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Operational policy manual

Entitlement to Health Care

Health Care
Application Date
This policy applies to all decisions made on or after January 1, 2004, for all accidents.
Published
12-Oct-2004
Subject
General
Title
Entitlement to Health Care
Document No.
17-01-02

Law

The Workplace Safety and Insurance Act provides:

A worker entitled to benefits under the insurance plan is entitled to such health care as may be necessary, appropriate, and sufficient as a result of the injury.

Guidelines

Definitions

Health professional -- is a member of a college of a health profession as defined in the Regulated Health Professions Act, 1991 (RHPA).

Health professionals include, but are not limited to

  • physicians and surgeons
  • chiropractors
  • dentists and oral surgeons
  • massage therapists
  • occupational therapists
  • optometrists
  • physiotherapists
  • psychologists
  • registered nurses (extended class)
  • registered nurses, and
  • speech therapists.

Health care practitioner -- is

  • any health professional (as defined in the RHPA, 1991)
  • a drugless practitioner regulated under the Drugless Practitioners Act, i.e., an osteopath or naturopath, or
  • a social worker.

Health care -- includes

  • professional services provided by a health care practitioner
  • services provided by or at hospitals and health facilities
  • prescription drugs
  • the services of an attendant
  • modifications to a person’s home and vehicle and other measures to facilitate independent living which are appropriate in the WSIB’s opinion
  • assistive devices and prostheses
  • extraordinary transportation costs to obtain health care
  • such measures to improve the quality of life of severely impaired workers as, in the WSIB’s opinion, are appropriate.

Location of health care

Generally, workers receive health care at the office or facility of the health care practitioner. The WSIB must pre-approve treatment that is to be provided in the worker’s home.

If there are health care practitioners available in the worker’s region, the WSIB does not expect the worker to travel outside of his/her region to obtain care. As well, the WSIB does not expect a health care practitioner to travel to the worker's region to provide care. For more on the payment of travel expenses for workers, see 17-01-09, Travel and Related Expenses.

Pre-approval of health care

In some cases, the WSIB must pre-approve the worker’s health care. For more information, see 17-01-03, Choice and Change of Health Professional. As well, the WSIB must pre-approve treatment from a health care practitioner who is not registered with the WSIB.

Application date

This policy applies to all decisions made on or after January 1, 2004, for all accidents.

Document history

This document replaces 17-01-02 dated December 15, 2003.

This document was previously published as:

17-01-02 dated June 15, 1999

8.1* dated January 1, 1998

06-01-02* dated February 14, 1992

06-02-03* dated July 17, 1992.

* These documents were replaced by 17-01-02 dated June 15, 1999.

References

Legislative authority

Workplace Safety and Insurance Act, 1997, as amended

Sections 2, 32, 33

Workers' Compensation Act, R.S.O. 1990, as amended

Section 50

Minute

Administrative

#4, June 14, 2004, Page 368

Compass: Guiding you to a healthy and safe workplace