compensation for a longer period than the period allowed
                           by the board; or
                  (D)    the decision of the board was based on a physician’s report that was erroneous or
                           incomplete; and
            (ii)    exhausted their rights to a reconsideration or review of a decision by the board; or
    (b)    a deceased worker’s dependant who claims compensation has:
            (i)    represented to the board that:
                  (A)    the deceased worker suffered a greater functional impairment than that decided by the
                           board;
                  (B)    the deceased worker suffered a greater limitation in working capacity than that decided by   
                           the board;
                  (C)    the deceased worker should have been granted compensation for a longer period than the 
                           period allowed by the board; or
                  (D)    the decision of the board was based on a physician’s report that was erroneous or
                           incomplete; and
            (ii)    exhausted their rights to a reconsideration or review of a decision by the board.”
  3. Section 59(2) of the Act states that “in the circumstances mentioned in subsection (1), the worker or the deceased worker’s dependant:
    (a)    may in writing request the board to provide for a medical review panel:
            (i)    to examine the worker; or
            (ii)   in the case of a deceased worker, to examine the medical information relating to the deceased
                   worker; and
    (b)    if a written request is made pursuant to clause (a), must specify whether the examination is to be in
            Regina or Saskatoon.”
  4. Section 59(3) of the Act directs that “a written request pursuant to this section must be accompanied by a certificate of a physician or chiropractor that:
    (a)    states that, in their opinion, there is a genuine medical question to be determined;
    (b)    sets out the aspects of the board’s determination of the medical question that the physician or
            chiropractor disagrees with; and
    (c)    provides sufficient particulars of the question to define the matter at issue.”
  5. The Medical Review Panel will not address decisions related to claim adjudication.

POLICY

Policy section content
Section detail
  1. Where the worker or dependant of the deceased worker has exhausted their rights to reconsideration or review of a decision made by the WCB, Section 59(2) of the Act allows the worker or dependant to request a Medical Review Panel.
  2. All requests for Medical Review Panels are to be made in writing, and in accordance with Section 59(3) of the Act, are to be accompanied by a certificate of a physician or chiropractor. The WCB interprets Section 59(3) of the Act to mean the physician or chiropractor must identify the medical position taken by the WCB with which they are in disagreement. In providing sufficient particulars to define the issue, the physician or chiropractor must provide the detailed medical grounds on which the disagreement is based. If required, the attending physician or chiropractor may seek the verbal advice of the WCB’s Medical Officer as to the requirements for a certificate.
  3. Upon receiving the request and certificate, the WCB will determine if the legislated requirements of Section 59(1), 59(2), and 59(3) of the Act have been met. Based on this determination, the injured worker and all interested parties will be provided the WCB’s decision in writing as to whether a Medical Review Panel will be convened.
  4. Once the certificate of a physician or chiropractor has been accepted, the WCB will provide the worker or dependant of the deceased worker a list from which the worker or the said dependant may choose either:
    1. One chiropractor and one specialist in the class of injury for which compensation is being claimed; or
    2. Two specialists in the class of injury for which compensation is being claimed.
  5. The practitioners the worker or dependant of the deceased worker selects and the chairperson (a qualified physician engaged in the practice of general medicine that is, with consultation from the Saskatchewan Medical Association, appointed by the WCB), will constitute the Medical Review Panel.
  6. The names of the practitioners the worker or dependant of the deceased worker selects for the Medical Review Panel must be forwarded to the WCB in writing.
  7. The chairperson will make the necessary arrangements for the Medical Review Panel to examine the worker or the medical information about the worker, in either Regina or Saskatoon. The appropriate travel allowances will be provided for the worker to attend the Medical Review Panel.
  8. Following the examination, the chairperson will provide the WCB with a certificate of decision which states:
    1. The condition of the worker,
    2. The fitness of the worker for employment;
    3. Where the worker is 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 injury in respect of which the worker claims compensation;
    5. The extent of any permanent functional impairment of the worker caused by the injury in respect of which the worker claims compensation; and
    6. Any further medical matters that any member of the Medical Review Panel considers to be pertinent to the claim.
  9. Where the Medical Review Panel’s certificate of decision fails to address all of the above stated issues, the WCB will return the certificate to the Medical Review Panel for clarification.
  10. A complete certificate of decision is binding on both the injured worker and the WCB.

The WCB will not be bound by opinions or recommendations made in the certificate of decision that are outside the scope of the legislated issues or the disputed medical question

Policy references

Policy reference content

Section heading

Act Sec #

Section detail

59, 60, 61, 62, 63, 64, 65

Section heading

Amended

Section detail

01 January 2014. References updated in accordance with The Workers’ Compensation Act, 2013

Section heading

Supersedes

Section detail

POL 20/2001 Medical Review Panels

Section heading

Complements

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