WCB Procedures

Collaborative care planning

Procedure summary

Published On

Oct 8, 2024

Purpose

To develop and manage a care plan for injured workers until they have recovered and are ready to return to work, using a collaborative approach that includes the worker, employer and treatment provider(s).

Description

The WCB-Alberta (WCB) decision maker works collaboratively with all interested partiesGenerally includes the worker, employer, treatment providers, and a worker or employer representative, if one exists. to develop a care plan that supports the worker’s recovery and return to work. Once a care plan is in place, the decision maker monitors its progress to ensure it stays on track or is adjusted as needed.

The decision maker reviews the worker’s claim information to determine what additional information is needed to begin the planning process.

The decision maker contacts the worker to discuss their:

Injury, its impact on the worker and their family and what supports they need.
Date-of-accident job duties, what modified duties they may be capable of and when they think they might be ready to return to work.
Relationship with their employer, how often they communicate and how the worker plans to maintain an attachment to their work during their recovery.
WCB support needs, return to work goals and plan.

The decision maker contacts the employer to discuss their:

Relationship with the worker and how often they communicate.
Intentions to support the worker’s recovery, provide modified work duties and keep the worker’s job available.
Date-of-accident job duties, modified and return-to-work goals and plan, and how WCB can support them.

The decision maker contacts the treatment provider(s) to discuss the worker’s fitness level, progress and next steps in treatment, and what supports WCB can provide.

The decision maker may facilitate a collaborative care planning session involving all interested parties and ensures that all agree on a care plan together. The decision maker confirms everyone understands their roles and responsibilities and documents the care plan.

The decision maker continues to monitor the worker’s recovery and adjusts their benefits and care plan as appropriate. This may include arranging new medical assessments, referrals to other service providers and the provision of other WCB services, as appropriate. Throughout the plan, the decision maker reviews incoming information and considers if the worker has a fitness level or if the worker has reached long-term or permanent medical plateauA medical plateau is normally reached when the worker's medical condition has stabilized, further significant medical improvement is unlikely, and permanent work restrictions can be confirmed. . The decision maker takes into account any expected or confirmed compensable work restrictions to formulate a care plan that facilitates a successful return to work.

Key information

Each worker is unique and so is each care plan.

Getting to know the interested parties involved is a key focus of WCB’s care planning process. Each party plays a unique role in supporting the worker’s recovery and return to work; all are necessary participants to ensure success.

Care plans evolve and are adjusted to meet the worker’s recovery needs over time. These adjustments are typically prompted by new medical information, feedback from the worker or employer about the existing plan, or if the recovery isn't going as expected.

A quality care plan is built on five key elements that support and guide a worker’s recovery and return to work. Incorporating all of them is crucial for the worker's successful recovery and return to work.

The key elements include:

Key element 1 - Appropriate causality-based decision making
Key element 2 - Frequent conversations about return to work
Key element 3 - Fostering modified work opportunities
Key element 4 - Create and communicate SMART (specific, measurable, achievable, realistic and time-bound) return-to-work goals
Key element 5 - Deliver on-track plans to achieve goals

Refer to the Five elements of a quality care plan section for details.

Additional resources are available for this procedure in the internal Procedure Resource Library.

