Member Resources
Determining the Status
of a WSIB Claim
There are some early steps you can take to
determine the status of a work related
claim in terms of ability to proceed with
assessment and/or treatment.
W
hen initiating treatment with
a WSIB patient, first confirm
that the injury was work-
related. Ask whether the claim has
already been registered with the WSIB
and if a claim number was assigned. The
patient should submit a Worker’s Report
of Injury/Disease (Form 6) and their
employer should submit an Employer's
Report of Injury/Disease (Form 7). Please
note that most claims are registered
within two weeks. An assigned claim
number is not a guarantee that the
claim is approved.
Practitioners can inquire about a claim’s
status by calling the WSIB’s General
Inquiry Line at 1-800-387-0750 or
416-344-1000. If you do not have the
claim number, provide your billing
ID and the patient’s name, address
(including postal code), telephone
number and date of birth.
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FALL 2017
When making this call, be aware that
the WSIB cannot disclose the patient’s
private information to you. Rather than
asking, “Is the claim approved?”, it is
recommended to ask, “May I proceed
with treatment?” If the WSIB says ‘yes,’
you may proceed and submit WSIB
forms (where applicable). If not, the
claim may have been denied or may
still be pending. The patient or health
care practitioner can follow up at a later
point in time.
Recommended Course
of Action
1. Follow up with the WSIB periodically
to inquire about proceeding with
treatment. Before proceeding there
should be a clear agreement with the
patient that they will be responsible for
costs in the event that the claim is not
approved for health care treatment.
Once the claim is approved, bill WSIB.
If the claim is denied, bill the patient as
you would normally.
2. Do not bill anyone until the status of
the claim and entitlement to treatment
is known. This will enable you to ensure
that the correct party is billed.
3. If a significant amount of time has
passed without a claim decision, it
may be reasonable to bill the patient. If
subsequent information indicates that
the claim has been accepted, the patient
must be reimbursed and WSIB may then
be billed.
Please note that the Low Back Program
of Care is unique in that the first block
of treatment will be paid even if the
claim is denied. This means that if you
are treating a WSIB patient under this
Program of Care, you can bill the WSIB
immediately, even if the claim is pending
or has been denied.