Special Physician and Health Care Fees - Archived December 5, 2024

Policy

The WSIB pays health care providers for services rendered to workers according to WSIB-approved schedule of fees. See also 17-03-01, Health Care Fees.

Guidelines

Interview time with a physician

The WSIB pays physicians a flat fee for their interview time with WSIB representatives. The fee is found in the WSIB Fee Schedule - Physician. See the WSIB website at www.wsib.on.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
$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, see 18-01-04, Recovery of Benefit-Related Debts.

Application date

This policy applies to all decisions made on or after January 1, 1993, for all accidents.

Document History

This document replaces 06-02-02 dated February 3, 1997.

References

Legislative Authority

Workplace Safety and Insurance Act, 1997, as amended
Sections 32, 33, 131

Workers' Compensation Act, R.S.O. 1990, as amended
Sections 50, 72(1)

Minute

Consolidated Board Order
#23, April 15, 1957, Page 78A

Administrative
#13, June 30, 2004, Page 386