Mild Traumatic Brain Injury Program of Care (mTBI POC) Frequently asked questions

Program overview

Is the mTBI program of care mandatory as the first line of care, similar to other programs of care?

Yes, injured people with an allowed claim for mTBI must be treated through the mTBI POC. The mTBI POC provides evidence-based care to help them recover and return to work, and enables early identification of people who need specialized services. 

What is the Clinical Expert Line and what is a Clinical Expert’s role?

The Clinical Expert Line is a WSIB phone line health care providers can call to discuss questions about specific claims for injured people they are treating through a program of care. A Clinical Expert is a regulated health care professional who can discuss aspects of the claim such as diagnosis, appropriate treatment, and barriers to recovery. Clinical Experts will help health care providers to determine the suitability of a program of care for an injured person they are treating. They can provide an opinion on next steps when an injured person’s response to treatment is not progressing as expected. 

Program eligibility and admission requirements

How should a health care professional proceed if they assess an injured person and determine that they do not meet the mTBI program of care admission requirements?

The health care professional should contact the WSIB Clinical Expert to discuss the case and determine the best way to proceed. The WSIB Clinical Expert may suggest referral for specialized services or further assessment to determine what care is required. To speak with a Clinical Expert, health care professionals should call the WSIB Clinical Expert Line at 1-866-716-1299 or 416-344-5739.

What is an allowed claim? How would a health care professional or injured person know if a claim has been allowed?

An allowed claim for a work-related injury is one that the WSIB has registered, reviewed and accepted. An allowed claim may have entitlement to health care benefits, such as treatment in a program of care.

To determine whether an injured person has an allowed claim, a health care professional should ask the injured person whether the injury is work-related. If it is, the health care professional should confirm that the injured person has registered a claim with the WSIB and, if they have, whether they have received a claim number and their claim has been allowed.

The assignment of a claim number does mean that a claim has been allowed. 

If the injured person’s claim status is uncertain, the injured person or the health care professional can call the WSIB at 1-800-387-0750 or 416-344-1000 to verify the status of the claim. The WSIB will not pay for services delivered to people whose claims are not allowed.
 

Program delivery and structure

What happens if a provider assesses an injured person and determines that they need vestibular rehabilitation, but the provider cannot complete it within their scope of practice?

The mTBI program of care provider should contact the WSIB Clinical Expert Line to discuss referral for specialized assessment and interdisciplinary treatment.

What is the length of the mTBI program of care and how many visits must be completed?

The mTBI POC lasts up to eight weeks consisting of two four-week blocks. The minimum number of visits is five in the first block and four in the second. The first block is expected to require more sessions because the initial assessment and a significant portion of education are delivered during the first four weeks of treatment. 

What if the injured person needs fewer than the minimum number of visits and is discharged before completing the minimum number of visits?

If the injured person has reached recovery or been discharged for any reason before completing an mTBI POC block, resulting in fewer than the minimum number of visits being completed, the WSIB will pay the provider for 50 per cent of the block.

Can more than one regulated health care professional provide treatment under the mTBI program of care?

The mTBI POC may be delivered by an interdisciplinary team, but only one health care professional or clinic may submit bills for the treatment. Only one report for each of the reporting requirements should be submitted. If more than one health care professional is involved in care, all of them should collaborate on the report. 

Can an injured person change to another provider after they have started receiving treatments in the mTBI program of care (POC) with another?

An injured person who has received partial treatment in the mTBI POC and wishes to continue treatment with another provider must obtain approval from the WSIB Case Management Team. The WSIB Case Management Team can be contacted at 1-800-387-0750 or 416-344-1000

Does treatment in the mTBI program of care (POC) include treatment for neck injury resulting from the mTBI?

Yes. The mTBI POC includes treatment for the neck, so the musculoskeletal program of care does not need to be delivered for neck treatment related to mTBI.

If an injured person has another area of injury in addition to their mTBI, can they receive treatment in more than one program of care (POC)?

Yes. An injured person may receive treatment in a maximum of two different POCs if they meet the admission criteria for each POC.

If the provider believes the nature of the multiple injuries needs further consideration, or if there are exceptional circumstances, the provider should contact the WSIB Clinical Expert Line at 416-344-5739 or 1-866-716-1299 to discuss the case.
 

Communication with the WSIB

Can providers extend treatment if the injured person has reached the end of the mTBI program of care but not achieved return-to-work and recovery goals?

If the provider expects the injured person to need further treatment or services upon completion of the mTBI POC, the provider should contact the Clinical Expert to discuss the claim and evaluate the need for a referral to a WSIB Occupational Health Assessment Program or Specialty Program. WSIB Clinical Experts can be contacted at 1-866-716-1299 or 416-344-5739.

When the injured person needs additional treatment in the community, it can be completed through the Supplementary Block of treatment within the mTBI POC. The provider must submit a Supplementary Report upon the completion of the block. 

Are there any points when providers must contact the WSIB?

A provider must call the WSIB at the end of block 1 should the injured person have no detectable change on the Patient Specific Functional Scale (required in mid-point report) and/or if the provider is recommending vestibular rehabilitation at that time. 

If the injured person’s recovery is not progressing as expected at any time during treatment through the mTBI program of care, the provider must call the WSIB Clinical Expert Line (1-866-716-1299 or 416-344-5739).