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AR 290/2006 MEDICAL PANELS REGULATION

(Consolidated up to 253/2017)

ALBERTA REGULATION 290/2006

Workers’ Compensation Act

MEDICAL PANELS REGULATION

Table of Contents

                1      Definitions

                2      Difference of medical opinion

                3      Selecting medical panel members


                4      MD advocate

                5      Review of records and information

                6      Duties and powers of medical panel

                7      Report of medical panel

                8      Rules of procedure

                9      Access to information

              10      Remuneration

              11      Cost of tests and assessments

              12      Duties and powers of panels commissioner

           12.1      Immunity

              13      Expiry

              14      Coming into force

Definitions

1   In this Regulation,

                               (a)    “Act” means the Workers’ Compensation Act;

                              (b)    “claim” means a claim for compensation under the Act;

                               (c)    “claimant” means a worker or, in the case of a worker’s death, a dependant of the deceased worker;

                              (d)    “MD advocate” means a physician selected by a claimant under section 4;

                               (e)    “medical opinion” means a full statement of the facts, medical evidence and reasons supporting a physician’s medical conclusion;

                               (f)    “panels commissioner” means the medical panels commissioner appointed under section 46.3(1) of the Act.

Difference of medical opinion

2   For the purposes of section 46.1(2) of the Act, a difference of medical opinion arises if, in the Board’s opinion,

                               (a)    the medical issue is substantial and material to the claim,

                              (b)    the physicians who provided the medical opinions are in possession of the same facts in respect of the medical issue,

                               (c)    the physicians have reasonably similar qualifications or expertise in respect of the medical issue, and

                              (d)    the medical opinions relate to the same time frame,

and the Board is not able to resolve the outstanding medical issue through consultation with the physicians.

Selecting medical panel members

3(1)  The Board or the Appeals Commission may refer a medical issue or matter to a medical panel under section 46.1 of the Act by delivering to the panels commissioner

                               (a)    a request for a medical panel, and

                              (b)    the records and information available to the Board or the Appeals Commission, as the case may be, relating to the medical issue or matter.

(2)  On receipt of a request under subsection (1)(a), the panels commissioner must

                               (a)    prepare from the general eligibility list of physicians prepared by the College of Physicians and Surgeons a case eligibility list of physicians specifically skilled in the medical issue or matter to be dealt with by the medical panel, and

                              (b)    send a copy of the case eligibility list to

                                        (i)    the claimant,

                                      (ii)    the Board, and

                                     (iii)    the employer unless the panels commissioner is required to choose a physician on behalf of the employer under subsection (4).

(3)  A medical panel must consist of 3 physicians chosen as follows:

                               (a)    one physician chosen by the claimant from the case eligibility list;

                              (b)    one physician chosen by the employer from the case eligibility list;

                               (c)    one physician chosen by the Board from the case eligibility list.

(4)  Notwithstanding subsection (3)(b), the panels commissioner must choose a physician on behalf of the employer if

                               (a)    the claimant is

                                        (i)    self‑employed,

                                      (ii)    a member of the employer’s family, or

                                     (iii)    a partner in, or a director of, the employer’s firm,

                                  or

                              (b)    the employer has ceased to carry on business in the industry in which the worker’s injury occurred.

(5)  Notwithstanding subsection (3), the panels commissioner must choose a physician if

                               (a)    the claimant, employer or Board does not select a physician within 2 weeks, or such longer period as determined by the panels commissioner, from the date of receiving a copy of the case eligibility list under subsection (2)(b), or

                              (b)    2 or more of the parties choose the same physician.

(6)  Notwithstanding subsections (3) and (4), a physician is not eligible to be chosen as a member of a medical panel if the physician

                               (a)    is or was the worker’s treating physician,

                              (b)    is being or has been consulted with respect to the worker’s injury unless, in the opinion of the panels commissioner, special circumstances exist and choosing the physician would not create a conflict of interest,

                               (c)    is providing or has provided medical services to the worker or the employer, or

                              (d)    is or was a partner or associate of a physician referred to in clause (a), (b) or (c) unless, in the opinion of the panels commissioner, special circumstances exist and choosing the physician would not create a conflict of interest.

(7)  The panels commissioner must choose one of the panel members as the chair of the medical panel.

MD advocate

4(1)  A claimant may select a physician to provide input and make representations on behalf of the claimant before a medical panel.

