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Physician's Frequently Asked Questions
1. What does the Workplace Safety and Insurance Board (WSIB) do?
The WSIB is part of an Ontario-wide system. The system is designed to help protect workers from injury or illness in the workplace, and to help them if they do suffer an injury. Most Ontario employers have workplace insurance coverage by law. Employers pay the premiums for their workers and are not allowed to deduct them from workers’ wages. It is a no-fault insurance system, which means that the worker cannot generally sue the employer.
The WSIB:
- Promotes health and safety in workplaces to prevent and reduce the number of workplace injuries and occupational diseases.
- Facilitates the return to work and recovery of patients who sustained personal injury or who suffered from an occupational disease
- Facilitates labour market re-entry (LMR) of workers when required
- Provides compensation and benefits to workers and to survivors of deceased workers.
The WSIB is working to create a comprehensive integrated response to workplace injuries and illnesses that links prevention, health care, return to work and compensation.
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2. Are all workers covered by the WSIB?
The WSIB currently provides coverage to approximately 70% of Ontario’s employers (more than 200,000 employers) and an estimated 4 million workers. This includes any family members who receive a wage and are not registered owners of the business. Workers can be full-time, part-time, seasonal, casual, paid students, or learners. In some cases, this may include sub-contractors. Sole owners, partners, independent operators, and executive officers are not automatically covered under the Workplace Safety and Insurance Act, but can apply for optional insurance.
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3. How can I avoid payment delays?
In order to receive prompt payment, you must:
- Be registered with the WSIB
- Supply your WSIB Billing Number
- Ensure that the WSIB has your current contact information
- Write legibly and always include your name, address, and telephone number on forms and payment labels
- Send all correspondence to:
Central Claims Processing
200 Front St. West
Toronto M5V 3J1
Fax: 416-344-4684 or 1-888-313-7373
If you are not currently registered with the WSIB, please call the Health Professional Access Line at 1-800-569-7919 or 416-344-4526.
All Health Professional’s Reports (Form 8s) are paid promptly unless:
- The Health Professional Billing Information in Section B is incomplete, illegible or incorrect.
- Only one page is received
- Your patient works for an employer who is not covered by the WSIB.
When your patient has an allowed claim, all requested reports (Physician’s Progress Report - Form 26) are paid as per page 5 of the WSIB Physician Fee Schedule (163k, pdf).
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4. How do I register with the WSIB?
To register with the WSIB, call the Health Professional Access Line at 1-800-569-7919 or 416-344-4526.
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5. How do I bill when I treat an injured/ill worker?
Physicians are paid for medical services and for reports.
1. Bill the MOHLTC for insured services using the MOHLTC Schedule of Benefits and indicate “WCB” for your billing. For example, use the code A001 for minor assessment or A007 for intermediate assessment. The WSIB and the MOHLTC have a billing agreement in place and joint MOH/WSIB audits occur periodically.
2. Bill the WSIB using the Provider Payment Request Form-Form 3947A (725k, pdf) in the following three circumstances:
1. Your patient does not have a MOHLTC number. In this case, complete the form using the MOHLTC fee schedule.
2. You are providing uninsured care, which has been pre-approved by the WSIB.
3. You have participated in an in-office interview with a WSIB representative (WSIB Service Code M645)
For billing instructions on the Provider Payment Request Form-Form 3947A (725k, pdf), please see page 8 of the WSIB Physician Fee Schedule (163k, pdf).
3. Physicians are automatically paid by the WSIB for forms, reports and for telephone calls initiated by the WSIB.
1. The fee code is included on WSIB Forms, e.g., Service Code FORM8 for the Health Professional’s Report (Form 8), Service Code M643 on the Physician’s Progress Report (Form 26), etc.
2. If a staff member from the WSIB calls you, then the WSIB will pay you for the call. The conversation must occur with the treating physician and your billing number must be provided at the time of the conversation. The caller will enter the fee code into our payment system and you will receive payment automatically. (Check your remittance statement.) It is suggested that you document the date of the call and the name of the WSIB staff who called for future reference.
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6. How can I check my payment status?
You have two options:
- For billing enquiries, call the Health Professional Access Line at 1-800-569-7919 or 416-344-4526.
- You can also register with Emergis, receive a password and check your payment status online without having to call the WSIB. This enables you check your payment status anytime, anywhere whether you are at home or at the office.
Please do not submit bills for WSIB forms online at this time as we do not yet have the ability to accept online form submission.
