Document name

Medical Review Panels

Document number

PRO 15/2024

1. POL 15/2024, Medical Review Panels, establishes guidelines for medical review panels.
2. A Medical Review Panel (MRP) is a medical examination completed by a panel of health care providers consisting of physicians and chiropractors who are independent from the WCB.
3. A request for an MRP must be submitted to the Board Appeal Tribunal (Tribunal) by the applicant (a worker, a deceased worker’s dependant or their representative). The MRP process is handled by the Board Services Department.

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 an accepted area of a work-related injury claim if they have exhausted their rights to appeal meaning they have already received a written decision related to a medical question resulting from a decision of the Tribunal.
   2. The applicant must represent to the WCB that the worker or deceased worker:
      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.
2. How can an MRP be requested?
   1. To request an MRP, the applicant must submit a written request stating the reason(s) that apply to the worker’s claim and specify whether they want the examination to occur in Regina or Saskatoon. The application form (Worker’s Request for Medical Review Panel) can be requested from Board Services.
   2. A health care provider must complete an enabling certificate (Enabling Certificate for Medical Review Panel Examination) which can be found on the WCB website.

Enabling Certificate

3. What information is required in the enabling certificate?
   1. The health care provider must provide:
      1. The medical position taken by the WCB 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, which include, but are not limited to:
         1. Medical evidence, or
         2. Medical literature supporting the position being advanced or the supporting opinion of another health care provider.
   2. The health care provider may request advice from the WCB’s Chief Medical Officer (CMO) on the requirements for a certificate by contacting Board Services.
4. Can a health care provider receive payment for completing an enabling certificate?
   1. Fees charged by a health care provider for completing the enabling certificate will be reimbursed by WCB’s Medical Accounts Department upon submission of an invoice.
      1. Fee codes 177 (general practitioner), 178 (specialist) and 406 (chiropractor) are applicable, at the rate outlined in the care providers’ fee schedules in place on the date the certificate was completed (see wcbsask.com for current fee schedules).

MRP Chairperson

5. What is the process for appointing an MRP chairperson?
   1. In consultation with the Saskatchewan Medical Association (SMA), WCB will appoint two chairpersons who are physicians engaged in the general practice of medicine in Saskatchewan.
   2. The MRP chairpersons will be appointed for a three-year term and until a successor is appointed. They will be eligible for reappointment.
   3. Board Services will provide an orientation to each new MRP chairperson.
6. Can WCB appoint an alternate chairperson?
   1. The WCB, in consultation with the Saskatchewan Medical Association, will appoint another physician (an alternate) to act as chairperson if both MRP chairpersons are unable or unwilling to participate in a specific MRP.
   2. The WCB can appoint more than one alternate chairperson to ensure that there are chairpersons available to sit on an MRP.
7. How will the chairperson for an MRP be chosen?
   1. The MRP chairperson will be selected by Board Services based on their proximity to the city named in the MRP request.
   2. If that chairperson is unable or unwilling to act as the MRP chair, Board Services will ask the other chairperson to act as the MRP chair.
   3. If both chairpersons are unable or unwilling to act has the MRP chair, Board Services will ask an alternate chairperson to act as the MRP chair.
8. Is the MRP chairperson required to attend the MRP examination in person?
   1. As the chairperson’s primary role is to facilitate and mediate the MRP’s discussion, the MRP chairperson may participate in the examination virtually via videoconference.
      1. If the selected chairperson resides in the city named in the MRP request, the chairperson is encouraged to attend the MRP examination in person.
      2. If the selected chairperson does not reside in the city named in the MRP request, they are encouraged to attend the MRP virtually (via videoconference) rather than in person. When it would not be appropriate for the MRP chairperson to attend virtually, travel expenses for the MRP chair to the examination location will be payable by WCB.
      3. If the MRP chair will be attending an MRP virtually, a teleconference will not suffice for the purpose of the MRP.