Detailed business procedure

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1. Review the claim Review the relevant information on the claim file: Details of the injury, diagnosis and the injuries accepted. Ensure all diagnoses have been adjudicated or investigated. If not, consider what information is needed to determine entitlement for unadjudicated diagnoses (e.g., gathering additional information from the worker or treatment provider). Current treatment plan Return-to-work status Details of the pre-accident job Modified work opportunity eCO alerts Try to determine the possible outcome for the worker. Are they likely to: Be fit for their pre-accident job duties? Be fit for modified work? Have long-term temporary or permanent work restrictions? Consider treatment protocol timeframes and anticipated recovery from the compensable injury to determine an estimated return-to-work goal date. Consider work restrictions to assist in forecasting a recovery goal date or return to suitable modified duties. Consider a referral to an internal consultant for a medical opinion, if needed, to clarify recovery time for the compensable injury. Determine (through discussions with the worker, employer and the treatment provider) whether the modified duties available are suitable based on: Anticipated work restrictions The modified work being meaningful, safe, productive and promoting a successful return to work	Administrative tasks Resources include: Surgical and fracture protocol recovery timeframes Disability duration reference Internal consultants Collaborative Care Planning site on the internal Electronic Workplace.
2. Call the worker Take time to get to know the worker. Ask mindful questions to build a trusting partnership and encourage them to include trusted treatment providers in their care plan. Ask the worker about: Their injury: How has it impacted them? How are they managing at home? What supports do they and their family need? Ask open-ended questions about the accident and what injuries were sustained? Their job: What are their duties, and do they have a job description. What duties can they do now? If return to work is a possibility, when will they be ready to return to work? What other jobs may be available with the date-of-accident employer and what training is required? Their relationship with their employer: When were they last in touch? How do they plan to stay connected to their work? How do they like to communicate and how often? What modified duties has the employer offered? General needs and claim information: Is there anything important that hasn’t been asked about or discussed? Other information they need or assistance with their recovery? Clarify the pre-accident job demands with the worker and educate them about WCB expectations of them, including their active participation in treatment, duty to work with their employer to find suitable modified duties as quickly as possible, and the return-to-work process. Ask if the worker has any questions about their plan, benefits or additional supports. Collaborate with the worker to establish recovery and return-to-work goals. Confirm their understanding of the plan moving forward.	Administrative tasks Document the conversation in a file note (Contact/Claimant Contact or Modified Work/Claimant Contact). Refer to the Collaborative Care Planning site on the internal Electronic Workplace. Follow the 3-1 Modified work procedure.
3. Call the employer Take time to get to know the worker’s employer and their plans to support the worker in their return to work. Educate the employer about the return-to-work process. Ask the employer about: The pre-accident job duties. Their relationship with the worker. How they prefer to communicate and how often. Modified work opportunities that are available. Consider asking: What other positions are available or what positions will you be hiring for in the near future? What type of training is required for these positions? If you had an extra set of hands right now, what would you have that person do? If I gave you a worker for free, what could they do for you? What can I do to help you in identifying modified work opportunities? Whether they will keep the worker’s job available. Their plan to keep the worker engaged with the workplace while recovering. Their expectations for the worker’s return to work. How they think WCB can help with the worker’s return to work. Clarify the pre-accident job demands with the employer and educate them about WCB expectations of them, including their duty to work with the worker to find suitable modified duties as quickly as possible, and the return-to-work process. Ask if the employer has any questions about the plan or additional supports, and request they submit a physical demands analysis if one is not already on file. Explain that a worker may become fit for work at different points of their recovery; attempt to pre negotiate modified work for when the worker achieves an anticipated fitness level. Continue to negotiate modified work throughout the worker’s recovery.	Administrative tasks Document the conversation in a file note (Contact/Employer Contact or Modified Work/Employer Contact) and select the correct status for the modified work. Resources include the: Employer Physical Demands Analysis (C-545) Collaborative Care Planning site on the internal Electronic Workplace Follow the 3-1 Modified work procedure
4. Call the worker’s treatment provider(s) and physician(s), if needed Call the treatment provider(s). Discuss the worker’s fitness level, progress and next steps in treatment: Share relevant medical information. Gather any missing information. Confirm next steps in the treatment plan. Ask the treatment provider(s): If treatment is progressing as expected. If not, find out what is preventing progress. If there are challenges that WCB can help resolve. If there are concerns that cannot be resolved through one-on-one conversations, facilitate a collaborative conversation between the worker and their treatment provider. Make additional referrals if needed, such as an internal consultant referral if the worker is not progressing with their current treatment.	Administrative tasks Document the conversation in a file note (Contact/Treatment Provider Contact). Refer to the Collaborative Care Planning site on the internal Electronic Workplace. Follow the appropriate procedure: 4-1 Medical testing, referrals and program support 4-2 Community treatments 11-1 Requesting medical reports
5. Collaborate with interested parties to agree on a care plan Contact the worker and review the proposed care plan (including the treatment plan and forecasted recovery or return-to-work goal date); involve care providers as appropriate. Consider what other benefits, supports and services the worker may require (for example, assistance with home care, short-term home assistance, etc.). Note: Ensure the forecasted return-to-work or recovery is a SMART Goal (i.e. specific, measurable, achievable, realistic and time-bound. See the Five elements of a quality care plan section. Contact the employer and review the proposed care plan and return-to-work goal date. Use these conversations to establish an agreement on a collaborative care plan that is focused on the worker’s unique needs and recovery. Consider arranging a case conference to have all parties involved in the development of the worker’s treatment and return-to-work goals.	Administrative tasks Document the conversation in a file note (Contact/Employer Contact or Modified Work/Employer Contact) and select the correct status for the modified work. For assistance in forecasting return-to-work or recovery goals, use the “Create a smart tool guide” located on the Electronic Workplace; WCB Made Easy; Tip Sheets; Case manager tip sheets.