NOTE: The telephone number listed for the WSIB on your Emergis statement is the central WSIB number. Please call the Health Professional Access Line at 1-800-569-7919 or 416-344-4526 if you have questions.
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7. What should workers know about reporting workplace injuries and illnesses?
Download our What Workers Should Know About Reporting Workplace Injuries and Illnesses (161k, pdf) fact sheet to learn more.
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8. What is the WSIB Drug Benefit Program?
Learn more about the WSIB Drug Benefit Program.
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9. How does my patient receive benefits?
When your patient suffers a work related injury/illness and comes to see you, you must complete a Health Professional's Report-Form 8 (486k, pdf), even if that patient first visited an Emergency Department. If your patient presents you with a Functional Ability Form for Timely Return to Work, you must also complete this form.
When your completed form(s) arrive at the WSIB, it is first scanned into the appropriate WSIB claim record and then sent for payment processing.
Your patient’s claim is managed by a service delivery team that includes an adjudicator and in some cases, a nurse case manager. The WSIB has 13 offices across Ontario, and service delivery teams are specialized to handle certain industry sectors and small businesses. The adjudicator makes the decision on whether to allow the claim. When a nurse case manager is involved, he/she will work with your patient to facilitate health care and the recovery process.
If your patient is very severely injured our Serious Injury Program handles the case.
The WSIB also has an Occupational Disease and Survivors Benefit Program to help workers who suffer from an occupational disease. Survivors of deceased workers are also assisted by this branch.
If your patient suffered an injury prior to January 1, 1990, then our Pre-1990 unit handles the claim.
If the adjudicator needs follow-up information from you, your patient will bring you a progress report to be completed. If in your opinion there is significant medical information that you want to bring to our attention, you can send us a report using your letterhead.
If at anytime you wish to talk to a WSIB physician, please call the WSIB and ask to speak to a medical consultant.
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10. What are the benefits that my patient receives?
The WSIB offers a range of financial and health care benefits. Your patient receives 85% of his/her net average income based on maximum insurable earnings of $67,700 (2005 rate). All health care benefits are covered and may include hospitalization, surgery, or emergency care, prescription of drugs, glasses and dental surgery.
The Serious Injury and Occupational Disease programs offer special services for severe and complex injury/illnesses.
A Non-economic Loss Benefit is paid to workers who suffer a permanent impairment as a result of a workplace injury/illness.
The WSIB also offers a Loss of Retirement Income Benefit that helps to replace the money your patient would have saved for pension (only available to workers on continuous benefits for 12 months).
Patient Health Care
Assessment and treatment resources are in place for musculoskeletal injuries, for occupational diseases, and for other conditions.
- Community Clinics are available in most areas for treatment of soft tissue injuries. Referrals can be made between 29 and 70 days post date of accident. (or after surgery or after a recurrence)
- Find Providers in your community who can deliver the WSIB Programs of Care for Acute Low Back Injuries (program for workers who have uncomplicated acute low back pain) or Noise Induced Hearing Loss.
- If you wish to have a second opinion for a soft tissue injury your patient can be assessed in a Regional Evaluation Centre. We can facilitate the referral.
- Several Specialty Programs are also in place for conditions ranging from hand injuries to psychological trauma.
Your patient’s nurse case manager can facilitate access to all of the above resources.
Read the WSIB’s health care policies.
Patient Recovery
Ideally, your patient will fully recover and return to regular activities with the same employer. Your patient will be able to perform the essential duties of his/her job without any modifications. Other times your patient will reach a plateau but will not fully recover. Quite often, a return to work with modified activities can be arranged.
Modified work is defined by what the patient can safely do following the injury/illness. If your patient’s employer cannot provide work with modified activities, or if your patient is physically unable to return to the pre-injury job, then a Labour Market Re-entry (LMR) assessment will be arranged. The assessment is based on the worker’s knowledge, skills and aptitude.
A non-economic loss (NEL) assessment will also be arranged if your patient has suffered a permanent impairment. Based on the outcome of this assessment, your patient will receive a NEL benefit.
Your patient may reach a plateau in recovery and return to regular or modified activities and then experience a “recurrence” of symptoms. In this case, further medical information will be required from you.
11. What are the top workplace hazards?
Read about the top workplace hazards.
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12. Can I read the WSIB 2003 statistical supplement?
You can download WSIB's Annual Reports and Statistical Supplements. |
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