Policy
Severely impaired workers may be entitled to independent living devices that cost more than $250 per item, and are not intended to accomplish any of the objectives of the services covered under the independent living allowance, see 17-06-02, Independent Living Allowance.
Devices that cost less than $250 are considered to be reimbursed through the independent living allowance (see exception, below).
Guidelines
For a definition of severely impaired workers, see 17-06-02, Independent Living Allowance. For up-to-date dollar figures, see 18-01-02, Benefit Dollar Amounts - Accidents from 1998.
Entitlement criteria
The WSIB reimburses a severely impaired worker for a device if it
- helps restore a worker's ability to
- communicate
- be mobile
- engage in self-care
- avoid further injury, or
- prevent future health complications due to the work-related injury
- is not intended to accomplish any of the objectives of the services covered by the independent living allowance (if the worker is receiving the allowance)
- meets a permanent or long-term need
- is appropriate, given the nature of the worker's impairment and functional limitations (e.g., it can be used safely and effectively)
- is prescribed or recommended by a health care practitioner
- is reasonable in terms of costs and anticipated benefits
- is cost-effective considering alternatives on the market
- meets performance standards generally accepted by medical or clinical rehabilitation specialists, and
- is certified by Canadian Standards Association International (C.S.A.I.) or meets other applicable safety standards.
Eligible devices
These include
- automatic page turners
- "Easylift" or "Veculator"-type chairs
- environmental controls
- hobby/sports equipment
- modification or purchase of suitable bicycles
- motorized scooters
- personal computers to enhance communication, and for therapeutic reasons for workers with severe head injuries
- remote vehicle starters
- special alert telephones
- special prosthetic devices
- hospital beds, chairs, mattresses, and
- sports wheelchairs.
NOTE
This list is not exhaustive.
Hospital beds
The WSIB may provide hospital beds to workers if their injury requires that they be moved frequently and this cannot be done without mechanical help.
In cases where a hospital bed is not necessary, the WSIB may provide a specialty mattress if it is prescribed for the worker's work-related condition. This does not include basic orthopaedic mattresses.
Medical conditions that could require the use of a hospital bed or mattress include severe burns, lung cancer, mesothelioma, lower extremity amputations, hip disarticulation, paraplegia, quadriplegia, hemiplegia, recurrent bed sores, or ulcerations that do not respond to other treatment.
If a worker requires a hospital bed or mattress, decision-makers consider entitlement to a model that corresponds to the size of the bed the worker currently uses (i.e., a double bed to accommodate a spouse).
Entitlement to a hospital bed or mattress includes the purchase of specialty sheets, if required. This does not include standard sheets (e.g., double, queen, king).
The bed may have additional features such as heating or vibration if the decision-maker determines that these features are medically necessary forms of treatment for the worker.
Hobby equipment
If the impairment prevents a severely impaired worker from pursuing a hobby, the WSIB may provide hobby equipment specially designed or adapted to the worker's needs, for one hobby only. Workers may use the independent living allowance to purchase additional hobby equipment.
Exclusions
The WSIB does not reimburse workers under this policy for items that achieve the same objectives as the services covered by the independent living allowance.
For example, this policy does not cover payment for riding lawn mowers, tractors, snow blowers, home exercise equipment, etc., because the independent living allowance covers these needs.
Pre-authorization
Workers should get approval from the WSIB before purchasing an independent living device. If they purchase a device without pre-authorization, and the device is not approved, the worker will not be reimbursed.
In some cases, the WSIB may require workers to purchase a device from an approved vendor.
The WSIB processes payment upon submission of receipts from workers, or invoices from vendors.
Maintenance/repair
The WSIB pays for maintenance, normal inspection, repair, and replacement of independent living devices (that cost over $250) unless the damage is due to misuse or to not following the warranty or operating instructions. Workers must ensure proper maintenance is carried out.
Application date
This policy applies to all decisions made on or after November 1, 1998, for all accidents.
Document History
This document replaces 17-06-03 dated October 12, 2004.
This document was previously published as:
17-06-03 dated June 15, 1999.
References
Legislative Authority
Workplace Safety and Insurance Act, 1997, as amended
Sections 32, 33
Workers' Compensation Act, R.S.O. 1990, as amended
Section 50
Minute
Administrative
#2, September 18, 2009, Page 476