Quebec’s Workers’ Compensation (WC) program, managed by the CNESST, operates in a unique way compared to other provinces and territories. Many of its distinct differences are particularly perplexing, making claims management in Quebec challenging.
WC case management in Quebec is commonly considered more of a battle than a cooperative process. Its most challenging characteristic by far is the medical model, which gives the treating physician full control over the claim.
Corresponding with the Treating Physician
Treating physicians will sometimes communicate minimally with the employer or representative in efforts to protect their patients. It can be challenging to assure the treating physician that we, at ReedGroup, are there to help. Once they understand we want the best for their patient, the process can become much simpler, but getting to that point can be a steep climb.
So, how does ReedGroup manage our physician connections?
Normally we write a letter to the doctor first, outlining how we can help, what the employer can do to accommodate the employee, and requesting information on recovery status. Some doctors are responsive, while others are not.
A significant obstacle is that the treating physician will not respond to any type of request or contact without a consent form from the employee. Only a handful of employees give us permission to speak with their treating physician. Without authorization, we sometimes must involve our consulting doctor or designated physician. Although it can sometimes take upwards of a few weeks to set up a discussion between our consulting doctor and the treating physician if they are difficult to reach, it can prove to be very informative regarding the recovery and return-to-work process.
We will also ask the CNESST to have their clinician discuss the recovery timeline and return-to-work status with the treating physician, so we can get an update. However, we then must accept the challenges of subjectivity.
In Quebec, we often use Independent Medical Evaluations (IMEs) for a second opinion.
Often considered a means to appeal a decision, IMEs can also obtain a specialist opinion on treatment and serve as a support for the treating physician. The second opinion can be used with medical arbitration, if required.
Even though the employer is required to pay for all additional testing and treatment (i.e., MRIs, echography, surgery, etc.), the added expense can sometimes help to lower claim costs by bypassing the public health system. In such cases, the treating physician can consider the employer as a helping hand in an employee’s treatment plan and recovery process.
Return-to-Work in Quebec
In Quebec, the treating physician must authorize the return to work for an employee to come back to work on modified duties. To ensure a smoother transition, we first propose very light duties and a gradual increase in hours.
We write detailed letters to the treating physician, outlining all opportunities for modified work and hours, including significant flexibility. Some employers have an on-site health and safety team or occupational nurse who can monitor the return-to-work program and make ad hoc adjustments in case of any complications, which is assuring for employees.
When a treating physician denies modified duties, we request clarification and then propose tasks that reflect the restrictions that the doctor specifies. We also ask the CNESST clinician to communicate with the treating physician and involve our designated doctor, when necessary, to understand what hinders a return to work. Most complex claims will require such collaboration.
Once we have medical documentation to support some functional capacity to return to the workplace, we request a return-to-work meeting with the CNESST, an independent ergonomist/occupational therapist (or sometimes the treating practitioner/therapist), the employee, and the employer. The CNESST typically assigns a rehabilitation agent to claims with challenging return-to-work needs. During the meeting, we discuss and prepare a return-to-work proposition to present to the treating physician, based on the patient’s functional abilities/restrictions.
Workers’ Compensation claims management in Quebec can be frustrating. However, ReedGroup Canada’s strategies and partnerships have paved the way to effective navigation of the Quebec medical model. Learn how we can make them work for you.
Information provided on this blog is intended for general educational use. It is not intended to provide legal advice. ReedGroup does not provide legal services. Consult an attorney for legal advice on this or any other topic.
Julie DesRochers leads ReedGroup Canada’s workers’ compensation team in Quebec. With more than 25 years of experience, she has established and optimized strategies to effectively manage Quebec’s medical model.
Backed by 20-plus years in workers’ compensation and occupational health, Melanie Leclerc, a senior case manager at ReedGroup Canada, specializes in navigating the medical model.