Medical treatment is important to your recovery and we want to assist you in every way we can. To help provide the best support, we work with your treating physicians to ensure you receive the appropriate benefits to assist in your recovery and safe return to work.
The decisions made on claims, such as benefits and treatment, are determined by the advice of physicians and medical specialists. To make fair and appropriate decisions on a claim, it's important to have the best medical information available.
During your claim, you may be seen by more than one treating physician (this could include your family doctor). Sometimes physicians give conflicting diagnoses, treatment suggestions, return-to-work recommendations or other opinions on your claim. When this happens, physicians will often have a discussion to resolve these differences in opinion.
Each claim is unique and any differences in medical opinion that arise are handled on a case-by-case basis. If the physicians can’t reach an agreement, further steps may be taken to resolve the differences in medical opinion. These may include an independent medical examination and/or a medical panel.
Independent medical examinations (IME)
During your claim, you may be referred to a specialist who will conduct an IME and provide an independent expert opinion on your injury or illness. These exams are used on many claims to ensure we have the best medical information available, and can also help resolve situations where there are conflicting medical opinions on the file.If you are referred for an IME, the exam can help answer specific medical questions about your injury or illness. For example:
- Is there anything else that should be done to verify your diagnosis or determine your need for further treatment?
- Do you have any work restrictions or limitations?
- Is your injury or illness permanent or could it improve?
When will an IME occur?
An IME can be booked any time during your recovery. It may take place soon after your injury or illness, a few weeks or months into the recovery, or after you have returned to work.
An IME may also be arranged to determine if you have a permanent clinical impairment (PCI). This is usually done around 24 months post-injury, when your injury/illness has stabilized and you have reached maximum medical recovery.
Who conducts the IME?
Physicians who have been trained to perform IMEs are selected based on their expertise in the injury or illness you have. Typically, an IME is a one-time assessment and the physician will be provided with any relevant reports from your treating physicians, including your family doctor.
During the IME, the physician will review the history of your injury or illness and examine you—the IME physician will not treat you. A copy of the report will be sent to your family doctor and to WCB. Your family doctor may review any treatment suggestions with you.
When differences in medical opinions cannot be resolved through other measures, an independent medical panel may be arranged to resolve any conflicting opinions that impact the benefits you receive.
The medical panel consists of three specialist physicians, chosen for their expertise in dealing with the issues under review. The medical panel is administered by a medical panel commissioner who is responsible for the overall operation of the medical panel process. The commissioner is appointed by the Minister, and operates independently of WCB-Alberta (and whose independence is subject to review by the Auditor General).
The panel is required to reach a consensus, and its decision is binding on all parties.
Medical panels may be initiated by either a request from WCB-Alberta or a request by the Appeals Commission.