Policy
The WSIB may pay for a special surgical operation or health care treatment for a worker if, by doing so, substantial payments under the insurance plan can be avoided. The cost of the operation or treatment may be paid from either the insurance fund or by the Schedule 2 employer.
Guidelines
Pre-January 2, 1990
For accidents which occurred before January 2, 1990, the WSIB considers paying the cost of treatment for non-work-related conditions if all of the following conditions are met
- the worker has, or will likely have, a permanent disability resulting from the work-related injury
- the worker suffers from a non-work-related medical condition that increases the impact of the work-related injury and, therefore, the cost of any future permanent disability payments, and
- a significant cost savings to the insurance fund is expected as a result of the treatment.
To determine if the WSIB will pay for treatment, the decision-maker considers whether
- there is, or likely will be, a permanent disability resulting from the work-related condition, and
- the proposed treatment is likely to lessen the impact of the work-related injury and reduce the degree of the permanent disability.
Post-January 2, 1990
For accidents occurring after January 2, 1990, the WSIB considers paying the cost of treatment for non-work-related conditions if the following conditions are met
- the worker suffers from a non-work-related condition that delays, impedes, or prevents recovery from the work-related condition
- the non-work-related condition will increase, or is likely to increase, the degree of the worker's permanent impairment, and
- a significant cost savings to the insurance fund is expected as a result of the treatment.
For post-January 2, 1990 claims, treatment costs for non-work-related conditions may be paid even though the work-related injury may not result in a permanent impairment. Payment may be considered at any time following the occurrence of a work-related injury.
Payment for treatment
If payment for treatment is allowed for either pre-or post-1990 claims, the decision-maker notifies the worker in writing that
- the WSIB will pay for treatment of the non-work-related medical condition for a limited period of time only, and
- there is no entitlement under the Act for the non-work-related condition.
Application date
This policy applies to all decisions made on or after August 13, 1990, for all accidents.
Document History
This document replaces 17-03-04 dated June 15, 1999.
This document was previously published as:
8.4* dated January 1, 1998
06-02-09* dated August 13, 1990
* documents were replaced by 17-03-04 dated June 15, 1999.
References
Legislative Authority
Workplace Safety and Insurance Act, 1997, as amended
Section 33
Workers' Compensation Act, R.S.O. 1990, as amended
Section 24
Minute
Administrative
#4, June 18, 2004, Page 372