MRP Member Selection

9. What is the process for selecting MRP members?
   1. The MRP will consist of the chairperson and two additional health care providers.
   2. The Worker’s Request for Medical Review Panel form asks the applicant to choose either two specialists or a specialist and a chiropractor to sit on the MRP.
   3. Board Services will request that the CMO provide a list(s) of health care providers within the city named in the MRP request. In accordance with the selection of the applicant, the list(s) will include either:
      1. The names of specialists who deal with the type of injury sustained by the worker (i.e., neurological, psychological, musculoskeletal specialists) or
      2. The names of specialists who deal with the type of injury sustained by the worker and the names of chiropractors.
   4. Board Services will provide the list(s) to the applicant and request that they indicate, in writing, the names of the health care providers they have selected from the list(s) provided to them.
   5. To avoid delays, Board Services will ask the applicant to rank their choice of health care providers in order of preference (i.e., their first, second, third and fourth selections).
   6. Board Services will contact the applicant’s first and second choices of health care providers to request their participation in the MRP.
   7. Board Services will request a response from the first two health care providers within two weeks.
      1. Board Services will follow up on the request to a maximum of two times.
      2. If there is no response after two attempts to make contact, Board Services will move on to the applicant’s third and fourth choices of health care providers to avoid further delays in arranging the worker’s MRP.
   8. Board Services receives no response or a refusal from the applicant’s first four choices, Board Services will contact the applicant to ask for the names of four additional health care providers from the list(s) provided. The steps outlined in subpoints e, f and g above will be taken by Board Services.
10. A health care provider with a potential conflict of interest may not be eligible to be part of the MRP. 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.
11. 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.
    1. If the Tribunal decides a health care provider cannot participate in the MRP, the applicant will be notified of the decision by Board Services.
    2. If the list of health care providers which were ranked by the applicant has not been exhausted, Board Services will contact the next health care provider on the ranked list. If, however, the ranked list has been exhausted, Board Services will contact the applicant to ask that they select additional health care providers from the list.

MRP Examination

12. How will the MRP examination be arranged?
    1. The MRP chairperson will contact the health care providers who have agreed to participate in the MRP to set up a date, time, and location for the MRP examination to take place.
    2. The MRP chairperson will notify Board Services of the date, time, and location of the MRP. Board Services will send a letter to the applicant with this information.
    3. If the MRP has been requested by a deceased worker’s dependant, the MRP chairperson will contact the health care providers who have agreed to participate to set up a date and time to review the deceased worker’s medical documentation. As a physical examination cannot be performed in this case, the medical documentation can be examined virtually by the panel members via videoconference or teleconference.
13. Can an MRP examination be completed virtually?
    1. It is recommended that an MRP examination is done in-person whenever possible. However, if a virtual examination must occur, at least one panel member must be physically present to examine the worker. The other panel member and the chairperson may participate virtually but must be able to observe the examination via videoconference. Teleconferences will not suffice for the purpose of the MRP.
    2. If the MRP is for a deceased worker where a physical examination cannot be done, the medical documentation can be examined virtually by the health care providers via videoconference or teleconference.

MRP Final Certificate

14. What information does the Tribunal require in the final certificate from the Panel?
    1. After the examination of the worker or after review of the deceased worker’s medical documentation, the chairperson of the MRP will certify in writing the findings of the panel and send the final certificate to Board Services. The final certificate must be signed by all health care providers that participated in the MRP.
    2. Point 18 of POL 15/2024 Medical Review Panels, outlines the information required by WCB in the final certificate.
15. What if clarification is required by the Tribunal in relation to the final certificate?
    1. If the MRP final certificate fails to address all of the issues outlined in Point 18 of POL 15/2024, Board Services may request written clarification from the MRP chairperson. A copy of the written request to the chairperson will be forwarded to the applicant to ensure transparency in the process.
    2. When requesting clarification of the MRP’s decision, Board Services will not provide any new information.
    3. If amendments to the final certificate are required, the MRP chairperson must provide an amended certificate with the initials of each panel member or written correspondence from all panel members confirming their agreement to the amendments.
    4. If the final certificate requires significant changes, the amended copies must be formally signed by all members of the MRP. A copy of the amended final certificate will be provided to the applicant by Board Services.
16. When is the decision provided to the applicant?
    1. Once Board Services has received the final certificate from the MRP, the Tribunal will provide the applicant their decision with respect to the matters set out in the certificate within 10 days. A copy of the panel’s final certificate will be included with the decision.
    2. A decision from the Tribunal may be delayed beyond 10 days if clarification is requested from the MRP as per point 15 of this procedure.
17. Is the employer notified of the MRP decision?
    1. The employer will be provided with a letter outlining whether WCB will be accepting further responsibility for the work injury as a result of the MRP decision.