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Policy: Role of Physicians in Certifying Illness and/or Assessing Capacity for Work

The purpose of a medical slip is to verify an illness/injury to an employer or insuring agency and to provide relevant information to enable the patient/employee to return to work as soon as medically possible.

Employers and their insurers will be relying on the information provided to them and in so doing, they may incur financial liability for sick leave, or disability pay. The employer is also relying on the physician's opinion that the employee is fit to return to work. Misinformation, or erroneous opinions, could result in harm to those relying on this information.

  1. Some illnesses/injuries may impair a person's capacity to do their regular work or alternative work. However, planning for return to work should begin at the first visit. A patient's limitations should be evaluated and emphasized to him/her. Work and other activities should be encouraged within the patient's evolving limitations.

  2. With respect to worker injury/illness incurred in the workplace, the procedures defined by the Workers' Compensation Board (WCB) apply.

  3. With respect to brief (i.e. several days) worker absence from the workplace due to injury/illness not incurred in the workplace, an employer may require written documentation from the physician of the worker's injury/illness.

  4. With respect to more severe worker injury/illness, an employer may require an objective physician evaluation of the worker's functional limitations to guide return to work (RTW) decisions.

  5. In each of these situations, the responsibility of the physician is to do an objective evaluation and to report the impact of an injury/illness and the limitations that the patient/worker's injury/illness places on their ability to perform certain functions.

  6. It is the responsibility of the employer to manage the worker's return to modified or usual work duties with the benefit of objective professional input from physicians and/or other health care professionals.

  7. To the extent that it is possible, functional capacity and limitations should be assessed objectively. It is, however, recognized that in formulating any professional opinion regarding a patient's/worker's functional capacity or limitations, a physician may be substantially reliant upon information from the patient/worker regarding subjective elements related to their injury such as pain, anxiety or dizziness.

  8. Some forms of restriction may delay healing and could lead to prolonged symptomatology and can also leave the impression that any activity beyond the limit is harmful or dangerous and may lead to permanent disability.

  9. It is prudent to avoid long-term prognostic opinions but rather to re-evaluate an injured worker's functional capacity at regular intervals. Many employers can align a modified job if they know an employee's capabilities and/or restrictions and will be counting on a physician's report to enable this process. An employer needs to know approximately when they can reasonably expect an employee to be able to return to their regular duties. This way they can properly manage and plan for the changes in their workplaces. They will generally be looking to the physician for an anticipated return to an employee's regular work date.

  10. With respect to brief self-limiting injury/illness, physicians are advised to use the "sick slip" prototype developed by the Saskatchewan Medical Association (SMA) or a similar reporting format. If a physician has not attended a patient professionally during the period of illness, no document should be signed that may infer they had.

  11. With respect to more extensive illness/injury that may involve early return to work with modified strategies, the following sequence of assessment and reporting is recommended:

    1. At the time the injured/ill patient attends a physician an initial form is completed and returned to the employer indicating the nature and extent of the condition and functional limitations.

    2. The employer discusses a modified work option that might allow the employee to return to work.

    3. The employer sends a summary of the modified work plan with the employee to the physician for review.

    4. The physician certifies the ability of the patient to undertake the proposed modified work plan and establishes and appropriate date for review.

    5. Following review, the patient/employee may increase the scope of work as the limitation of the medical condition allows.

  12. Any release of information to an employer should be strictly on a "need to know" basis, limited to the worker's injury/illness and only after the patient has provided a signed consent for the release of such information.