POLICY NUMBER: 1. 1. 3

Effective Date: February 1, 1996
Date Issued: December 1, 1995
Date Approved by Board of Directors: October 4, 1995
Topic: Claims Adjudication - Processing Continuing Claims
Section: Entitlement
Subsection: Injuries

Policy Statement

1. Regardless of the probable period of disability, claims will be referred to the Medical Officers at intervals not exceeding three months. A Form 10 will be forwarded as required. If it appears that further information is needed before additional payment may be made, then the file is to be returned to the Claims Adjudicator of record for appropriate action.

2. Medical reports will be referred to the Medical Officers as necessary and returned to the Claims Adjudicator for adjudication. All specialists' reports are to be referred to the Medical Officers before adjudication.

3. In cases where a claim is closed on the current information and medical reports, and where subsequent reports indicate a further short period of disability, such claims can be reopened and paid for the additional disability periods as merited on the authority of the Claims Adjudicator.

4. Re: Permanent Medical Impairment
The granting of a permanent impairment indicates that the worker has an impairment of a permanent nature and this implies that it could improve, remain stable or worsen. Flare-ups of such a condition can be considered for payment of temporary earnings replacement if the medical evidence indicates that it is a recurrence of the compensable condition.

5. Whenever an Adjudicator makes a decision regarding payment of W.C.B. benefits (close, continue, reduce, etc.) following review of the file by a Board Medical Officer, the Adjudicator shall have the decision, with explanations for the decision, typed on a Form 51.

Application

This policy applies to all decisions made on or after February 1, 1996.

References

Workers' Compensation Act (Chapter 10, Acts of 1994-95), Section 37(1)