After WCB learns the extent of your injuries, and your family doctor has taken you off work, the claim adjudicator will have a medical consultant phone your family doctor to ask them why you are taken off work. I have documented proof that my doctor was over-powered by WCB in the beginning. Some of the general practitioners seem to be quite intimidated by WCB’s doctors. There have been stories floating around by a lot of injured workers that some doctors have even been threatened.
If you have serious injuries, you will be sent for what is known as a Medical Status Exam (MSE). This exam is performed by one of WCB’s doctors. In Edmonton, these doctors work out of the Millard Health Centre which is owned and operated by WCB. The doctor will do a very short examination and type up a large report with their opinion on a diagnosis (before a scan) and work restrictions. Even when you have broken bones, these doctors will determine you are fit for some type of modified duty.
The Independent Medical Exam or IME is expedited when WCB needs an opinion by a specialist because they are viewed as expert diagnosis. IME doctors in Edmonton and Calgary work out of WCB’s main office. These doctors are not expedited to provide care. You will usually only see them once during your claim. This is done long before your own doctor is able to get you into a non-WCB specialist. WCB will use these opinions to determine diagnosis, treatment needed and fitness for work. I was once told by my case manager that they are only able to send you for an IME once every 6 months.
Section 38 of the WCB Act states you have to comply or your benefits can be suspended or terminated. The doctor's performing these exams are the very doctors that in my experiences helped bury serious injuries! This is why it is very important to have your family doctor send you to the applicable specialist's immediately. I had serious injuries buried due to these exams, but resurfaced after finally seeing a non-WCB specialist! WCB can expedite appointments for scans, x-rays and MRI's faster than your doctor can, but are famous for using the same radiologists. I have heard stories about some of the family doctors that will get very aggressive with WCB and inform them of the health laws and ethics. There isn’t too many of them around unfortunately.
I cannot stress enough how important it is to obtain copies of all documents. Reports from all scans can be obtained by your family doctor printing them from Netcare. I have seen and heard about hundreds of workers injuries getting buried because the average person doesn't even think this would be required. I never knew I was entitled to get a copy of these until a couple months after my accident.
Once I read the report for my CTscan, I opened google and started researching what it all meant. This is when I discovered WCB was burying some very serious injuries. They rely on injured workers not knowing what these reports are about.
Once you have copies, and have found out the extent of injuries, send them in to your claim file. As stated in critical info, if WCB knows you have copies of reports, they don't get buried or disappear! Also send an email to your case manager telling them you have obtained a copy and will be discussing the results with your family doctor. A good doctor will have done this already!
WCB rarely listens to your family doctor. Their policies surrounding medical help them get away with this. Their medical consultants are merely doctors or therapists sitting at a desk, looking at medical info on your claim, then writing up a large report with their opinions. Every time your doctor or their specialists send in a report, the claims manager will obtain a medical consultants opinion.
It is very important to know and remember that the medical consultant’s opinions and reports hold no validity over specialist’s opinions! You will need to continually remind your case managers of this.
Once you do get to see a non WCB specialist, and they determine your injury or injuries were the result of your workplace accident, get a copy of this report immediately and send it in to WCB. Under WCB policy, your claims manager has to accept this new diagnosis. This holds more validity than any of their doctors, medical consultants and IME/MSE doctors reports.
If you have previously had a claim denied or a decision on your file that affected your benefits or entitlement, and had an appeal that did not turn out in your favour, you can have the new evidence reviewed by submitting a Request for Review. If you obtain new evidence within 6 months of an appeal with the commission, you can send it to the commission for review. For example, if you receive new evidence 2 months after you lost an appeal, the new evidence needs to be sent to the commission immediately. Their policy states they don’t have to accept it if you did not make it available in a reasonable time period!
The policy explaining the new evidence can be viewed below: https://www.wcb.ab.ca/assets/pdfs/public/policy/manual/printable_pdfs/0108_1.pdf This has to be accepted even if it's long after you were cut off. As long as it meets the criteria noted in the policy above. This is stated in the policy below: https://www.wcb.ab.ca/assets/pdfs/public/policy/manual/printable_pdfs/0108_2_app1.pdf
Most of us have experienced our case managers changing the wording from medical reporting that came from their own doctors as well as non WCB specialists. They do this to deny claims or prevent accepting injuries.
There is something you can do about that. As stated on many occasions, it’s very IMPORTANT that you obtain all reports especially medical! You need to contact the FOIP (Freedom of Information Department) of WCB. All medical reports need to be assessed through this department prior to being released. Do this by email or letter only!! Tell them you want it changed immediately and to receive the changed documents.
If the FOIP department refuses to have it changed, you can file a complaint with the Privacy Commission. https://www.oipc.ab.ca/ The commission is obligated to look into this and if the commission does not enforce the change, you are entitled to have an inquiry started. I have been told by a claimant they won going through this process and they were back paid benefits after WCB was forced to amend the document and decision.
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