Audiologist's current audiometric results and hearing-loss findings for a WCB hearing loss claim.
- Completed by
- Audiologist
- Issued by
- WCB Nova Scotia
- Format
- Fillable PDF
- Language
- English
WCB Nova Scotia Hearing Loss Exception to Benefits Form
Audiologists and hearing instrument specialists use this one-page form to seek WCB Nova Scotia approval for devices or services that differ from those in its Hearing Health Services Guide. Requests range from more frequent re-fitting, extra batteries or maintenance and an advanced dry aid kit to a tinnitus assessment or a hearing aid outside the approved list, each with a written rationale. A worker section records any cost-sharing agreement.
Who completes it
The audiologist or hearing instrument specialist completes the service provider, request and rationale sections and signs. The worker completes and signs the cost-sharing section when the recommended device requires a cost-sharing arrangement with the clinic.
Submitting and payment
- How to submit it
- Upload the completed PDF as a secure-message attachment in WCB Online, or fax it to WCB, with the claim number on every page.
- Who pays
- WCB pays approved items under its hearing health fee codes, such as 19B for hearing aids and 19T for tinnitus assessments, and in a cost share the worker pays the clinic any difference above WCB's cap.
Good to know
- Replacing a hearing aid under five years old needs a written request with rationale to the case worker plus this form, and written or verbal approval before proceeding.
- An advanced dry aid kit requires proof of at least two moisture-related repairs in the past 12 months, and a hearing aid request needs proof of a trial with an approved aid.
- WCB's typical battery supply is 60 cells per hearing aid per year; more needs this form with a rationale and prior approval from the case worker.
- A tinnitus assessment needs pre-approval case by case, and WCB's guide suggests describing when the worker hears it, whether it is constant, how long, one or both ears, and its effect on daily function.
Get the official form
Download the current version from the source each time; forms change without notice.
Hearing Loss Exception to Benefits Form
Fill it with Vero
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
How this list is checked
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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Frequently asked questions
When do I need WCB Nova Scotia's Hearing Loss Exception to Benefits Form?
Whenever you seek approval for a device or service that differs from WCB's Hearing Health Services Guide: replacing an aid under five years old, a device from the approval-required list or another manufacturer, more frequent re-fitting or repairs, extra batteries, other accessories or maintenance, a tinnitus assessment, or full coverage above the hearing aid cap in exceptional circumstances.
How does cost sharing work for WCB Nova Scotia hearing aids?
A worker can choose a device outside WCB's approved pricing list. WCB then reimburses the clinic up to its hearing aid cap per aid, and the worker pays the clinic the difference between the manufacturer's invoice cost and the amount invoiced to WCB. The worker signs the cost-sharing section to confirm they understand this.
Can WCB Nova Scotia cover a hearing aid above its price cap in full?
In exceptional circumstances, with pre-authorization from the case worker before ordering. You explain on this form why the device is needed, give examples of difficulty with current aids and how the new one better meets the worker's needs, and include a completed audiometric assessment showing the loss cannot reasonably be addressed by other amplification.