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WSIB Form 8W (0425A): Vibration White Finger Report

When a patient reports work-related vibration induced white finger disease, the WSIB sends out this physician's report, which you complete and return to the WSIB. The WSIB adjudicates hand-arm vibration syndrome, which it also calls vibration induced white finger disease (VIWFD) or Raynaud's, in its Occupational Disease and Survivor Benefits Program. The WSIB supplies the form rather than posting it for download.

Who completes it

The physician completes the whole form. The worker's claim (Form 6) and the employer's report (Form 7) are filed separately, and the WSIB may ask the worker to sign a permission form so it can obtain a specialist's report.

Submitting and payment

How to submit it
Complete the copy the WSIB supplies and return it to the WSIB; if you fax it, the physician fee schedule says not to also send the original.
Who pays
Bill the WSIB directly under physician fee code M657, the code for the physician's report on vibration induced white finger disease.

Good to know

  • The WSIB lists hand-arm vibration syndrome (HAVS) among the occupational diseases adjudicated in its Occupational Disease and Survivor Benefits Program, noting it is also known as VIWFD or Raynaud's.
  • The WSIB notes that a medical specialist often needs to diagnose an occupational disease, and it may ask the patient to sign a permission form to obtain the specialist's report.
  • When permanent impairment from HAVS is rated, WSIB policy 16-01-09 weighs vascular, neurological and musculoskeletal components, using tests such as finger re-warming, vibration perception threshold and grip strength.
  • Other occupational illnesses use different WSIB physician reports: Form 8D (0307A) for occupational disease generally, Form 8D2 (0353A) for skin disease and Form 8S (0407A) for chest disease.

Get the official form

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

Physician's report - vibration induced white finger disease (Form 8W)

Official page

Fill it with Vero

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Frequently asked questions

What does the WSIB call vibration white finger?

The WSIB's list of occupational diseases uses hand-arm vibration syndrome (HAVS) and notes it is also known as vibration induced white finger disease (VIWFD) or Raynaud's; its HAVS policy describes a condition affecting workers who use hand-held vibratory tools. The physician's report for it is Form 8W (0425A), which the WSIB sends when a patient reports the condition.

What billing code applies to WSIB Form 8W?

Physician fee code M657. The WSIB physician fee schedule lists it in the physician reports table and describes it as a form the WSIB sends when a person reports a work-related vibration induced white finger illness, to be completed and returned to the WSIB. Accounts received more than six months after the service may be reduced.

Do I need my patient's consent to send Form 8W to the WSIB?

The WSIB's reporting requirements page cites section 37(1) of the Workplace Safety and Insurance Act, which requires health care practitioners to share the information the WSIB needs, and section 43(1)(h) of the Personal Health Information Protection Act, which allows a health information custodian to disclose health information to the WSIB without consent.