bulletin

Bulletin Number
        4336
Date
        May 11, 1999
Direct inquiries to

         Ministry of Health
         Processing Office


(address below)
Distribution  
Physicians, Hospitals, Clinics, and Laboratories
Subject     BILLING FOR THIRD PARTY SERVICES COVERED BY THE OCCUPATIONAL HEALTH AND SAFETY ACT

Inquiries to the Ministry of Health have identified the need to clarify the procedure for billing of third party services that are covered by regulation under the Occupational Health and Safety Act. These third party services are not OHIP insured services but are the responsibility of the third party.

Where it is determined that a specific substance, for example, asbestos, benzene or lead, is present in the workplace, the Ministry of Labour, through its control program, may request that employees undergo a medical examination and/or clinical tests such as, chest x-rays, blood tests and/or urine tests.

A number of regulations under the Occupational Health and Safety Act, state :

"A worker shall, at the expense of the employer, undergo the medical examinations and clinical tests required under the control program."

The medical examinations and/or clinical tests may be performed by any physician the employee chooses, however the costs associated with these services are the responsibility of the third party and cannot be billed to OHIP. Similarly, laboratory requisition forms contain a box labeled "Third Party/Uninsured" this box should be checked for third party uninsured services.

Any follow-up or tests resulting from such examinations and/or tests that are required for treatment for a medical condition must be, where related to workplace injuries or illnesses covered under the Workplace Safety and Insurance Act, claimed through the Workplace Safety and Insurance Board. All other medically necessary services required for a medical condition not covered under the Workplace Safety and Insurance Act would be covered by OHIP.

Since physicians may not be familiar with regulations under the Occupational Health and Safety Act that impact on them, they should consider the Health Insurance Act, Regulation 552, Section 24(1) 8. And 8.1 when determining if a service is OHIP insured, or not.

./2

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