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WorkSafeNB Telephone Consultation & Case Conference

When WorkSafeNB initiates or requests a telephone consultation or case conference, the physician documents and bills it on this one-page form. It records the claimant, injury diagnosis, consultation type, duration in minutes, any travel to a WorkSafe office, the WorkSafeNB contact person and a summary plan, and it carries a review line for a WorkSafeNB medical advisor or case manager.

Who completes it

The physician, either the patient's primary care physician or a specialist, completes and signs it, including the physician's account and WorkSafeNB payee number. The WorkSafeNB medical advisor or case manager signs the review line.

Submitting and payment

How to submit it
Fax the completed form to WorkSafeNB, or mail it; it applies only to consultations or conferences that WorkSafeNB initiated or requested.
Who pays
WorkSafeNB pays physician consultations with a specialist or physiotherapist (W1060, W1062, W1050) at the office visit fee, and employer, case manager and conference codes (W1020 to W1041) at the office visit fee for the first 10 minutes plus 48% for each further 10.

Good to know

  • Use it only for calls WorkSafeNB initiated or requested; the employer consultation code (W1020) is not to be used for employer-initiated calls.
  • Record total minutes for the consultation or conference (W1028, W1038) and total kilometres if you travelled to a WorkSafe office for a case conference (W1039).
  • Case conferences can be in person or by teleconference, for case management (W1040) or with WorkSafeNB's Rehabilitation Centre (W1041).
  • The form's version date is October 2012, and a French version is posted on WorkSafeNB's French-language site.

Get the official form

Download the current version from the source each time; forms change without notice.

WorkSafeNB Telephone Consultation and Case Conference Form

Formulaire de consultation par téléphone et de conférence de cas de Travail sécuritaire NB

Official pagePDFVersion française

Fill it with Vero

If your copy of the form is a fillable PDF, upload it 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.

See how Vero Documents works

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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Can I bill WorkSafeNB for a call I initiated?

This form is for telephone consultations or case conferences initiated or requested by WorkSafeNB, and the employer consultation code W1020 specifically excludes employer-initiated calls. Each consultation type has its own W-code, and the form has a review line for a WorkSafeNB medical advisor or case manager.

Which W-codes are on the WorkSafeNB telephone consultation form?

Physician to specialist (W1060), specialist to specialist (W1062), physician to physiotherapist (W1050), employer (W1020), case manager (W1030), WorkSafeNB physician (W1031), Cadre physician (W1032), case management conference (W1040) and WRC conference (W1041), plus duration (W1028, W1038) and travel (W1039).