The commissioning of care by Workers' Compensation Boards alongside provincial healthcare insurance plans functions in Canada in much the same way as parallel private insurance functions in countries like England and Australia. Parallel payers introduce policy conflict, undermine equity and promote privatization. WCB demands for expedited care for injured workers create challenges for the efficiency and fairness of the healthcare system. Unfortunately, the legitimate policy of goals of WCB and universal healthcare insurance are difficult to reconcile in the real world of Canadian healthcare policy.