Case Management

Disability Case Management Referral Form

Manager (or designate) to complete the Disability Case Management Referral Form (Not required for WCB Claims) for employees that are absent due to medical reasons for greater than 2 weeks (10 working days) or requesting medical accommodation.

REMINDER: If you are submitting a Disability Case Management Referral Form (above) to WRHA OESH due to an employee being off on a medical leave greater than 2 weeks (10 working days), you must also submit a LOA request to PHRSS in order to prevent future issues with employee benefits. Request For Leave of Absence – SH Forms Central

Additional Disability Case Management Documents:

• Operational Procedure – Reasonable Accommodation and Return to Work
• Employee Responsibilities & Procedures Quick Reference
• Modified Duty Form

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