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WSCC Physiotherapy Request for Extension (CS007)

A physiotherapist or occupational therapist in the Northwest Territories or Nunavut sends this one-page request when a WSCC claimant needs treatment beyond what has been approved. A physician can refer a worker directly for up to six weeks of therapy, and any extension needs the WSCC's approval first. The request sets out progress to date, the reason, the number of additional treatments and the expected effect on return to work.

Who completes it

The treating physiotherapist or occupational therapist completes and signs the whole form, entering the clinic name, WSCC claim number and the worker's Social Insurance Number. The worker and employer do not complete any part.

Submitting and payment

How to submit it
Email or fax it to WSCC's NWT or Nunavut claims department using the contacts printed on the form, before the extra treatment starts, since extensions require prior WSCC approval.
Who pays
Treatment past the approved period is covered only once the WSCC approves the extension, and approved treatment is billed on the WSCC Medical Invoice form within one year of the service.

Good to know

  • Prior WSCC approval is also needed for treatment in a clinic the WSCC does not recognize, treatment in the worker's residence, or more than one treatment per day.
  • The form asks for the dates of the most recent and next progress reports, which tie it to the Physiotherapy/Occupational Therapy Progress Report, Form B (CS112).
  • Tick whether a maintenance program applies: the WSCC may approve up to six weeks of maintenance therapy a year, on a treating physician's recommendation, after the condition has stabilized.
  • The PDF has no fillable fields, so it is printed and completed by hand; dates are written year, month, day, and the printed code is CS007 0924.

Get the official form

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

Physiotherapy Request for Extension

Demande de prolongation – Physiothérapie et ergothérapie

Official pagePDFVersion française

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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

How many physiotherapy sessions does WSCC cover before an extension is needed?

The treatment terms printed on the form say a treating physician may refer a worker directly to an approved physiotherapy or occupational therapy program for up to six weeks of treatment. Requests from the physician, physiotherapist or occupational therapist to extend treatment beyond that require prior WSCC approval, using this form.

What does the WSCC extension request ask for?

Dates of first treatment and of the most recent and next progress reports, progress to date, the reason for the extension, the number of additional treatments, changes to functional goals since the last progress report, whether the extension should lead to return to work, the expected return date, and goals such as remaining at work.

Can occupational therapists use the Physiotherapy Request for Extension?

Yes. Although WSCC lists it as the Physiotherapy Request for Extension, the form itself is headed Physiotherapy/Occupational Therapy, Request for Extension, and the signature block is for the physiotherapist or occupational therapist. The French version is titled for both physiotherapy and occupational therapy as well.