Chapter:
CLAIMS
Subject:
HEALTH CARE PROVIDERS – ROLES AND RESPONSIBILITIES
Effective Date:
July 19, 2001
Last Updated On:
March 5, 2025
PURPOSE STATEMENT
The purpose of this policy is to explain who the Workers Compensation Board considers to be health care providers and how those providers can bill for services.
REFERENCE
Workers Compensation Act R.S.P.E.I.1988, Cap. W-7.1, Sections 1(1)(r), 18, 59(2)
DEFINITION
In this policy:
“Health Care Provider” means both medical practitioners and other practitioners.
“Medical Practitioner” means a person duly registered under the laws of the Province as authorized to practice medicine in the Province.
“Practitioner” means a person who has met the professional and legal requirements necessary to provide health care and related services.
POLICY
- The role of the health care provider is to provide advice, assessment, investigation, and treatment to a worker with awork-related injury.
-
The WCB recognizes a health care provider if they are governed by legislation and a self-regulating body responsible to ensure patient safety and standards of practice in Prince Edward Island. The health care provider must be licensed by, and in good standing with, a recognized licensing body to practice in Prince Edward Island or certified by a recognized national body.
For an out of province provider to be recognized by the WCB, they must meet the equivalent requirements of #2 of the province in which they practice.
-
The exceptions to #2 are the following health care providers, who will be considered as being authorized to provide services to workers if they hold the appropriate certification or registration:
-
Orthotists certified with Orthotics Prosthetics Canada
-
Prosthetists certified with Orthotics Prosthetics Canada
-
Audiologists registered with Speech-Language & Audiology Canada
-
Hearing Instrument Specialists with National Board Certification in Hearing Instrument Sciences
-
Kinesiologists who are affiliated with the Canadian Kinesiology Alliance and providing services under the supervision of a health care provider who meets the criteria under #2.
-
-
Other health care services may be recognized if provided by a licensed, certified, or registered health care provider who applies for and is granted service provider status by the WCB, meets the requirements set out in #2 or #3, and where the service is within their scope of practice. Applicants must provide information to confirm their certification, registration or licensing at the time of application.
Reporting and Fee Payment
- Health care providers must provide the WCB with objective, legible reports of services relevant to the work-related injury and other reports the WCB determines are necessary for the management of a claim. Invoices will not be paid without a report.
- Fees for health care services will be paid to health care providers who are registered service providers with the WCB.
- Health care providers may either directly deliver health care to a worker or supervise the delivery of that care by other health care providers or their assistants. Payment will be made to the recognized health care provider.
- The WCB may procure services and establish agreements with health care providers or organizations representing the health care providers which include a schedule of fees to be paid for health care services.
- Health care providers are not permitted to charge a worker extra fees above those paid by the WCB or charge workers directly for services provided.
- Requests for payment must be received by the WCB within six months of the date of service or within the agreed reporting timeframes as outlined in service provider agreements.
HISTORY
March 5, 2025 – non-substantive changes to reflect Massage Therapists moving under Regulated Health Professions Act.
January 26, 2023 – amended to update requirements for an out of province provider to be recognized by the WCB; removal of Counsellors from list of exceptions.
January 23, 2020 – Amended to include the conditions for recognizing massage therapists, kinesiologists and counsellors as health care providers.
December 20, 2016 - Non-substantive changes to clarify the criteria and reporting requirements for health care providers.
June 23, 2011 - Amended to incorporate the content from POL-75, “Fees For Health Care Services”, which will be rescinded. In addition, moved the section on out-of-province treatment to POL-92, “Medical Aid”.
September 25, 2008 - Amended to update the requirements of health care providers and to clarify information on out-of-province treatment.
March 31, 2005 - Amended to ensure the policy was clear about which health care providers are accepted by the WCB to provide medical aid to workers. Most of the types of health care providers listed in #4 were updated and/or additional information was added. Also added a section to clarify out-of-province treatment.
Board of Directors Approval Date: July 19, 2001