Internal consultant referrals
To identify when and how to make a referral to an internal consultant for an opinion, guidance, support and/or authorization.
The decision maker determines whether an internal consultant’s assistance or opinion is needed to move the claim forward.
When a consultant’s opinion is needed, the decision maker ensures the entitlement is up to date and the worker’s relevant claim details and medical reports are on file. A request is made for anything missing before sending the referral.
The referral is made based on the type of review that is required.
Internal consultants are not decision makers on the claim; they provide advice as requested to the decision maker.
The decision maker communicates the outcome of the review to the worker and employer and contacts any treatment providers when appropriate before actioning the recommendations.
A consultant can assist with interpreting and assessing medical reports, confirming diagnosis, commenting on medical relatedness, recommending treatment options, and evaluating the worker’s recovery progress or fitness for work.
The consultant may also communicate with the treatment provider, approve treatment and medications, facilitate specialized exams, such as a medical panel, as well as help to resolve a conflict of medical or psychological opinion or address complaints submitted about treatment providers or examiners.
The internal consultants included in this referral process are:
Referrals are directed to the consultant whose specialty relates to the specific injury.