The WSIB pays temporary total disability/loss of earnings benefits to workers who incur a wage loss due to absence from work for health care reasons.
"Absence from work" means time off from the worker's normally scheduled working hours.
"Health care reasons" means consultation with, examination by, or treatment from a health care practitioner, relating to a work-related injury or disease, and includes instances when a worker
- is requested by the WSIB to report to a WSIB office, or any practitioner, specialist, or clinic for interview, examination, or to complete a WSIB form
- arranges an appointment with a practitioner, providing that the appointment is medically justified and does not constitute an unauthorized change in health professionals and is solely for purposes of examination, with appropriate reports submitted
- is supplied by the WSIB with an artificial appliance and is required to lose time from work for the purpose of repairs, refitting, or the replacement of the artificial appliance, or
- undergoes a practitioner's treatment requiring the worker's absence from work provided that the appropriate reports are submitted.
An employer cannot avoid a lost time claim by reimbursing a worker for lost wages as a result of missing time from work for health care appointments. The WSIB considers such payments to be advances and reimburses the employer. For more information, see 18-01-11, Compensation Advances by Employer. Employers making such payments to workers are not exempt from reporting the lost time to the WSIB.
The WSIB compensates workers for lost wages due to health care appointments in claims that are not yet allowed if the health care appointment is pre-authorized. Attendance at such appointments is pre-authorized if the worker has made a claim and there is sufficient information in the file to warrant the WSIB requesting that the worker undergo special health care investigations or examinations so that a determination of entitlement to benefits may be made.
"Sufficient information" includes an opinion from the worker's treating health professional about the condition that, in the decision-maker's view, indicates that there may be grounds for allowance of the claim, but that is not sufficient for actual allowance of the claim.
If the claim is subsequently denied, lost wages are paid fully without deduction for CPP, Employment Insurance, and income tax.
This policy applies to all decisions made on or after April 1, 1989, for all accidents.
This document replaces 17-01-05 dated October 12, 2004.
This document was previously published as:
06-01-05 dated November 4, 1991
06-01-05 dated March 29, 1996.
Workplace Safety and Insurance Act, 1997, as amended
Sections 43, 56
Workers' Compensation Act, R.S.O., 1990, as amended
Sections 37(1), 45
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