6. Finalize and communicate the care plan Communicate the care plan in writing so all parties clearly understand the plan and their responsibilities in the worker’s recovery. Send the appropriate letter to the worker and employer. Make additional referrals if needed, such as an internal consultant referral if the worker is not progressing with their current treatment.	Administrative tasks Send the appropriate letter: IED Entitlement Determined (CL041A) Care Plan Defined (CL041B) Fit for work-Care Plan Combined (CL041I) Reopen Recurrence Accepted (CL016G) Follow the 11-2 Internal consultant referrals procedure.
7. Monitor the worker’s recovery and adjust the care plan as needed Monitor the worker’s recovery and progress towards their return-to-work goal by assessing medical reporting as it is received. Communicate with the worker biweekly to review their recovery progress and address any concerns regarding their treatment and recovery. Regularly communicate with the employer (at least every 6 weeks or as there are changes to the care plan). Ensure the care plan remains on track and the worker is likely to achieve their goal. A plan is on track when: Diagnosis and treatment are consistent with claim entitlement. The worker is actively engaged and attending appointments regularly. There is improvement in the worker's function and abilities There is a decrease in symptoms and/or work restrictions. Medical information supports an estimated return-to-work date is reasonably expected within the time period outlined in the care plan. The date the worker estimates that they will return to work within the time period outlined in the care plan. Modified work opportunities have been fully explored. No barriers have been identified by the healthcare provider. A plan is not on track when: Additional investigations or consultations are recommended by the healthcare provider. Diagnosis does not match claim entitlement, it has changed or it is not consistent between all healthcare providers. The return-to-work date changes and is no longer within the expected care plan timeframe. The worker is not making any improvement in their function and abilities, work restrictions, symptoms or pain. The worker does not estimate that they will return to work within the expected time period outlined in the care plan. Modified work opportunities have not been fully explored. There are concerns with worker or employer cooperation. The healthcare provider does not have a clear understanding of the date-of-accident physical job demands. Barriers have been identified by the healthcare provider. Addressing barriers Determine entitlement if any new diagnosis is identified. Address any identified barriers and develop a plan to help overcome them. Identify the supports or referrals needed to help get the plan back on track. Consider: A case conference to have a collaborative discussion about return to work with the worker, employer and healthcare provider. Whether the healthcare providers have all the information to support the plan and return-to-work goal (e.g., job description, physical demands analysis, etc.). A referral to an internal consultant (e.g., medical consultant, physiotherapy consultant, psychological consultant etc.) to obtain clarity about the worker's expected recovery for the injury, if a new diagnosis is identified. Referrals for additional investigations or consultations, as appropriate [e.g., medical status exam, independent medical exam, psychological assessments, visiting specialist clinic (VSC) for surgical consult, non-surgical consultation (NSC), or diagnostic tests such an MRI, ultrasound, etc.] A return-to-work program or psychological counselling if there are social or cognitive barriers A return-to-work planning meeting (RTWPM) or a referral to an industry specialist if there are employment barriers (i.e., difficulty identifying modified work options, relationship issues between the worker and the employer). A referral for re-employment services when: the worker's job with the date-of-accident employer is no longer available, or the worker has or will have permanent work restrictions and the employer confirms permanent accommodation is not available. There may be a unique circumstance delaying the worker's recovery and/or return to work such as the worker is awaiting admission to hospital. Consider the reason for the delay in recovery or return to work and determine what compensation benefits or services the worker is eligible for. Refer to the Compensation pending hospital admission section below. When the worker or employer are not cooperating, consider applying duty to cooperate. Adjust the care plan as needed, focusing on the worker’s goals for medical recovery and return to work. This will vary depending on the worker’s circumstances. Respond to unexpected events that may occur and collaborate with the worker and employer to resolve any interruptions or obstacles to the care plan. If there is a significant change to the care plan, communicate those changes in writing. Continue to monitor the worker’s progress and recovery until they are able to return to full duties or find suitable alternate employment.	Administrative tasks Document the conversation in a file note (Modified Work Contact/Claimant Contact or Modified Work/Employer Contact) and select the correct status for the modified work. Document the conversation in a file note (Contact/Treatment Provider Contact). Follow the appropriate procedure: 3-1 Modified work 3-3 Duty to cooperate 4-2 Community treatments 4-1 Medical testing, referrals and program support 11-2 Internal consultant referrals Send the Care Plan Update letter (CL041F) outlining the changes to the treatment and recovery plan goals.
8. Determine fitness for work When medical reporting supports a fitness level, collaborate with the worker, employer and treatment provider to develop a return-to-work plan. Depending on the claim circumstance, a return-to-work plan could involve: Return to full duties. Return to modified duties or hours. A graduated return to full duties or hours. Suitable alternate employment. Refer to the 1-8 Fitness for work decision procedure to make and communicate the fitness-for-work decision and address any barriers. The decision and rationale regarding fitness for work can be communicated verbally before the medical report is received to file. The fitness for work decision is formalized in writing after the medical report is filed and the decision maker verifies the details within that report. Determine if the worker's injury will or is likely to result in a permanent clinical impairment (PCI). If yes, discuss the PCI review process with worker including when the review will take place.	Administrative tasks Send the appropriate fit-for-work letter from the CL041 series. Follow the appropriate procedure: 1-8 Fitness for work decision 3-1 Modified work 4-1 Medical testing, referrals and program support 4-2 Community treatments 7-1 Triage assessment referral 11-2 Internal consultant referrals

