The WCB covers the costs of assessments from the following direct access health care providers for work-related injuries and illnesses:
- Physicians
- Nurse Practitioners
- Physiotherapists (if approved as a WCB service provider)
- Chiropractors
- Psychologists (for psychologists contracted with the WCB)
- Audiologists
- Pharmacists
Assessments do not need pre-approval from the WCB. Limited treatments may also be approved for physiotherapy and chiropractic services before an initial claim decision is made.
After an assessment, WCB will review the report and any recommendations and determine what health care benefits will be approved. Decisions are based on evidence and are made according to workers compensation legislation and WCB policies, including POL-160, Decision Making.
While not considered direct access health care providers, WCB approves treatment with various other health care providers when necessary, such as:
- Occupational Therapists
- Counselling therapists
- Social Workers
- Massage Therapists
- Dentists
Other types of health care treatment may be approved when it is recommended by a health care provider, for example, a psychologist recommends treatment with a counsellor.
WCB may also approve functional assessments, such as Functional Scans and Functional Capacity Evaluations, to support return to work and stay at work.
Fees for health care services
Fees for health care services are generally based on established agreements between the WCB and the health care providers. Providers are not permitted to charge a worker additional fees above those that are reimbursed by the WCB. Providers are also not permitted to charge fees to workers for missed or late appointments.
Health care providers bill the WCB for all costs related to the work-related injury. Requests for payment must be received by the WCB within six months from the date of service, or within the agreed reporting timeframes outlined in service provider agreements. Health care providers must provide the WCB with clear reports about the treatment related to the work injury or illness, as well as any other information needed to manage the claim. The WCB will not pay an invoice without a report. The WCB has a number of forms for different types of health care providers to ensure the proper information is reported.
The WCB may approve out-of-province treatment when the required treatment is not available in Prince Edward Island, or when the worker's primary residence is in another province.
For more information, please refer to the WCB's policies on health care services.