Application 2: Rehabilitation Surgery Program

1. Why does the WCB pay an allowance when the surgery is for non-compensable conditions?

Rehabilitation surgery assistance is a cost-effective means of reducing future claims costs by making it possible for the worker to undergo surgery for a non-compensable pre-existing condition that would otherwise continue to be aggravated by employment.

The WCB provides the worker with financial support for the period of treatment and convalescence.

2. What criteria does the WCB consider in determining whether to grant an allowance?

The WCB will consider granting a rehabilitation surgery allowance if all the following conditions are met:

• the worker has an established claim for aggravation of a non-compensable pre-existing condition,
• surgery is required solely for the pre-existing condition, at the same site as the aggravation,
• it is probable the surgery will return the worker to employability and minimize future aggravational claims, and
• the worker is not entitled to comparable benefits from some other source.

3. What limitations are there?

Rehabilitation surgery allowances are subject to the following limitations:

• the WCB does not normally provide rehabilitation surgery assistance to workers living outside Alberta
• when the WCB makes an offer of rehabilitation surgery assistance the worker must accept the offer, in writing, within 12 months from the date the offer was made
• the WCB does not accept responsibility for any disability or condition which results from the treatment or surgery.

4. What benefits does the WCB pay?

The rehabilitation surgery allowance is equal in value to the worker's calculated rate of compensation immediately prior to treatment.  This allowance is paid for the period of temporary disability, usually beginning on the day of hospital admission.  The WCB may, on a discretionary basis, pay the allowance for a reasonable period prior to hospital admission.

Following rehabilitation surgery, the WCB may provide vocational and rehabilitation services.

Medical aid is limited to expenses not paid by the Alberta Health Care Insurance Plan or other plan under which the worker may be eligible.

5. When is this policy application effective?

This policy application (Application 2 - Rehabilitation Surgery Program) is effective February 15, 1997, except when noted otherwise in a specific policy section(s).