Document name
Health Care Services
Document number
POL 18/2016

Effective date: September 1, 2016

Application: All claims.

Policy subject: Health care services – general

Purpose:

To establish entitlement and guidelines for the provision of health care services to injured workers.

DEFINITION

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Medical Aid, also referred to as health care, means “the provision of medical and surgical aid, of hospital and professional nursing services, of chiropractic and other treatment and of prosthetics or apparatus” (Section 2(1)(v) of The Workers’ Compensation Act, 2013 (the “Act”)).

Health Care Professional, also referred to as a health care provider, means “a physician, dentist, chiropractor, optometrist, psychologist, occupational therapist, physical therapist, nurse or any other person who is registered or licensed pursuant to any Act to practise any of the healing arts” (Section 2(1)(p) of the Act).

Evidence-Based Practice means the use of accepted external clinical evidence and individual clinical expertise in making decisions about the diagnosis and care of a patient by a health care professional.

BACKGROUND

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  1. In order to minimize the impact of a worker’s injury and to promote successful long-term recovery, the WCB follows a Continuum of Care model that facilitates quality health care and an appropriate return-to-work (POL 08/2014, Continuum of Care). This includes:
    1. Paying for or reimbursing suitable health care to treat a worker whose injuries arose out of and in the course of employment, and
    2. Supporting the functional rehabilitation model which recognizes the importance of returning the injured worker to functional activities relevant to their life, including returning to work, during the recovery period. The functional rehabilitation model encourages health care providers and workers to recognize that successful long-term recovery is associated with return to function, even in the presence of increasing subjective symptoms where there are no objective signs of harm.
  2. WCB will only fund the costs of health care services when:
    1. The treatment is provided or referred by a licensed health care provider, and
    2. The treatment is within the treating health care provider’s scope of practice.
  3. Treatment provided to WCB customers must be:
    1. Listed in a Medical Services Payment Schedule established through the Saskatchewan Ministry of Health, or
    2. Listed in a fee schedule established by WCB and, where applicable, health care provider groups, or
    3. Deemed appropriate and recognized by evidence-based practice to be effective in treating the worker’s injury.
  4. WCB recognizes several health care provider disciplines (see appendix). These include:
    1. Physicians licensed to practice in North America.
    2. Health care providers accredited and funded by the Saskatchewan Ministry of Health (e.g., chiropractors).
    3. Health care providers licensed with a legislated, self-regulating national or provincial body, and accredited by WCB for each location in which they treat customers (e.g., physical therapists).
    4. Health care providers who are registered with a national or provincial body that is not self-regulating, but is scientifically accepted and accredited by WCB for being effective in the treatment of workplace injuries or return-to-work planning (e.g., exercise therapists).
  5. If a health care provider group is not accredited through the Saskatchewan Ministry of Health, WCB will attempt to create an accreditation process to ensure that the health care provider is qualified and is in good standing with a legislated, self-regulating body or a representative professional organization.
  6. If a health care provider group does not wish to participate with the WCB to create an accreditation process, the WCB may establish accreditation standards, applicable only to services provided to WCB customers, using the expertise of WCB’s Health Care Services (HCS).
  7. WCB may approve payment to an unaccredited health care provider that offers infrequent service to WCB customers (e.g., naturopaths or orthotists). Prior to approving any such treatment, WCB will perform a review to ensure the unaccredited health care provider is registered with a national or provincial representative professional organization and that any proposed treatment(s) follow evidenced-based practice.
  8. Out-of-province health care providers will be reviewed by WCB to ensure they meet the accreditation standards of:
    1. The Saskatchewan Ministry of Health.
    2. Another jurisdiction’s Ministry of Health, or
    3. The Saskatchewan WCB.
  9. WCB will establish procedures, practice standards and fee schedules, for recognized health care provider groups. Additional health care provider groups may be added to the list of recognized disciplines through procedure where WCB deems the type of care to be supported by appropriate scientific evidence.
  10. Where an out-of-province health care provider proposes a fee not listed in a WCB fee schedule, HCS will perform a review to determine the fee’s appropriateness.
  11. Health care providers will establish direct billing to WCB for each customer and will bill according to the WCB endorsed fee schedule. If a health care provider demands and receives from the customer a fee in excess of that determined by the WCB, the WCB will contact the health care provider to request a refund for the customer and the WCB will pay the appropriate WCB approved fee. Where the refund is not provided, the extra billing will be recovered from the WCB payment to the health care provider or deducted from any future amount owed to the health care provider.

Attachments

Attachments

Policy references

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Section heading

Act Sec #

Page/document title
2(1)(p), 2(1)(v), 19(1)(b), 55, 56, 57, 103, 104

Section heading

Supersedes

Section detail

POL 05/96    Health Care Services
POL 57/80    Medical Fees – Extra Billing 
 

Section heading

Complements

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