What the Eye Injury Report is for
The report gives WCB Nova Scotia what it needs for a permanent impairment assessment after a traumatic eye injury. It asks for standard measurements, such as Snellen acuity, intraocular pressure and visual fields, alongside your view of how the injury changed the eye. WCB’s impairment examiners use the AMA guides to rate permanent loss of function.
Who completes it
An ophthalmologist completes, signs and dates it. Add pages if you need more space. There’s no worker section, and WCB asks you to contact it with questions about the form.
How to fill in the report
Injury, condition and outlook (sections A to F)
Describe the work-related injury and the worker’s concerns and symptoms. Record the location and condition of each eye, noting abnormalities of the lid, globe, cornea, pupil, vitreous, retina and disc. Explain how the condition affects the usefulness of the eye, what treatment or referral could improve it, and whether the worker is at maximum medical recovery. If not, estimate when they will be.
Visual acuity (section G)
Report central acuity as the Snellen 20-foot equivalent for near and far vision, both eyes and each eye, with and without correction. Answer the aphakia, pseudophakia, capsular opacification and photophobia questions for each eye.
Pressure, fields and motility (sections H to J)
Give intraocular pressure for each eye. Mark visual fields normal or abnormal and attach the plotted chart if abnormal. Record diplopia and the percentage decrease in ocular motility on each side.
Disfigurement and other disturbances (sections K and L)
Record any facial or eye disfigurement, epiphora and metamorphopsia, each with a degree of mild, moderate or severe.
Before and after the injury (sections M to O)
Describe the eye’s condition before the injury and what changed because of it. Then estimate what share of the current deficit relates to the pre-existing condition and what share to the compensable injury. Leaving this blank leaves WCB to apportion without your opinion.
Common reasons it’s delayed
- Completed by someone other than an ophthalmologist.
- Acuity reported without the with and without correction values for each eye.
- Abnormal fields with no plotted chart attached.
- No answer on maximum medical recovery, or no estimated date.
- The apportionment question in section O left blank.
Submitting and who pays
Fax the report to WCB Nova Scotia at 902-491-8001 or mail it to 200-137 Venture Run, Dartmouth, NS B3B 0L9, with the claim number on every page. With WCB Online access, upload it as a secure message attachment instead. Physicians bill WCB through MSI with WCB as the payee, within six months of the service.