Supporting information

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Five elements of a quality care plan

Key element 1 - Appropriate causality-based decision making

Ensure all of the diagnoses on the claim have been properly adjudicated or investigated.

Review medical reports, consider each diagnosis, and determine if it arose out of and in the course of employment and has a relationship to the work accident. In some circumstances, additional information may need to be gathered before making an entitlement decision for a diagnosis. Refer to Policy 02-01, Part I; the 1-1 Initial entitlement decision and 1-3 Determine additional entitlement procedures.

Manage the injuries or diagnoses that are related to the work accident.

Key element 2 - Frequent conversations about return-to-work

Collaborate with the worker, employer, and health care providers to ensure everyone has a good understanding of the worker's injury, treatment and the plan for recovery and return to work.

Have regular conversations whenever there is a change in the care plan or to follow-up on modified work. At minimum, call the worker every two weeks and the employer every six weeks. Sharing information is an important step in building trust and ensuring everyone is involved in the care planning process.

Key element 3 - Foster modified work opportunities

Modified work can support workers in their recovery and keeping them connected with their date-of-accident employer. Negotiating modified work is a key aspect in all conversations with the worker, employer and treatment providers.

Explore all available modified work opportunities (e.g., modification of work duties, reduced hours or earnings, placement in a suitable alternate position or employer-sponsored training, etc.).

Key element 4 - Create and communicate SMART (specific, measurable, achievable, realistic and time-bound) return-to-work goals

The success of care plans is enhanced by setting a SMART goal as it provides all parties with a clear and concrete endpoint to aim for.

