A worker complained that the WSIB had denied entitlement for a consultation with a specialist in the United States to address persistent complications related to a serious leg injury from 2010. The worker had already undergone 16 surgeries in Ontario. Several Ontario surgeons had written to the WSIB saying the worker needed emergency care that was beyond their expertise and recommended a consultation with the US doctor who specialized in joint and bone infections.

The WSIB denied entitlement for the consultation in late 2022, so the worker paid out-of-pocket to see the US specialist in early 2023. She assessed the worker, provided a plan of care, and he returned to Ontario.

Unfortunately, the worker’s condition deteriorated shortly afterwards and he required emergency surgery in Ontario.

The WSIB reconsidered and upheld its decision to deny entitlement for out-of-province care on the basis that the recommended health care is available in Ontario. The WSIB specialty clinic report cited in the decision said that much of the US specialist’s plan of care is available in Ontario but added that it would be difficult to find an Ontario surgeon willing to take on such a complex case.

With the worker’s symptoms of infection persisting, two Ontario surgeons wrote to the WSIB to advise that the worker’s condition was likely to deteriorate further and could result in his leg being amputated.

Given the seriousness and urgency of the situation, we inquired with a director about the WSIB’s role in arranging necessary and appropriate health care treatment for the worker. The director took immediate action, and following a meeting with the case management team, he informed us that the WSIB could reconsider entitlement and reimburse the worker for his previous consultation with the US specialist because the Ontario surgeon had relied on her report when he carried out emergency surgery. Additionally, the WSIB granted entitlement for another assessment and updated treatment plan with the US specialist.