Document name
Medical Aid Billings – Payment
Document number
PRO 53/2006

Effective date: December 1, 2006

Application: All claims involving medical aid billings.

Policy subject: Health care services – general

Purpose:

To outline the procedure for the payment of late billings from health care providers.

DEFINITION

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Medical aid is defined in Section 2(1)(v) of The Workers’ Compensation Act, 2013 (the “Act”) as the provision of medical and surgical aid, of hospital and professional nursing services, of chiropractic and other treatment and of prosthetics or apparatus.

BACKGROUND

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  1. Section 103 of the Act states that a worker who is entitled to compensation is entitled to receive medical and surgical aid that shall be furnished or arranged for by the Workers’ Compensation Board (WCB) in any manner that it may approve.
  2. Section 104(1) of the Act states that the fees for medical aid furnished by any health care professional are those that are determined by WCB.
  3. Section 110 of the Act states that, subject to the approval of the Lieutenant Governor in Council, the WCB may make regulations governing the payment of medical accounts and the assessment of penalties for the late filing of those accounts.
  4. This procedure sets out the period for which bills should be submitted for reimbursement for health care services.

PROCEDURE

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  1. WCB will not pay any account rendered by a physician, surgeon, hospital or other health care professional or institution for medical aid services if application for payment is received by Operations or Medical Accounts after a twelve-month period from the time the medical aid is administered to an injured worker. However, this does not apply to the reimbursement of a medical invoice that has been paid by an injured worker.
  2. Health care providers entitled to be paid by WCB for any services performed or for any medication or material supplied, shall bill WCB directly. Injured workers shall not be charged with these costs.
  3. WCB will authorize payments in the case of medical aid billings received by Operations or Medical Accounts after the twelve-month period only when acceptable reasons for the late submission of billings are provided, specifically where:
    1. A claim was originally denied by WCB but is accepted on appeal; or
    2. The delay in payment to the health care provider is the result of an administrative oversight or delay on the part of WCB.
  4. All other medical aid billings received after the twelve-month period for reasons other than those provided for in Point 3(a) or (b) above, will not be considered for reimbursement.

Policy references

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Section heading

Act Sec #

Page/document title
2(v), 103,104, and 110

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Amended

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01 January 2014. References updated in accordance with The Workers’ Compensation Act, 2013

Section heading

Supersedes

Page/document title
Board Directive 17/50 Medical Aid – Late Discount

Section heading

Complements

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