Effective date: June 1, 2017
Application: All secondary and tertiary assessment.
Policy subject: Health care services – Providers
To provide guidelines for approving and evaluating secondary and tertiary assessments.
- Upon the Workers’ Compensation Board’s (WCB) approval, a worker entitled to benefits under The Workers’ Compensation Act, 2013 (the “Act”) is also entitled to (Section 103):
- Any medical aid that may be necessary as a result of the injury.
- Any other treatment by a health care professional.
- Any prosthetic or apparatus that may be necessary as a result of the injury, and
- Any travel and sustenance costs associated with receiving medical treatment as a result of the injury.
- The WCB is authorized to determine health care services fees (Section 104).
- The WCB supports the functional rehabilitation model, which allows for assessment and treatment of the injured worker delivered at three levels (i.e., primary, secondary and tertiary) (POL 08/2014, Continuum of Care).
- The functional rehabilitation model incorporates:
- Physical examination.
- Consistency of effort testing, and
- Care provider opinion with the functional testing provided in a basic Functional Capacity Evaluation.
- The functional rehabilitation model ensures a valid opinion for re-employment planning where the worker demonstrates permanent restrictions to their pre-injury job duties.
- Assessment teams accredited by the WCB to complete secondary and tertiary assessments for injured workers can access the following at www.wcbsask.com:
- The Secondary and Tertiary Assessment Team Manual.
- The fee schedule for assessment teams.
- Reporting and billing forms.
The Coalition of Physical Rehabilitation Centres of Saskatchewan and the WCB will negotiate changes to these documents as needed.
- There are three levels of assessment:
The levels progress towards increased program complexity, scope and resources, depending on the needs of the worker.
- A Case Manager (CM) or the worker’s health care provider will notify Medical and Health Care Services (MHCS) if the worker needs a secondary or tertiary assessment team review.
- An assessment team review may be requested if a worker is not working and has no confirmed return-to-work (RTW) date and:
- The expected recovery date has passed.
- A passive treatment plan is in place where active treatment is appropriate.
- A definitive diagnosis has not been achieved and is hindering recovery and RTW planning.
- Significant risk factors for chronic disability have been identified.
- The worker continues in employment but has not returned to full duties and/or full hours after the work injury.
- Psychosocial factors may be hampering recovery and RTW.
- The worker’s recovery has plateaued and there is risk of layoff from work.
Secondary and Tertiary Assessments
- The CM will provide a Job Information Worksheet (JIW) to the worker prior to the assessment. They will advise the worker to complete the JIW with their employer and have it available for the assessment.
- MHCS will make a referral to the first appropriate and available assessment team (i.e., secondary or tertiary) taking into account the:
- Length of time the worker has been away from regular job duties.
- Presence of psychosocial and pain management issues.
- Assessment teams include three to four health care providers (i.e., physician, physical therapist, occupational therapist, chiropractor or psychologist). The team provides a:
- Medical examination.
- Biomechanical examination.
- Functional ability assessment, and
- Psychosocial screen.
MHCS may also request the services of other health care providers (i.e., health care specialists), as required.
- Assessment team reports will be sent to the WCB following an assessment, as follows:
- Secondary assessment teams will submit reports within two working days.
- Tertiary assessment teams will submit reports within four working days. An additional day to report may be given if a specialist was added to the team.
- The JIW and comprehensive reports will be submitted within 10 working days.
- The assessment team report generally includes treatment and RTW plan recommendations, such as:
- If further primary, secondary, tertiary, or other care is required.
- If specialist and diagnostic services should occur at the same time as other treatment.
- The timeline for return to work planning, which may include an immediate return to work.
- If the worker’s condition is preventing a return to the pre-injury job.
- To help the assessment team, MHCS will give the assessment team any medical or other relevant documents from the worker’s file.
- MHCS will implement the assessment team’s recommendations if the primary care provider agrees (PRO 51/2016, Health Care Services – Secondary and Tertiary Treatment).
- MHCS will regularly evaluate secondary and tertiary assessment teams and continued accreditation will be based on:
- Quality assurance evaluations, and
- Performance evaluations.
- Workers can report complaints of any nature to the WCB. The WCB employee receiving the complaint may refer the complaint for resolution to other WCB staff including the Manager of Health Care Services. If the complaint alleges professional incompetence or misconduct by a care provider, the Manager of Health Care Services will direct the complainant to the providers’ professional association. MHCS will note all complaints and resolutions on the service provider’s accreditation file.
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