Smart goals are:

Specific - The return-to-work goal is well defined.
Measurable - The decision maker is able to determine when the return-to-work goal has been met.
Achievable - The right supports are in place to achieve the return-to-work goal. If not, consider what it is missing and address any barriers that arise.
Realistic - The return-to-work goal is possible, and the care plan developed ensures it's success.
Time-bound - The date that the return-to-work goal will be achieved is clear.

Refer to the create a smart tool guide located on the Electronic Workplace; WCB Made Easy; Tip Sheets; Case manager tip sheets.

A care plan may include a short-term goal and/or a long-term goal. A short-term goal is needed when a worker is not fit for any type of work and identifies when a worker is expected to return to modified work. The short-term goal is dependent on the worker's fitness level and what modified duties are available with the date-of-accident employer. Not every care plan will need a short-term goal, but all care plans require a long-term goal. A long-term goal identifies when the worker is expected to be medically cleared to return to their date-of-accident duties or in the case of permanent work restrictions, when the worker will be employable in a new position.

The return-to-work goal date is an estimate based on the available medical information on the claim (e.g., treating physician, specialist, physiotherapist, chiropractor, psychologist, psychiatrist or return-to-work providers etc.). Additional resources including a referral to an internal consult, disability duration guidelines, physiotherapy treatment protocols and assessment wait times may be used to identify an appropriate SMART goal. Refer to the 4-2 Community treatment and 11-2 internal consultant referral procedures.

Plan for contingenciesA contingency plan is an alternate plan to consider if the current plan is not successful, also known as a Plan B. by determining the next steps to take if the current plan does not go as expected. Examples for a contingency plan may include an extension in treatment, a new or repeat assessment or additional different form of treatment.

Key element 5 - Keeping the plan on track

Each worker is unique and so is each care plan. Getting to know the interested parties involved is a key focus of WCB’s care planning process. Each party plays a unique role in supporting the worker’s recovery and return to work; all are necessary participants to ensure success.

Care plans are adjusted to meet the worker’s recovery needs over time. Adjustments are typically prompted by new medical information, the worker or employer reporting concerns about their current care plan, or a lack of progress in the worker’s recovery.

Monitor incoming medical information to confirm the worker is making progress, the plan is on track and the worker is likely to achieve the goal. Address barriers that arise through collaboration with the worker, employer and healthcare providers or by arranging additional supports or assessments to help get the plan back on track.

Collaborate with the worker, the employer and all healthcare providers and together build a plan that focuses on great outcomes. While the goal is to help the worker fully recover and return to their date-of-accident job, sometimes a worker's injury prevents them from returning to the type of work they were doing before their injury. If this occurs, discuss available modified work options with the date-of-accident employer or other supports available to help the worker return to employability (i.e. re-employment services).

Compensation pending hospital admission

Administrative tasks

Follow the appropriate procedure:

Supporting references

Policies

Procedures

Workers’ Compensation Act

Applicable sections

Section 38 (2) - Medical examination and investigation
Section 54 - Reduction or suspension of compensation
Sections 88 (1) - Reimbursement of general revenue fund

General Regulation

Applicable sections

Related Legislation

Applicable sections

Procedure history

September 17, 2024 - October 7, 2024

November 29, 2022 - September 16, 2024

Compatibility Warning

WCB Procedures

Collaborative care planning

Procedure summary

Detailed business procedure

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Administrative tasks

Addressing barriers

Administrative tasks

Administrative tasks

Supporting information

Key element 1 - Appropriate causality-based decision making

Key element 2 - Frequent conversations about return-to-work

Key element 3 - Foster modified work opportunities

Key element 4 - Create and communicate SMART (specific, measurable, achievable, realistic and time-bound) return-to-work goals

Key element 5 - Keeping the plan on track

Administrative tasks

Supporting references

Policies

Procedures

Related links

Workers’ Compensation Act

General Regulation

Related Legislation

Procedure history