Law
Section 33 of the Workplace Safety and Insurance Act provides:
A worker who sustains an injury is entitled to such health care as may be necessary, appropriate, and sufficient as a result of his or her injury.
The WSIB may arrange for the worker’s health care or may approve arrangements for his or her health care. The WSIB shall pay for the worker’s health care.
The WSIB may establish such fee schedules for health care as it considers appropriate.
No health care practitioner shall request a worker to pay for health care or any related service provided under the insurance plan.
No action lies against the WSIB for payment of an amount greater than is established in the applicable fee schedule for health care provided to a worker.
The WSIB shall determine all questions concerning the necessity, appropriateness and sufficiency of health care provided to a worker or that may be provided to a worker, and payment for health care provided to a worker.
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Policy
The WSIB may pay for the provision, replacement, or repair of hearing aids and related accessories, and hearing assistive technologies where entitlement has been established for work-related traumatic hearing loss or occupational noise-induced hearing loss.
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Guidelines
Definitions
Audiologist: regulated health professional qualified to measure hearing, and prescribe, supply, and fit hearing aids and assistive technologies according to individual needs.
Hearing aid: a small battery-powered electronic apparatus which typically fits in or behind the worker’s ear, and is designed to amplify and modulate sound to compensate for impaired hearing.
Hearing aid accessories: items required for the proper care and maintenance of hearing aids.
Hearing assistive technologies (HATs): items that can present auditory, visual, or tactile information to workers with impaired hearing.
Hearing device: any item, including hearing aids, that is used to provide amplification for workers with impaired hearing.
Hearing instrument practitioner: practitioner qualified to test hearing, and to select, fit, counsel and dispense hearing instruments pursuant to a prescription.
Noise-induced hearing loss (NIHL): permanent loss of hearing in both ears resulting from sensorineural (inner ear) damage due to prolonged, continuous, hazardous noise exposure (see 16-01-04, Noise-Induced Hearing Loss).
Traumatic hearing loss: sudden onset of hearing loss experienced after an acute trauma (see 15-04-01, Traumatic Hearing Loss).
Hearing aids
Entitlement criteria
Workers should request approval from the WSIB before purchasing a hearing aid to avoid having to pay for the device if it is not ultimately approved by the WSIB.
The WSIB may authorize the purchase of a hearing aid when
- the worker has an allowed claim for NIHL or traumatic hearing loss, and
-
it is prescribed by an audiologist or physician, and
-
a hearing evaluation (i.e., audiogram) has been conducted which meets practice standards, and contains findings that support the use of a hearing aid.
The WSIB expects the hearing aid dispenser to conduct a trial for at least 30 days from the date the worker is provided with the hearing aid before submitting a payment request to the WSIB. This trial period helps ensure the worker has been fitted with the proper hearing aid.
Payment
Once the worker has entitlement to a hearing aid, the WSIB pays up to the amount set out in Operational Policy Manual document 18-01-05, Table of Rates. This amount covers the hearing aid and its integrated options and features.
Options and features are components integrated within the hearing aid that range from basic functioning and user control, to advanced components that are often digital in operation and are related to programmability, fitting, and sound/noise management (e.g., receiver tubes, domes, adaptive directional microphones).
Exceptions
The WSIB only pays for costs above the amount set out in the Table of Rates if there are exceptional circumstances. An exception may be made if there are no hearing aid models available for the amount set out in the Table of Rates that meet the clinical requirements of the worker as documented by the treating health professional.
When reviewing hearing aids above the amount set out in the Table of Rates, the WSIB considers the integrated options/features clinically required for the worker to be able to function fully and safely at home, work, and/or in the community.
Examples of exceptional circumstances may include workers with severe to profound hearing loss who may require high gain hearing aids that use prescriptive methods not found in other hearing aids, and workers with tinnitus who may require noise generation options/features that are not available for the amount set out in the Table of Rates.
Hearing aid repairs
After the warranty period, the WSIB may pay reasonable costs to repair a hearing aid unless there is evidence that the device was deliberately damaged, misused, or the operating instructions were not properly followed. The WSIB also covers the cost for the loan of a hearing aid while repairs are being made.
Hearing aid replacements
The WSIB may approve a worker's request for a replacement hearing aid every
- three years for an in-the-ear hearing aid, and
-
four years for a behind-the-ear hearing aid.
A hearing re-evaluation (i.e., audiogram) should be conducted when a replacement is being considered.
If the WSIB allows the request for a replacement hearing aid, it pays up to the amount set out in the Table of Rates unless the requested device meets the exceptions outlined above.
Lost hearing aids
If the worker's hearing aid is lost or stolen, the WSIB may authorize a replacement device on a once only basis. In the event the WSIB has authorized a replacement and the device is lost or stolen again, the purchase of a new device is generally the worker’s responsibility.
Hearing aid batteries
The WSIB may authorize reasonable requests for the replacement of hearing aid batteries.
Hearing aid accessories
The WSIB may authorize payment for hearing aid accessories that are required for the proper care and maintenance of hearing aids. Hearing aid accessories include items such as a cleaning kit, sanitizer, wipes, brush, carrying case, battery tester, telephone pads, ear hooks, dri-aid kit, wax guard/basket, and ear mold blower.
Hearing assistive technologies (HATs)
The WSIB may authorize the provision of HATs, which are items that present auditory, visual, or tactile information to workers with impaired hearing (e.g., alerting systems, telephone amplifiers, television specific devices, FM systems). When determining entitlement, the WSIB considers evidence that the requested HAT supports the worker’s return to work, facilitates improved communication at home or in the community, or increases the worker’s personal safety.
Workers should request pre-approval from the WSIB for the initial purchase of a HAT as well as for subsequent repairs/replacements, in order to avoid having to pay for items not ultimately approved by the WSIB.
After the warranty period, the WSIB may pay reasonable costs to repair a previously authorized device, unless there is evidence that the device was deliberately damaged, misused, or the operating instructions were not properly followed.
The WSIB authorizes the replacement of a HAT when necessary. When determining the necessity of the replacement, the WSIB considers factors such as the condition of the device, and permanent changes in the worker’s clinical requirements that impact the ongoing use of the device as documented by the treating health professional.
Application date
This policy applies to all requests for initial or replacement hearing aids and related accessories, and hearing assistive technologies that are received by the WSIB for approval on or after November 23, 2009, for all injuries/diseases.
Document history
This document replaces document 17-07-04 dated October 12, 2004.
This document was previously published as:
06-04-03 dated February 23, 1994.
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References
Legislative authority
Workplace Safety and Insurance Act, 1997, as amended
Sections 32, 33, 119(1)
Workers’ Compensation Act, R.S.O. 1990, as amended
Sections 50, 51, 52, 73
Minute
Administrative
#1, October 16, 2009, Page 478
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