WSIB Issues Dealing with the Board

FAQ

Services are free and confidential

Walk-ins are welcome. Toll-free calling is available, and collect calls are accepted by either agency.

The Help Centre:

905-372-2646 or 1-888-698-3382

The Northumberland
Communty Legal Centre:

905-373-4464 or 1-800-850-7882

Medical Issues

Questions that workers have about their medical care usually centre on:

Getting more therapy/Continuation of treatment
Other Health Care benefits
Secondary injuries
Poor reporting/record keeping by the doctor
Board doctor’s opinion versus the opinion of the worker’s doctor (see also question 9)
Deciding if work is suitable (see question 9)
Reassessment of NON ECONOMIC LOSS/Permanent Partial Disability Pension (see questions 24, 19)

chiropractic or physiotherapy treatments are usually initially authorized for 12 weeks of treatment during the acute phase of the injury
the Board now has a “Best Approaches” Adjudicative Support Document on the WSIB website that outlines the circumstances in which a worker may be able to get “maintenance” treatments once the condition is no longer acute
Will have to obtain medical information to match the criteria in the Best Approaches document that such treatment will either:

Enable the worker to continue working at regular or suitable work
Lead to a reduction in the worker’s pain and/or decreases the worker’s medication use
Increase the worker’s level of functioning or prevents a deterioration in the worker’s level of functioning
Teach the worker independent management of their condition

If still denied, will have to appeal, as Workplace Safety And Insurance Appeals Tribunal has allowed maintenance treatments

the short answer is no - if it is not related to the compensable injury, the Board will not pay for those things
drugs for the injury are covered - but Board has to decide if they are needed (doctor to submit request and if approved, worker submits receipts)
little known/used provision of the Act (s. 42(8) of the new Act) that the Board has the power to pay for other things if the worker needs it for successful completion of Labour Market Re-Entry plan (eg. glasses)
childcare is not covered - Board says your employer would not pay for that so that you could come to work, so they will not either
there is payment for travel to medical appointments for the injury
may also be eligible for a clothing allowance

secondary injuries can be compensable
the importance of medical evidence linking the two is vital
if that secondary condition resulted in lost time from work, can get further lost time benefits if the Board recognizes the secondary condition as compensable
likewise, if the secondary condition causes a permanent problem, could be assessed for a Non Economic Loss for that body part, if it is recognized as compensable

doctors get paid to fill out the WSIB forms
the adjudicator has a protocol to follow where the treating physician fails to provide the requested reports
the worker has a role to play to be sure that doctor hears and records the complaints and should keep own diary of what complaints were at each visit
may have a Human Rights complaint if the doctor refuses to treat the worker because of being a WSIB case

The adjudicator relies on the Board doctor’s opinion, which is based only on a review of the documents on file (which proves how important the doctor’s reports really are)
Where there is a difference of opinion of the Board’s doctor versus the opinion of the worker’s doctor, worker will need to get more medical evidence that refutes or challenges the Board doctor’s conclusion (ie. show the Board doctor’s opinion to the treating physician and ask for written comments)
Will likely need to appeal but some doctors are willing to call the Board doctor directly if asked