WSIB

The WSIB was created by Ontario government legislation and is responsible for administering the Workplace Safety and Insurance Act (WSIA). WSIB is funded by the employers of Ontario. Employers pay premiums for no-fault collective liability workplace insurance. Under this system, workers give up the right to sue as a result of their work-related injuries, in return for guaranteed compensation and benefits for accepted claims. In turn, employers are protected from lawsuits.

The OCA works closely with the WSIB to advocate on behalf of chiropractors and to make relevant information available to our member in a timely manner. On this page you will find relevant information about the WSIB and its work.

Determining the Status of a WSIB Claim

There are some early steps you can take to determine the status of a work related claim in terms of your ability to proceed with assessment and/or treatment.

Non-Surgical Fracture Episode of Care

An Episode of Care (EOC) is a new WSIB payment model to bundle health care services together for a particular diagnosis. The Non-Surgical Fracture EOC is for workers who sustained a fracture on or after May 31, 2017, which did not require surgical intervention. The Non-Surgical Fracture EOC is delivered by regulated health professionals if their scope of practice includes the treatment of non-surgical fractures. It includes an initial assessment, an initial assessment report, treatment, outcome measurement, communications and a summary (discharge) report.

Programs of Care

OCA Webinar on Demand: HCAI and Coding (April 6, 2011)

FAQs

Following are frequently asked questions regarding WSIB. If your question is not answered here and you require further assistance please contact the OCA at oca@chiropractic.on.ca or 416-860-0070 or 1-877-327-2273.


1. What is a Program of Care?

A Program of Care is a health care model that has been developed by the WSIB to outline best practices and improved ways of dealing with the WSIB for certain injuries. For a complete listing of Programs of Care and related resources visit the WSIB website.

2. If my regular fee schedule is higher than that being paid by WSIB, can I charge the patient the additional amounts?

Under the Workplace Safety and Insurance Act, health practitioners who deliver health care for work-related injuries are paid through the WSIB. Chiropractors are not allowed to bill above and beyond the normal rates and therefore have to bill the WSIB rates if treating an injured worker. Details of the fee schedule can be found on the website.

3. How do I bill WSIB?

To be able to bill WSIB, you need to go online and register with Telus Health. For further details please go to the website www.wsib.on.ca.

4. If my patient’s case is denied, what options do I have?

From a funding point of view, if a patient’s case is denied, the patient is responsible for paying the chiropractor for services that were rendered. If there is a concern about the decision making, the patient has the ability to request an appeal. This can be done by contacting the adjudicator. This appeal needs to be launched by the patient and not the health professional.

5. If I have questions regarding my patient’s claim, whom can I contact?

You can contact the adjudicator or nurse case manager. The number is 1-800-387-0750 or 416-344-1000. If it is a specific chiropractic concern, you can ask for Dr. Ryan Friedman, who is the Clinical Practice Leader for chiropractic services at the WSIB. He can be reached at 416-344-3989.

6. If a patient has two injuries, one within the Program of Care and one outside of the Program of Care, can I bill both a fee for service and Program of Care?

If both injuries have been confirmed as injuries that were sustained at work, then you are entitled to bill both fee for service as well as Program of Care. It is critical that in your documentation it is specifically identified what service you are providing.

7. What arrangements need to be made at the IHF for WSIB-related X-rays?

X-rays for patients referred by chiropractors to independent health facilities should be billed to the WSIB by the chiropractor and not billed to the Ministry of Health and Long-Term Care by the IHF. The IHF should bill the chiropractor and the chiropractor should then bill WSIB at the rate cited in the WSIB fee schedule for chiropractors. In the requisition to the IHF, it should be clearly indicated that the patient is a WSIB patient so these films are not inadvertently billed to the Ministry of Health.

8. What is a Regional Evaluation Centre and how are chiropractors involved?

Regional Evaluation Centres (RECs) are independent, hospital-based facilities approved by the WSIB to provide workers with soft-tissue injuries quick access to Multidisciplinary Health Care (MDHC) Assessments performed by a physician specialist and either a chiropractor or physiotherapist. The assessment can be requested by the WSIB or the patient’s health professionals.

Chiropractors are part of the assessment team. The independent Hospital facilities have their own selection criteria and chiropractors interested in performing assessments need to contact the facilities directly.

9. Can workers obtain treatment from more than one health professional for the same injury or illness?

Yes. The WSIB recognizes that on some occasions, a worker may initially obtain health care from more than one health professional for different aspects of the same injury or illness. For example, a worker may obtain treatment from both a physician and physiotherapist that complement each other. The same would apply to a chiropractor and a physician or a chiropractor and a physiotherapist.

10. If a worker is being treated by another health professional and now the worker wishes to obtain care from me, what do I need to know?

If a worker is seeking care for the same injury or illness that complements the care already being provided, you can treat the worker. The worker would not require a referral from the original health professional, nor require authorization from the WSIB. Please complete the Form 8 as usual and submit for payment.

This is a change from the prohibition on concurrent care. Any time concurrent care is contemplated, members should consult with the other practitioner involved in the case.

11. How can I get additional copies of the Health Professional’s Report (Form 8)?
You can obtain additional forms by:

  • printing them from the WSIB website www.wsib.on.ca – Health Professionals tab, Forms
  • faxing your request to (416) 344-4684 or 1-888-313-7373.

12. Can the Health Professional Reports (Form 8) be used as a progress report?

No. If the WSIB requires a progress report, it will be sent to the worker for you to complete. However, if you become aware of new or significant information that is relevant to the worker’s injury, complete and submit a narrative report on your own letterhead and use a payment label for payment.

13. Has there been a change to the chiropractor’s or physician’s Progress Report (Form 26)?

Yes. Both forms were replaced in 2004 with a single form that can be used by chiropractors, physicians, physiotherapists, and registered nurses (extended class).

14. Does the Health Professional’s Report (Form 8) replace the Functional Abilities for Timely Return to Work Form (FAF)?

No. If the worker or employer requests the completion of a Functional Abilities for Timely Return to Work Form (FAF), please complete as usual.

15. Do chiropractors and physiotherapists need to complete the Health Professional’s Report (Form 8) and the Program of Care for Acute Low Back Injuries Initial Assessment Report when considering enrolling a worker into the Program of Care?

No. If the worker is clinically appropriate for the Program of Care for Acute Low Back Injuries, complete only the Program of Care Initial Assessment Report. If the worker is not appropriate for this program, complete only the Health Professional’s Report (Form 8). If you need to do further investigations, complete a Form 8. When and if the worker becomes clinically appropriate for the Program of Care, submit the Initial Assessment Report.

16. Are chiropractors and physiotherapists still expected to complete a treatment extension request?

Yes. The chiropractor’s and physiotherapist’s Treatment Extension Request Form must be completed when an extension of treatment beyond the initial 12 weeks is required. The extension request should be submitted at least four weeks prior to the completion of the 12-week treatment period.

For more information, visit www.wsib.on.ca (look under the “Health Professional” tab), or call 416-344-1000 or toll-free 1-800-387-0750.