Policy
The WSIB pays health care providers for services rendered to workers according to the WSIB-approved schedule of fees. Also refer to 17-03-01, Health Care Fees.
Purpose
The purpose of this policy is to outline the special physician and health care fees the WSIB may authorize as a result of a work-related injury/disease.
Guidelines
Interview time with a physician
The WSIB pays physicians a flat fee for their interview time with WSIB representatives. The WSIB fee schedule is on wsib.ca.
Physician's emergency room facility
A fee for a physician's emergency room facility is paid if:
- a separate area, designated by the physician, is used for minor surgery or as a cast room, and
- ordinary materials, such as sutures, drugs, dressings, etc., are included in this fee.
Physician's consultation fee - specialty exam
Physicians who have completed training in their specialty but are waiting to write their specialty examinations and who are acceptable to the WSIB, are paid for consultations at the general practitioner consultation rate. Physicians, who provide consultations to other physicians and generate an appropriate consultation report, are paid at the general practitioner consultation rate.
Cancelled licence (registration) number
The WSIB does not pay accounts from physicians whose licence to practice has been cancelled by the College of Physicians and Surgeons of Ontario.
Deafness claim reports
The WSIB pays for medical reports which are used in the adjudication of occupational noise-induced hearing loss claims, even if the claims are subsequently rejected.
Skin donor
The WSIB pays a skin donor (heterodermic skin grafting), who suffers a loss of earnings:
- all hospital expenses, and
- $10.00 for each day in hospital.
Note
If, however, the donor requires a long period of hospitalization or, if infection develops, the decision-maker has the authority to pay after obtaining the medical consultant's advice.
Payment error/altered entitlement
For situations where an error was made in payment or if entitlement was altered, refer to 18-01-04, Recovery of Benefit-Related Debts.
Application date
This policy applies to all decisions made on or after December 5, 2024, for all accidents.
Document history
This document replaces 17-03-02 dated October 12, 2004.
This document was previously published as:
06-02-02 dated February 3, 1997.
References
Legislative authority
Workplace Safety and Insurance Act, 1997
Sections 32, 33, 131
Workers' Compensation Act, Revised Statutes of Ontario 1990
Sections 50, 72(1)
Approval
Consolidated Board Order
#23, April 15, 1957, Page 78A
Approved by the President and CEO on December 3, 2024.