Medical Aid Principles Policy 25-001 | Effective Date: March 28, 2024

Policy

WorkSafeNB has the legislated authority to determine the necessity, character, and sufficiency of medical aid required to treat an injury by accident under s. 41(1) and 41(3) of the Workers' Compensation Act (WC Act). The principles in this policy guide WorkSafeNB’s discretion in arranging and paying for this medical aid.

The president and CEO may delegate authority to the chief medical consultant, director of health services, or other staff as appropriate, to:

• Establish standards for care and treatment;
• Purchase, arrange, or provide medical aid; and
• Negotiate the fees it pays for medical aid.

WorkSafeNB is committed to workers receiving care that is timely, appropriate, cost-effective, and evidence-based. That commitment is reflected in a framework that WorkSafeNB has adopted for medical aid that ensures injured workers receive:

• The right care, that is delivered by
• The right provider, and is obtained at
• The right cost.

From that framework flow the following principles that guide WorkSafeNB’s medical aid services and decisions.

Principles

I. WorkSafeNB is committed to injured workers receiving quality, evidence-based care and treatment.

WorkSafeNB develops, adopts and follows evidence-based standards for care and treatment which are consistent with the other principles set out in this policy and with generally-accepted medical practices.

WorkSafeNB is also committed to the practice of consulting with health care providers in the development of plans for the optimum care and rehabilitation of injured workers.

II. WorkSafeNB promotes the use of guidelines for medical recovery that have been shown, by scientific literature or experience, to be effective in the treatment of injury or occupational disease.

WorkSafeNB manages the care plans proposed by the worker’s health care provider using guidelines that include:

• Clinical care maps;
• Disability duration guidelines;
• Healing times; and
• Treatment, or clinical practice guidelines. 

III. WorkSafeNB requires scientific evidence of effectiveness of new, non-standard or not generally accepted treatment and tests.

WorkSafeNB is committed to workers receiving quality health care and related services that are evidence based and known to be effective in the rehabilitation of injury and occupational disease. WorkSafeNB does not authorize the administration of treatment or tests to workers until the scientific evidence has been reviewed and the procedure approved.

IV. WorkSafeNB promotes timely access to evidence-based treatment and services.

Prompt access to appropriate, evidence-based treatment and services is important to aid the recovery of injured workers. Significant delays accessing investigations and treatments increase the risk of not returning to work, which has been shown to increase risk of morbidity and early mortality. WorkSafeNB may arrange for workers to receive treatment or services in another location, including out of the province if local sources of services are unavailable or delayed.

V. WorkSafeNB promotes early and safe return to work as therapy.

Injured workers do not always need to be fully recovered before they benefit from returning to work in some capacity. Early and safe return-to-work is recognized as being therapeutic for the injured worker and is an integral part of their rehabilitation.

WorkSafeNB’s rehabilitation goals focus initially on helping workers stay at work during rehabilitation, or safely return to work as early as possible. For more information, see Policy 21-400 Rehabilitation. 

VI. WorkSafeNB designates specific treatments and tests for prior approval.

WorkSafeNB arranges and pays for the tests and treatments that are evidence based and necessary to treat the workplace injury within generally accepted treatment guidelines.

For treatments or tests in excess of generally accepted treatment guidelines, WorkSafeNB may require a second opinion, or prior authorization of payment.

If prior authorization is not given and WorkSafeNB determines that the tests, treatments and procedures are beyond necessary medical aid, the worker may decide to pursue these treatments, tests or procedures, either at their own expense or through other means. WorkSafeNB does not pay for this treatment.

If evidence demonstrates that these treatments or procedures, not approved by WorkSafeNB, impede recovery as per s. 41.2 of the WC Act, WorkSafeNB applies Policy 21-214 Continued Entitlement to Compensation for Loss of Earnings to determine whether loss of earnings benefits should cease.

VII. WorkSafeNB promotes appropriate and cost-effective prescription drug administration.

WorkSafeNB is committed to workers receiving only the appropriate medications, in the appropriate quantities, that evidence indicates are required to effectively treat the injury or occupational disease. In making these determinations, WorkSafeNB uses recognized standards, including the World Health Organization Pain Relief Ladder.

