The purpose of this policy is to:
This policy applies to injured workers who require rehabilitation.
Rehabilitation is a planned, yet flexible process that requires a cooperative, multidisciplinary approach to support workers injured in an accident arising out of and in the course of employment, in achieving medical recovery and return to work goals.
Plans for rehabilitation may include a range of benefits and/or services provided under the authority of the Workers’ Compensation Act (WC Act). Depending on the injured worker’s eligibility, the following may be integrated into the rehabilitation plan:
1.1 Medical Aid
WorkSafeNB has a legislated responsibility to determine the need for medical aid, as well as the type and extent of medical aid required. In providing rehabilitation, WorkSafeNB is committed to injured workers receiving the right care (based on the right diagnosis), by the right provider, and at the right cost.
Medical aid may include, but is not limited to, treatment and ongoing care of workplace injuries or diseases. It may include the services of physicians, specialists, and other health care providers, who may provide therapy, medications, and prosthetic and/or assistive devices as required and in accordance with WorkSafeNB’s medical aid policies.
For more information, see Medical Aid policies such as:
1.2 Financial Assistance
WorkSafeNB also operates a wage loss compensation system, which means that rehabilitation planning focuses on services, programs, and activities that will help minimize injured workers’ loss of earnings by assisting them to return to suitable employment. Injured workers may receive financial assistance such as loss of earnings benefits and compensation for permanent physical impairment.
For more information, see policies such as:
1.3 Return to Work Activities
WorkSafeNB may provide injured workers with appropriate and cost-effective rehabilitation to lessen or remove barriers resulting from the injury, which limit opportunities for injured workers to return to work.
Return to work activities promote early and safe return to work as part of the therapeutic process of recovery from workplace injury or disease. It is also recognized that, when safe to do so, staying at work during treatment is beneficial physically, psychologically and financially for injured workers. For workers who are unable to stay at work following a workplace injury, rehabilitation focuses on facilitating return to work at a suitable occupation, including gradual or modified return to work programs on a time-limited basis, and/or assisting with workplace modifications needed to accommodate a work-related disability.
For more information, see Policy No. 21-420 Return to Work – Principles.
2.0 Achieving Rehabilitation Goals
The overall goal of rehabilitation is to help injured workers achieve:
Consistent with Policy No. 21-420 Return to Work – Principles, WorkSafeNB’s rehabilitation goals focus initially on helping injured workers safely continue with their pre-accident employment, or return to the pre-accident employment and/or employer as early as possible.
However, when this is not possible due to a permanent work restriction, WorkSafeNB’s rehabilitation goals become focused on helping injured workers develop the capacity to re-enter the workforce to obtain employment:
In some cases, return to work may be impossible or unlikely. Therefore, throughout the rehabilitation process, WorkSafeNB determines if further treatment or services are appropriate by:
WorkSafeNB is responsible to decide if a specific rehabilitation activity will significantly improve an injured worker’s function. This is achieved by analyzing, on a case-by-case basis, information gathered based on the criteria listed above and all other relevant medical evidence. If WorkSafeNB determines that significant improvement in function is not expected from the activity, WorkSafeNB does not approve the rehabilitation requested. For more information, see Policy No. 21-113 Decision Making.
However, WorkSafeNB may provide specific services to severely injured workers to promote independent living to the extent possible, given the compensable injury. These services are based on the following policies:
2.1 Responsibilities in Rehabilitation
WorkSafeNB develops rehabilitation plans in cooperation with the injured worker, employer, health care providers, physicians, and other parties involved, such as unions, in order to set return to work goals and objectives that are compatible with the medical, functional, and vocational status of the injured worker.
To be successful, rehabilitation plans require active participation and open communication on a regular basis among all parties involved in the rehabilitation process. For more information, see Policy No. 21-419 Communications in Rehabilitation.
Injured workers and accident employers have legislated responsibilities under the WC Act to cooperate in the worker’s safe and early return to work. Accident employers, for their part, have an obligation under the WC Act to re-employ injured workers, and a broader duty to accommodate under the Human Rights Act. WorkSafeNB expects:
For more information, see:
3.0 Phases of Rehabilitation
Since rehabilitation must be flexible and designed to meet individual workers’ needs, services within the medical, financial, and return to work components of rehabilitation may be provided simultaneously or at various times in the care and management of a worker’s injury.
To facilitate the rehabilitative process, WorkSafeNB has identified three phases of rehabilitation (acute, sub-acute, and chronic), which correspond to the phases of recovery from injury described in Policy No. 25-002 Medical Aid Standards of Care.
Most injured workers do not go through all phases. Also, not all injured workers progress from one phase to the next in a predictable or sequential manner. The actual timing of interventions and rehabilitation activities may vary according to the injured worker’s medical condition and rate of recovery. For example, activities associated with one phase may be more appropriately initiated at an earlier phase.
Though subject to the specifics of each individual case, rehabilitation generally falls into these three phases of activity.
3.1 Phase I – Acute
In the acute phase of the injury, WorkSafeNB works closely with physicians and health care providers in order to:
In many cases, services provided during this initial phase, such as medication and physiotherapy, are sufficient to enable injured workers to continue working, or return to work within the disability duration guidelines for their injury type. WorkSafeNB may also provide assistance for workplace modifications, as determined by WorkSafeNB to be necessary, appropriate, and expedient during this phase.
