Contracted psychology provider's initial counselling report.
- Completed by
- WCB-authorized psychologist or master's-level social worker
- Issued by
- WCB-Alberta
- Format
- Word document
- Language
- English
WCB Alberta C1392: Mental Health First Report
Psychologists and social workers send this report to WCB-Alberta when a client says a psychological condition was caused, at least in part, by something at work and it has kept or will keep them off work or from regular duties. It is due within 48 hours of suspecting a work-related condition, is completed once per client, and starts a claim that an adjudicator then investigates.
Who completes it
The psychologist or clinical social worker who suspects the work-related condition completes and signs the whole report. The Act's reporting duty covers anyone licensed under the Health Professions Act to practise the healing arts in Alberta.
Submitting and payment
- How to submit it
- Contracted community psychology providers report through myWCB psychology electronic injury reporting; other providers complete the C1392 Word form and send it to WCB-Alberta within 48 hours of suspecting a work-related condition.
- Who pays
- WCB-Alberta pays the report under fee code PSYRF01 for contracted providers or PR08 for non-contracted providers, ticked in the form's billing section.
Good to know
- A DSM diagnosis is not needed to report; after one session you can describe symptoms or use terms such as work-related stress, though acceptance eventually requires a DSM diagnosis.
- The duty to report under section 34(1) of the Workers' Compensation Act applies even if the client expressly refuses disclosure to WCB.
- If reporting stays outstanding, WCB-Alberta may raise the concern with your College or withhold payment for your services until the report is received.
- The report includes a suicide risk rating, at least one psychosocial measure such as the BDI, BAI or HADS, current medications and any substance use concerns.
Get the official form
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Mental Health First Report - C1392
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Frequently asked questions
When do psychologists have to report to WCB Alberta?
When a client reports their psychological condition was caused, in whole or in part, by something at work, and the symptoms have kept them off work for more than a day, stop them doing their regular duties, or are likely to. Report within 48 hours of suspecting a work-related condition; there is no statute of limitations on provider reporting.
What happens after WCB receives the Mental Health First Report?
WCB-Alberta creates a claim, and an adjudicator contacts the worker and employer for more information. If it supports a compensable work-related condition, the claim is accepted and benefits begin. Stress from the normal pressures of work, such as a performance evaluation, would likely not be covered, while symptoms after a traumatic event at work may be.
Should I report if I'm not sure my client is covered by WCB?
Yes. WCB-Alberta's guide says meeting the duty includes reasonable efforts to confirm your client is a worker, so ask whether they are covered. If you remain unsure, report anyway and WCB will help determine whether the client is a worker covered under the Act. Clients normally have 24 months after an injury to make a claim.