Document name
Medical Review Panels
Document number
(PRO 02/2023)

Effective date: April 1, 2023

Application: Applies to claimants who have an accepted WCB claim or their dependants, who have exhausted their rights to appeal and have a valid medical question with which they disagree.

Policy subject: Reconsiderations and appeals

Purpose:

To establish processes for medical review panels.

BACKGROUND

Policy section content
Section detail
  1. POL 02/2023, Medical review panels, establishes guidelines for medical review panels.
  2. A Medical Review Panel is a medical assessment completed by a panel of physicians/chiropractors who are independent from the WCB.
  3. All procedures for medical review panels are the responsibility of the Board Services Department. The following procedure provides guidance for the implementation of the policy.

PROCEDURE

Policy section content
Section detail
  1. Who can request a Medical Review Panel (MRP)?
    1. A worker or deceased worker’s dependant with an accepted WCB claim may request an MRP related to that accepted claim if they have exhausted their rights to appeal (i.e., they have received a related decision from the Board Appeal Tribunal) and have represented to the board that they:
      1. Have 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.
      3. Received a WCB decision based on an inaccurate or incomplete medical report, or
      4. Any combination of the reasons listed above.
    2. If a worker or deceased worker’s dependant chooses to appoint a representative, they must submit an Authorization Letter of Representation (WREP) form to the WCB.
  2. How can a worker or dependant request an MRP?
    1. To request an MRP, the worker, deceased worker’s dependant, or their representative must submit a written request stating the reason(s) that apply to the worker’s claim and specifying whether they want the examination to occur in Regina or Saskatoon. The application form (WRMP) can be requested from Board Services.
    2. A physician or chiropractor must complete an enabling certificate (ECMRP), which can be found on the WCB website.

Enabling Certificate

  1. What information is required for the enabling certificate?
    1. The physician or chiropractor must provide in the enabling certificate:
      1. The medical position taken by the WCB they disagree with.
      2. The specifics about the medical question in the Board Appeal Tribunal decision they disagree with, and
      3. The sufficient particulars to define the issue, which include, but are not limited to:
        1. Medical evidence, and
        2. Reasons supporting their medical conclusion, which can include either medical literature supporting the position being advanced or the supporting opinion of another physician.
    2. The physician or chiropractor may request advice from the WCB’s Chief Medical Officer (CMO) on the requirements for a certificate by contacting the WCB.
    3. Fees charged by a physician or chiropractor for completing the enabling certificate will be reimbursed by Medical Accounts upon submission of an invoice. Fee codes 177 (GP), 178 (specialist) and 406 (chiropractor) would be applicable, at the rate outlined in the fee schedule in place on the date the certificate was completed.

MRP Chairperson

  1. What is the process for appointing an MRP chairperson?
    1. In consultation with the Saskatchewan Medical Association (SMA), Board Services will appoint a chairperson who is:
      1. A resident of Regina or Saskatoon.
      2. A physician engaged in the general practice of medicine.
    2. The MRP chairperson will be appointed for a term of three years and until a successor is appointed, and will be eligible for reappointment.
    3. Board Services will provide an orientation to each new chairperson of the MRP.
  2. Can Board Services appoint an alternate chairperson?
    1. If the MRP chairperson is unable or unwilling to participate in a specific MRP, Board Services will appoint another MRP chairperson in consultation with the SMA.
    2. Board Services has the ability to secure more than one alternate for Regina and Saskatoon to ensure that there are chairpersons available to sit on an MRP.
    3. Board Services will review the eligibility (e.g., place of residence) of appointed chairperson(s) and alternates every three years.

