Policy
The WSIB may authorize the purchase of one or more health care products that fall into the category of health care equipment and supplies when an injured worker requires the health care product(s) as a result of a work-related injury/disease.
The WSIB expects Ontario workers to purchase health care equipment and supplies from preferred suppliers that have entered into an agreement with the WSIB for the provision of these health care products to injured workers, refer to 17-01-07, Preferred Suppliers of Health Care Products and Services.
Purpose
The purpose of this policy is to outline the health care equipment and supplies the WSIB may authorize as a result of a work-related injury/disease and the criteria for reimbursement of purchases made.
Guidelines
This policy should be read in conjunction with 17-01-07, Preferred Supplier of Health Care Products and Services.
Definition
Health care equipment and supplies are products used:
- as a treatment or functional aid during the worker’s recovery, or
- to improve or maintain the worker’s independent living.
Health care equipment and supplies are products available off-the-shelf and do not require:
- complex modification, customization, fitting, precise sizing or adjustment, or
- a pharmacist or health professional to oversee the provision and purchase of the product.
Not included in health care equipment and supplies are:
- prescription, over the counter or off-the-shelf medications, and
- health care products which require complex modification, customization, fitting, precise sizing or adjustment.
Health care equipment and supplies include but are not limited to:
- crutches, tips
- back rests (e.g., Obus formes/seats)
- wrist supports/splints
- genito-urinary supplies
- toilet seats, commodes
- tub stools, grab bars
- walkers and accessories.
Refer to the complete list available on wsib.ca.
Entitlement criteria
The WSIB may authorize health care equipment and supplies prescribed by a health professional when all criteria are met:
- the claim is allowed and there is ongoing entitlement to benefits and/or services
- recent health care reports provide objective clinical findings, confirm the need for the health care equipment and supplies, outline treatment goals including duration of use and need
- the health care equipment and supplies are required as a result of a work-related injury/disease, and
- the health care equipment and supplies are used to treat and/or alleviate the effects of the work-related injury/disease, or are used to improve or maintain the worker’s independent living.
Prescriptions
Workers must provide the WSIB with the original prescription for all health care equipment and supplies. If a prescription is not approved by the WSIB, a new original prescription must be provided if approval is requested again in the future.
A new prescription is also required if a request is made for a different type of health care equipment and supplies.
The prescription must be provided by the treating health professional, who cannot be the same person as the dispenser of the health care equipment and supplies.
Criteria for payment
The WSIB pays for a worker’s prescription health care equipment and supplies, in an allowed claim where there is ongoing entitlement to benefits and/or services, if the health care equipment and supplies:
- meet the entitlement criteria, set out in this policy, and
- are approved by the WSIB.
Approval before purchase
Before purchasing new or replacement prescription health care equipment and supplies, workers should get approval from the WSIB for all of the following:
- the health care equipment and supplies
- the cost, and
- the supplier/provider.
Requesting approval before purchase is important:
- If the WSIB does not authorize the purchase, refer to "Entitlement criteria", the WSIB is not responsible for the cost of the health care equipment and supplies.
- If the price exceeds the amount that would be authorized by the WSIB, the WSIB is not responsible for the costs above the amount authorized.
For additional information, refer to 17-01-07, Preferred Supplier of Health Care Products and Services, “Exceptions to the general rule - Purchases made prior to claim allowance”.
Purchase from preferred suppliers
Workers are expected to purchase health care equipment and supplies from organizations which have entered into an agreement with the WSIB for the provision of these products to injured workers, refer to 17-01-07, Preferred Supplier of Health Care Products and Services.
Use of the preferred suppliers ensures the worker will not have to pay to obtain the authorized and approved health care equipment and supplies. The WSIB will pay the preferred supplier directly.
Exceptions to use of preferred suppliers
Payment for the purchase of authorized and approved health care equipment and supplies will only be made to workers or non-preferred suppliers in exceptional circumstances described in “Exceptions to the general rule” in 17-01-07, Preferred Supplier of Health Care Products and Services.
Repairs and replacements
The WSIB may approve requests for repairs or replacement of health care equipment and supplies if:
- the WSIB previously approved and paid for the health care equipment and supplies
- the claim is allowed and there is ongoing entitlement to benefits and/or services, (i.e., ongoing loss of earnings benefits, permanent disability/impairment is present or likely)
- recent health care reports provide objective clinical findings, confirm the continuing need for the health care equipment and supplies, outline treatment goals including duration of use and need
- the health care equipment has deteriorated due to regular or heavy use, but not damaged as a result of the worker's negligence, and
- a request for a replacement is accompanied by a new prescription.
All of these criteria need to be met in order for the WSIB to approve repairs or replacements.
Note
The approval process under “Repairs and replacements” also has to be followed if, as the result of a change in the worker’s clinical condition, a request is made for a different type of prescription health care equipment and supplies.
Exception
If there is evidence the health care equipment and supplies were deliberately damaged, misused or the warranty requirements or operating instructions were not properly followed, the WSIB will not authorize or pay to repair or replace the health care equipment and supplies.
Application date
This policy applies to decisions made on or after December 5, 2024, for all purchases of health care equipment and supplies made on or after March 3, 2008, for all accidents.
Document history
This document replaces 17-07-06 dated April 6, 2009.
This document was previously published as:
17-07-06 dated March 3, 2008.
References
Legislative authority
Workplace Safety and Insurance Act, 1997
Sections 32, 33(1)(2)(3)(5)(6)(7)
Workers' Compensation Act, Revised Statues of Ontario 1990
Sections 50(1)(2)(3)(4)(6)(7)
Approval
Approved by the President and CEO on December 3, 2024.