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
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.