MRP Member Selection

  1. What is the process for selecting MRP members?
    1. Board Services will contact the CMO to obtain a list(s) of medical practitioners within Regina or Saskatoon, based on their expertise in dealing with the class(es) of injury (e.g., musculoskeletal, psychological, neurological) under review.
    2. Board Services will provide the list(s) to the worker, or deceased worker’s dependant, or their representative, and request that they indicate in writing the names of the two medical practitioners they have chosen from the list(s). They may choose:
      1. One chiropractor and one specialist, or
      2. Two specialists.
    3. To avoid delays, Board Services will allow workers to provide their top four choices of specialists or chiropractors. The worker or deceased worker’s dependant will be asked to rank them in the order of their preference.
    4. Board Services will contact the specialists or chiropractor based on the order of preference provided to advise that the worker or deceased worker’s dependant has chosen them to be part of the panel and will request their participation in the MRP.
    5. Board Services will request a response from the selected specialists or chiropractor within two weeks. Follow up will be made by Board Services to a maximum of three times, and if there is still no response, Board Services will move on to the worker’s next choice of specialists or chiropractor to avoid further delays in arranging the worker’s MRP.
    6. If Board Services has already received a refusal from all of the worker’s or deceased worker’s dependant’s first four choices, Board Services will contact the worker to ask that additional physicians or chiropractors be chosen following the steps outlined in subpoints b, c and d above.
    7. If there is no available specialist with the required expertise or chiropractor in the location specified by the worker or deceased worker’s dependant, panel members may be invited to participate from the alternate location (i.e., if the worker or deceased worker’s dependant had chosen Regina for the MRP but there are no specialists or chiropractors available in Regina, the lists of specialists and chiropractors for Saskatoon can be provided).
    8. A medical practitioner with a potential conflict of interest is not eligible to be part of the MRP. This includes a physician or chiropractor who has:
      1. Provided the enabling certificate.
      2. Provided a recorded opinion regarding the medical question stated in the enabling certificate.
      If there is a conflict of interest or a perceived conflict of interest, the Board Appeal Tribunal will make a decision regarding a medical practitioner’s eligibility as a panel member and ability to perform the assessment without bias or the perception of bias.

MRP Examination

  1. Can the examination be done virtually?
    1. It is recommended that the MRP examination is done in-person. However, if a virtual examination must occur, at least one panel member must be physically present to examine the worker. The other panel member may participate virtually and should be able to observe the examination via video. Teleconferences will not suffice for the purpose of the MRP.
    2. As the chairperson’s (or alternate) primary role is to facilitate and mediate the panel’s discussion, the MRP chairperson may participate in the examination virtually via video.
    3. If the MRP is for a deceased worker where a physical examination cannot be done, the medical documentation can be examined virtually via video or teleconference.

MRP Final Certificate

  1. What information does Board Services require in the final certificate of decision from the Panel?
    1. After the examination of the worker or after review of the deceased worker’s medical information, the chairperson of the MRP will certify in writing the decision of the panel and send that certified decision to Board Services.
    2. Point 17 of POL 02/2023, Medical review panels, outlines what the WCB requires in the MRP final certificate.
  2. What if Board Services requests clarification from the MRP?
    1. If the MRP final certificate of decision fails to address all of the issues outlined in Point 17 of POL 02/2023, Board Services may request written clarification from the MRP chairperson. A copy of the written request will be forwarded to the worker, the dependant of the deceased worker, or their representative.
    2. When requesting clarification of the MRP’s decision, Board Services will not provide any new information to the MRP.
    3. If amendments to the final certificate are required, the MRP chairperson must provide Board Services with an amended certificate with the initials of each panel member or a written correspondence confirming agreement to the amendments by all panel members.  
    4. If the final certificate requires significant changes, the amended copies must be signed by all members of the MRP. A copy of the amended decision will be provided to the worker, the dependant of the deceased worker, or their representative.
  3. When is the MRP’s decision provided to the worker or deceased worker’s dependant?
    1. Once WCB has received the certified decision from the MRP, Board Services will provide the worker or deceased worker's dependant the decision from the Board Appeal Tribunal with respect to the matters set out in the certificate within 10 days. Board Services will include a copy of the Panel’s report with the decision. A decision may be delayed if clarification is requested from the MRP as per point 9 of this procedure.

Policy references

Policy reference content

Section heading

Legislative Authority

Section detail

The Workers’ Compensation Act, 2013
59, 60, 61, 62, 63, 64, 65

Section heading

Document History

Section detail

(1)    September 1, 2023. Updated procedure to clarify reimbursement of fees for the completion of an enabling certificate.
(2)    POL and PRO 18/2010, Medical Review Panels (effective June 2, 2010 to March 31, 2023).
(3)    January 16, 2015. Policy and procedure review completed.
(4)    January 1, 2014. References updated in accordance with The Workers’ Compensation Act, 2013 (Bill 58).
(5)    September 1, 2011. Policy and procedure review completed.
(6)    POL and PRO 20/2001, Medical Review Panels (effective January 1, 2002 to June 1, 2010).
(7)    POL 09/1996, Medical Review Panels (effective January 1, 1998 to December 31, 2001).
(8)    POL 05/1998, Medical Review Panels – Qualification of Binding of Decision (effective January 27, 1998 to December 31, 2001).
(9)    POL 01/1996, Appointment of Chairmen for the Regina and Saskatoon Medical Review Panels (effective November 1, 1995 to December 31, 2001).

Section heading

Complements

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