Employer-Requested Health Exams: WSIB Claims

August 15, 2017 at 12:06pm

Workers Comp Claims & Appeals: Employer Requested Health ExamsInformation adopted from the Ontario Worker Adviser (OWA) website. Used with permission.

What Is an Employer-Requested Health Examination?

If you are receiving benefits from the WSIB or have made a claim for WSIB benefits, your employer may ask you to agree to a health examination conducted by a doctor chosen and paid for by the employer.

Do You Have to Attend an Employer-Requested Health Examination?

You do not have to attend an employer-requested health examination until ordered to by WSIB. You can object to the examination or to the nature and extent of the examination. The WSIB, however, will decide if you must attend the examination. In the meantime, you will continue to receive WSIB payments. Contact a UFCW Locals 175 & 633 Workers’ Compensation Representative if your employer requests that you attend an Independent Medical Exam (IME). Many WSIB referrals will be to Altum Health, Sunnybrook and other providers of WSIB approved Program of Care (POC) facilities.

WSIB may request that you attend a health examination without the employer asking for one first. If that happens and you do not attend the examination, WSIB may reduce or suspend your payments. WSIB pays for this examination.

What Should You Do if You Do Not Want to Attend the Examination?

If you do not want to attend the employer-requested health examination then you must tell your employer that you object to the examination.

Keep your own records. Note the date, time, and name of the person you spoke to when you informed your employer about your objection. You should follow-up with a written letter to your employer, emphasizing your objection to the examination. You are not required to provide your employer with reasons for refusing to attend the health examination at this time.

After receiving your objection, your employer has 14 days to write and request that WSIB order you to attend the health examination.

How Will WSIB Decide Whether to Order You to Attend the Examination?

WSIB will decide if the examination is necessary, and if the nature and extent of the examination is appropriate.

How Will WSIB Decide If the Examination is Necessary?

WSIB considers the employer-requested health examination necessary if it will:

  • Help with your early and safe return to work,
  • Provide significant new information not already available in your claim file,
  • Help clarify any disagreements in the medical opinions of doctors, or
  • Help to better understand the nature of your injury. This includes whether the injury is related to your work, your level of impairment, or your physical restrictions.

How Does WSIB Decide If the Nature and Extent of the Examination Is Appropriate?

WSIB considers the nature and extent of the examination appropriate as long as the examination is about the injuries, diseases, or conditions for which you are claiming benefits.

Also, a “health professional” must perform the examination. This includes medical doctors, chiropractors, physiotherapists, psychologists, and other types of health-care professionals.

What Can WSIB Decide?

The WSIB will consider all the evidence, including arguments from you and your employer. The decision will be one of the following:

  • if the examination is not necessary then you will not be required to attend,
  • if the examination is necessary:
    • But WSIB disagrees with the nature or extent of the examination, WSIB will order your employer to arrange an appropriate examination, or
    • The nature and extent of the examination are appropriate, WSIB will order you to attend the examination.

What if You Do Not Obey the WSIB Order to Attend the Examination?

If you do not attend the examination, or if you do not obey the order without a good reason, WSIB will reduce or take away your benefits for as long as you disobey the order.

Can You Appeal the WSIB Decision that Orders an Employer-Requested Health Examination?

You can appeal the WSIB decision that orders you to attend an employer-requested health examination through their internal appeal system. However, you cannot appeal the final WSIB decision ordering you to attend an employer-requested health examination to the Workplace Safety and Insurance Appeals Tribunal (WSIAT).