1.    A physician reviews each medical report you submit to WorkSafeBC.
(a)    True    
(b)    False

2.    You’ve just encountered an emergency in your office (for example, a worker-patient who is acutely sui-cidal or has cauda equina syndrome). You would:
(a)    Call WorkSafeBC immediately and request an emergency MRI and neurosurgical assessment.
(b)    Treat this patient as you would anyone else in an emergency.
(c)    Note on your Form 11 that you’ll need to speak right away with a WorkSafeBC medical advisor.

3.    Match each term with the appropriate scenario:    Impairment    Disability    Restriction    Limitation

(a)    A patient sustains a spiral fracture of her right tibia. This diagnosis/pathology could also be described as a(n) ______.
(b)    Following open reduction internal fixation (ORIF), the orthopaedic surgeon informs the same patient she must not weight-bear for at least 8 weeks to avoid an ununited fracture: ______.
(c)    This patient reports pain and swelling 30 minutes after having the leg dependent, but is reasonably comfortable having her leg elevated: ______.
(d)    This patient’s job as a porter requires her to walk independently. The employer can provide a desk job that enables her to perform her work with her foot elevated. The patient has a(n) ______ from her job as a porter, but is able to perform the sedentary job desk job.

4.    Your patient has submitted a WorkSafeBC claim for alleged workplace bullying and harassment. Knowing that the Workers Compensation Act requires a diagnosis by a psychologist or psychiatrist for claim processing, you should do everything except:
(a)    Treat your patient as is medically appropriate, including, if necessary, providing a psychology or psychiatry referral.
(b)    Submit Form 8/11.
(c)    Refer this patient—and all such patients—immediately to a psychologist or psychiatrist, regardless of clinical presentation.

5.    Employers have a right to which of the following:
(a)    A diagnosis.
(b)    Treatment details.
(c)    The length of time the patient will be off work.
(d)    Medical and legal restrictions and their duration.
(e)    Limitations.

Answers
1.    (b) False. WorkSafeBC automatically processes and pays most claims, and ensures they meet privacy requirements. A WorkSafeBC medical advisor will review only those claims that contain complex medical or medical-legal issues related to recovery. 

2.    (b) WorkSafeBC does not provide patient care, nor do we have hospital or inpatient facilities. However, we can facilitate elective referrals on an expedited basis. 

3.    (a) Impairment is defined by the World Health Organization as any loss or abnormality of psychological, physiological, or anatomical structure of function.
       (b) Restriction is a medical/legal contraindication. Even if the patient wishes to engage in a task, medical or legal standards wouldn’t allow it. 
            Example 1: weight-bearing on an unstable fracture. 
            Example 2: driving after a new diagnosis of epilepsy.
       (c) Limitation = measurable capacity + symptom tolerance. It occurs where a patient would be permitted to engage in a particular task, but is unable to do so, either due to incapacity or inability to tolerate symptoms, such as a frozen shoulder that won’t move more than 90 degrees or is still in the painful stage. 
       (d) Disability is the inability to perform an activity or task as a result of impairment. It is therefore task-dependent. For example, a worker-patient can be disabled from portering patients but not from desk work that allows the leg to be elevated. 

4.    (c) Treat your patient as is medically appropriate. WorkSafeBC will arrange assessment as required for claim processing purposes.

5.    (c), (d), and (e) Employers require patient consent to request medical details concerning diagnosis and treatment. However, employers have a legal duty to accommodate employees who are disabled from tasks at work. They will need to know the length of the accommodation period and the types of accommodations required in order to maintain their workforces.

—Celina Dunn MD, CCFP
Manager, WorkSafeBC Medical Services

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This article is the opinion of WorkSafeBC and has not been peer reviewed by the BCMJ Editorial Board.