WorkSafeNB may refuse payment for prescriptions which are excessive or inappropriate for the worker, or may cause substance use disorders. In the case where WorkSafeNB determines that an injured worker’s substance use disorder resulted from the treatment of a compensable injury or disease, WorkSafeNB will be responsible for the costs of harm reduction programs. For more information, see Policy 25-012 Medical Aid - Opioids.

WorkSafeNB may require additional monitoring, measurement and reporting of outcomes for specific prescriptions, and will not generally approve payments for those prescriptions where there is evidence of harm or insufficient evidence of benefit.

WorkSafeNB ensures the best price for prescription drugs by using a generic brand whenever possible. WorkSafeNB further manages drug costs by using a prescription drug formulary. WorkSafeNB may make an exception for a prescription drug in the event that the treating physician provides reasons for specific drug requirements.

VIII. WorkSafeNB arranges and purchases evidence-based care for workers determined to be necessary medical aid.

WorkSafeNB arranges and purchases the necessary medical aid in the appropriate quantities that evidence indicates are required to effectively treat the injury or occupational disease of a worker.

Accordingly, WorkSafeNB is committed to being proactive in validating an injured worker’s diagnosis upon which to base medical and rehabilitation planning.

WorkSafeNB may refuse to approve payment for treatments that are in excess of generally accepted treatment guidelines and/or fail to produce evidence of functional improvement. In such situations, WorkSafeNB explores alternate rehabilitation options.

IX. WorkSafeNB requires workers to actively participate in rehabilitation plans, assessments, treatments and services.

Section 41.2 of the WC Act provides authority for WorkSafeNB to reduce or suspend loss of earnings benefits whenever an injured worker does not attend and participate in medical examinations, treatments, and/or rehabilitation programs. For more information, see Policy 21-214 Continued Entitlement to Compensation Payments for Loss of Earnings.

X. WorkSafeNB only recognizes providers that have been authorized to deliver health care services.

WorkSafeNB may approve providers that have been licensed or accredited to deliver health care services in the province by provincial or national licensing agencies. If such agencies do not exist for a particular health care provider, WorkSafeNB may approve these health care providers on an individual basis.

XI. WorkSafeNB strives to support injured workers in their choice of approved health care provider, while promoting optimum care and rehabilitation.

Injured workers have the right to choose their health care provider from among those who are approved by WorkSafeNB.

WorkSafeNB may limit the number of visits to health care providers and the number of health care providers visited to what is reasonable for the injured worker’s compensable condition.

In certain circumstances, injured workers may have a reason to request a change of health care provider. WorkSafeNB also has the authority to change a worker’s healthcare provider. WorkSafeNB may authorize the injured worker’s request or initiate referral of the injured worker to another health care provider when:

• Another provider would offer the worker a better opportunity for recovery;
• The worker’s injury is complex in nature;
• Recovery is slower than anticipated; or
• Other barriers to recovery are apparent.

When authorizing appointments with, or changes to, approved health care providers, WorkSafeNB considers such factors as the condition of the worker, waiting times, and distance to be travelled for the appointment or treatment. All decisions concerning choice of and changes to health care providers are subject to a test of reasonableness, must be evidence-based, and must be consistent with the framework of right care, right provider and right cost.

XII. WorkSafeNB establishes the fees it pays for health care and related services, by negotiating with individuals or health care provider groups or by adopting health care provider fee schedules, as appropriate.

WorkSafeNB negotiates fees with:

• Medical practitioners and specialists;
• Nurse practitioners;
• Chiropractors;
• Physiotherapists;
• Dentists and denturists; and
• Any other health care providers, as required.

WorkSafeNB pays fees according to the current rate schedules as established by the following health care providers and facilities:

• Hospitals;
• Optometrists;
• Nursing and home health care services; and
• Any other health care providers and services, as required. 

Previous versions

• Medical Aid Principles, release 7, effective January 17, 2019
• Medical Aid Principles, release 6, effective March 29, 2017
• Medical Aid Principles, release 5, effective March 17, 2016