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Reporting requirements for health professionals

This section will answer basic questions about reporting requirements for health care professionals who are treating injured workers claiming benefits from the WSIB.

  • Legislation and reporting
  • Patient confidentiality and reporting
  • Reporting requirements regarding billing
  • Reporting requirements for your specific health profession

The WSIB will make decisions about an injured worker's claim for benefits based on the information that we have on the claim file.

Legislation and reporting

The Workplace Safety and Insurance Act (Sections 37 (1)) states: Every health care practitioner who provides health care to a worker claiming benefits under the insurance plan or who is consulted with respect to his or her health care shall promptly give the Board such information relating to the worker as the Board may require.

The Personal Health Information Protection Act, 2004, Section 43(1) (h) permits a health information custodian to disclose health information without consent as permitted or required by law including section 37(1) of the Workplace Safety and Insurance Act.

The Ministry of Health and Long-term Care, the Ontario Hospital Association, the Ontario Medical Association and the College of Nurses have recognized that personal health information can be disclosed without consent if permitted or required by law and specifically for required reporting of information to the WSIB under WSIA.

In addition to a general requirement to provide information when requested, many health care professionals are required to submit specific forms appropriate to the kind of care you provide. You will find a description of these forms in your Fee Schedule.

Patient confidentiality and reporting

As a health care professional, you may have concerns about a conflict between patient confidentiality and the need to provide us with patient information.

  • If a health information custodian takes the position that consent is necessary before disclosure to WSIB is made, it is the health information custodian that asks for consent, not the WSIB.
  • If an injured worker requests that a health care professional not share personal health information with the WSIB, then the health care professional should inform the worker that the WSIB will make its decisions on the claim based on the information (or lack thereof) in the claim file.
  • Workers are required to cooperate with the WSIB in their recovery in order to receive benefits. WSIA Section 22(5) requires the worker to consent to share his or her functional abilities information with the employer. This permission comes in the form of a signature on the Worker's Report of Injury/Disease (Form 6). Consents are not required for you to share the worker's functional abilities information with the employer.

Reporting requirements regarding billing

You will bill us directly for any service you provide under our insurance plan. Detailed instructions for billing are provided in your health profession's Fee Schedule.

Late billing can result in reduced payment

Accounts received more than 6 months from the date of service may be reduced as follows:

  • 7 to 9 months: 25% payment reduction
  • 10 to 12 months: 50% payment reduction
  • more than 12 months:100% reduction

We understand that sometimes delays are caused by factors beyond your control. We may waive late billing penalties if good reason for the delay is provided.

Reporting requirements for your specific health profession

You can find descriptions of reporting requirements and WSIB forms specific to your health profession in your Fee Schedule.

 

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