The owner of a physiotherapy clinic complained that the WSIB denied payment for a musculoskeletal (MSK) program of care for an injured worker. The clinic owner presumed that the WSIB had allowed the claim because it had paid him for the completion of Functional Abilities Forms under the same claim. However, the WSIB had yet to make an initial entitlement decision at the time he followed up with the WSIB about payment for the program of care. The WSIB told him he should have sought approval before treating the worker.

The clinic owner said he tried to escalate the issue through the WSIB’s Clinical Expert Line but did not receive a call back. By that point, the worker had made a full recovery and was not returning the calls of the WSIB or the clinic.

Under new MSK program of care rules, the WSIB allows payment for an initial block of treatment for a single zone of injury regardless of the claim’s status. A manager told us that the clinic treated the worker before the new rules came into effect. Since the clinic was new to the WSIB and this was their first experience with a denied payment, she approved payment on an exceptional basis.