(2)  The panels commissioner shall, when sending a copy of the case eligibility list to the claimant under section 3(2)(b), provide the claimant with notice of the claimant’s right to select an MD advocate under this section.

(3)  A claimant must select an MD advocate by notifying the panels commissioner of the selection in writing within 2 weeks from the date of receiving a notice under subsection (2).

(4)  An MD advocate may provide input and make representations on behalf of the claimant before a medical panel in person, by telephone or in writing.

(5)  A claimant is responsible for paying an MD advocate’s fees and expenses unless the MD advocate is the worker’s treating physician in which case the MD advocate’s fees and expenses shall be paid pursuant to section 10.

Review of records and information

5(1)  After a medical panel has been appointed, the panels commissioner

                               (a)    must review the records and information received from the referring body that relate to the medical issue or matter,

                              (b)    may request the referring body to provide additional records and information related to the medical issue or matter, and

                               (c)    must provide copies of the records and information received under clauses (a) and (b)

                                        (i)    to each member of the medical panel, and

                                      (ii)    to all other interested parties including the MD advocate, if the claimant has selected one.

(2)  A person receiving records and information under this section shall not use or disclose the records or information except for a purpose related to the proceedings of the medical panel.

Duties and powers of medical panel

6   For the purposes of providing a report of its medical findings under section 7, the medical panel

                               (a)    must review the records and information received under section 5,

                              (b)    if the claimant has selected an MD advocate, arrange to receive the MD advocate’s input and representations, and

                               (c)    may

                                        (i)    interview or examine the worker,

                                      (ii)    invite the worker’s treating physician, or any other health provider whom the medical panel considers appropriate, to provide input,

                                     (iii)    seek, or request the panels commissioner to seek, advice or information relevant to the medical issue or matter from one or more medical specialists or health care providers, and

                                     (iv)    request the panels commissioner to do one or both of the following:

                                              (A)    to arrange for any tests on or assessments of the worker;

                                              (B)    to compile medical information relevant to the medical issue or matter.

Report of medical panel

7   A medical panel must prepare a report of its medical findings, including reasons supporting the medical findings, and through the panels commissioner provide copies of its report to

                               (a)    the claimant,

                              (b)    the employer,

                               (c)    the Board, and

                              (d)    if the Appeals Commission has referred the medical issue or matter to the medical panel, the Appeals Commission.

Rules of procedure

8(1)  The panels commissioner must establish general rules of procedure for proceedings before a medical panel.

(2)  The chair of a medical panel may make additional rules of procedure for a medical panel that are not inconsistent with the general rules of procedure established by the panels commissioner.

(3)  Without restricting the generality of subsection (2), the chair of the medical panel may determine whether anyone other than an MD advocate may appear on behalf of the claimant before the medical panel.

Access to information

9   A medical panel may, through the panels commissioner, request the Board, the Appeals Commission or the claimant to provide it with any records or information that it considers necessary to make a medical finding.

Remuneration

10   The panels commissioner, the members of a medical panel and a worker’s treating physician who participates in the proceedings before a medical panel shall be paid remuneration and expenses under section 46.3(2) of the Act at the rates set by the Minister.

Cost of tests and assessments

11   The Board shall pay the cost of any tests on or assessments of a worker that are requested by a medical panel under section 6 as part of the claim.

Duties and powers of panels commissioner

12   In addition to the panels commissioner’s other powers and duties under this Regulation, the panels commissioner is responsible for the operation of the medical panel process, including, without limitation,

                               (a)    co‑ordinating the referral of medical issues and matters to medical panels,

                              (b)    developing and implementing processes to ensure the timely completion of medical panel reviews and reports, and

                               (c)    ensuring the efficient operation and financial management of the medical panels office.

Immunity

12.1   No action may be maintained or brought against the panels commissioner or an employee of the panels commissioner in respect of any act or decision done or made in the honest belief that it was within the panel commissioner’s jurisdiction.

AR 319/2009 s2

Expiry

13   For the purpose of ensuring that this Regulation is reviewed for ongoing relevancy and necessity, with the option that it may be repassed in its present or an amended form following a review, this Regulation expires on December 31, 2019.

AR 290/2006 s13;70/2016;253/2017

Coming into force

14   This Regulation comes into force on the coming into force of sections 3 and 4 of the Workers’ Compensation Amendment Act, 2005 (No. 2).