When injuries are severe or complex, or if the injured worker has not returned to work within the disability duration guidelines, the case moves into the next phase of rehabilitation and case management.
3.2 Phase II – Sub-acute
Generally, this phase of rehabilitation begins when the expected disability duration has elapsed and the injured worker requires additional treatment in order to progress with return to work activities.
WorkSafeNB works with physicians, health care providers, employers, and return to work specialists, as needed, to:
The key interventions during this phase are to determine what factors may be impeding the injured worker’s return to work, and to confirm re-employment opportunities for the worker with the accident employer.
Some of the factors influencing whether the injured worker is likely to return to work with the accident employer are:
3.3 Phase III – Chronic
Generally, the chronic phase begins when healing times for an injury have elapsed. Healing times refer to the point in time when medical healing is usually complete and the medical condition is relatively stable, whereas disability duration in Phase II refers to the point in time when most workers with a particular injury are able to return to work.
WorkSafeNB provides on-going treatment when there is evidence of its medical effectiveness in restoring function and supporting the worker’s return to suitable employment, either with the accident employer or an alternate employer.
If an injured worker has not returned to work when the healing time has elapsed, WorkSafeNB determines whether the worker has a permanent work restriction. WorkSafeNB determines if a work restriction exists by reviewing medical evidence and/or using a range of objective assessments (for example, functional capacity assessments).
If the preponderance of evidence shows that the worker:
When further treatment will not improve the worker’s medical condition (i.e., medical condition has reached a plateau), most injured workers who are still unable to return to work will have an identified work restriction.
When an injured worker has a permanent work restriction and the accident employer can accommodate it, WorkSafeNB may provide:
If the accident employer cannot or is not willing to accommodate the worker’s permanent work restriction, the injured worker is then eligible for vocational rehabilitation. Vocational rehabilitation plans are interdisciplinary, unique to each individual, and take into consideration such factors as the severity of the worker’s injury and any resulting loss of earnings due to the work restriction, functional capacity, transferable skills, educational level, aptitudes, and interests.
For more information, see Policy No. 21-421 Vocational Rehabilitation.
3.4 Conclusion of Rehabilitation
Rehabilitation or rehabilitation plans may be brought to an end or suspended at any time during the phases when:
4.0 Documenting the Rehabilitation Plan
The rehabilitation plan is a tool used through all phases of rehabilitation to organize, record, and evaluate the injured worker’s progress. Each plan is unique, time-specific, and clearly outlines responsibilities and expectations in rehabilitation.
At a minimum, an injured worker’s rehabilitation plan should:
5.0 Monitoring and Adjusting Rehabilitation Plans
WorkSafeNB expects rehabilitation planning to be a continuous process of planning, monitoring, evaluating, and then adjusting the plan to reflect the injured worker’s progress and any changes to goals and measures.
WorkSafeNB regularly monitors the medical, financial, and return to work aspects of the rehabilitation plan, including re-employment activities facilitated by accident employers.
In monitoring rehabilitation plans, WorkSafeNB reviews whether:
As a result of the on-going monitoring and review of the plan, WorkSafeNB may:
6.0 Injuries During Rehabilitation
Injured workers who suffer an injury or recurrence of injury while participating in a WorkSafeNB-approved rehabilitation program or return to work activity may be entitled to continued benefits, if the tests for entitlement are satisfied. For more information, see Policy No. 21-108 Conditions for Entitlement - Injuries During Rehabilitation.
Policy 21-421 Vocational Rehabilitation
Appeals Tribunal – means the Workers’ Compensation Appeals Tribunal established under the WHSCC & WCAT Act.
Disability duration – that interval of time, following an injury or surgery, after which 70-75% of persons are able to return to work.
Functional capacity – the ability of an injured worker to productively perform the tasks of the pre-accident employment (with or without accommodations) or alternate employment.
Healing time – that interval of time following an injury or surgery, after which anatomical impairment has healed.
Medical aid – includes medical, surgical and dental aid, hospital and skilled nursing services, services of a registered chiropractor within his legal jurisdiction, artificial members and apparatus including the repair and replacement thereof, transportation, clothing allowances with respect to damage caused to clothing as a result of the use of an artificial apparatus or as a result of any accident, and such other treatment, services or attendance as are necessary as a result of any injury.
Rehabilitation – for the purpose of this policy, rehabilitation is a planned, flexible process that requires a cooperative, multidisciplinary approach to support injured workers in achieving medical recovery and return to work goals. It integrates medical aid, financial assistance such as loss of earnings benefits, and return to work activities.
Return to work – the act of re-introducing injured workers to safe and productive employment that eliminates or minimizes wage loss, as soon as medically possible.
Suitable employment – appropriate employment that a worker who suffered a personal injury by accident is capable of doing, considering the worker’s physical abilities and employment qualifications and which does not endanger the health, safety or physical well-being of the worker. (WC Act)
WorkSafeNB – means the Workplace Health, Safety and Compensation Commission or "the Commission" as defined by the WHSCC & WCAT Act.