This section summarizes Part IV of the Workplace Safety and Insurance Act, 1997 as it relates to health professionals.
- Definition of health care-what does it include?
- Health Exams
- Fees and Billing
- Reporting Requirements
Definition of health care
The Workplace Safety and Insurance Act refers to health care as all or any of the following:
- Professional services provided by a health care practitioner
- Services provided by hospitals and other health care facilities
- Prescription drugs
- Services of an attendant
- Modifications to a person's home or vehicle, as well as other measures that facilitate independent living for an injured worker
- Assistive devices and prostheses
- Extraordinary transportation costs to obtain health care
- Appropriate measures to improve the quality of life of severely impaired workers
Health exams may be requested by the WSIB.
We may require a worker receiving benefits to have a medical exam by a health care professional selected and paid for by us.
Health exams may be requested by the worker's employer.
An employer may request that a worker have an examination by a health care professional selected and paid for by the employer.
Fees and billing
Who do I bill for health care for a workplace-related injury?
The WSIB should be billed for all health care related to claims allowed for a work-related disability.
Is there a specific time frame for billing?
All billings and reports should be sent to the WSIB as soon as possible, since late billings may be reduced. Consult the Information for Health Professionals Billing the WSIB (416k, pdf) document.
Who decides what may be paid by the WSIB?
We determine what health care is necessary, appropriate, and sufficient, and the fee payable.
What's your responsibility?
Under the Act, you are required to provide us with any information we need regarding a worker's health care. You do not need a medical waiver to release this information to us.
Access to relevant medical information in a timely manner helps workers receive the right treatment at the right time without delays, facilitating an early and safe return to work/function.
- Under section 37(2) of the Workplace Safety and Insurance Act, waivers are not required to release medical information to the WSIB regarding the worker
- The Public Hospitals Act and Regulation 965/90 recognize our authority to compel every hospital or health facility to disclose medical information without the worker's consent
Functional Abilities Form (FAF)
What is your responsibility?
The WSIB is encouraging communication of functional abilities information between the workplace parties and the health professional. The health professional's provision of the FAF will assist in achieving a positive return to work outcome. The FAF allows your patient to consent to the release of functional information in support of this communications process.
The health professional is required under the Act to provide us with any information we need regarding a worker's health care.
The worker or an employer may request a Functional Abilities report
A Functional Abilities Form (FAF) for Early and Safe Return to Work (370k, pdf) provides information about a worker's abilities. The worker and employer will use this information as a tool for planning the worker's return to suitable work. These forms should only be initiated by the employer or the worker and, ideally, should only be completed when the worker is functionally able to return to work. Only regulated health professionals can complete the FAF.
When you have completed the Functional Abilities Form, please provide pages 2 and 3 to the worker and/or employer. This report should notinclude any diagnostic or confidential information, only functional abilities information. For more on how to complete the Functional Abilities Form, please refer to the Guide to Completing the FAF (239k, pdf).
Is completion of a Functional Abilities Form billable?
Yes. We pay a set fee for completion of the WSIB Functional Abilities Form. For billing purposes, please fax or mail pages 2 and 3 to the WSIB. (Note: Employers may request functional abilities information on a form of their own design. In this case, the employer must pay you directly for the completion of the form).