As part of the reforms to the current auto insurance system, Bill 198 (Keeping thePromise for a Strong Economy Act (Budget Measures), 2002 authorizes the Superintendent to issue guidelines relating to treatment, goods and services associated with medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.
With this Bulletin, the Superintendent is introducing Pre-approved Framework (PAF) Guidelines to the accident benefits system. The PAF Guidelines provide specific protocols for accessing treatment for certain impairments without requiring prior insurer approval in order to commence treatment.
The PAF Guidelines address whiplash associated disorders (WAD I and WAD II), the most common conditions resulting from an auto accident. Insured persons who do not have an impairment which fits within these Guidelines may continue to use the Treatment Plan process outlined in the Statutory Accident Benefits Schedule.
The PAF Guidelines provide an overview of the expected course of treatment with a focus on the insured person maintaining normal daily activities; they are not clinical guidelines. The PAF Guidelines set out block fees which will be paid depending on the duration of the treatment. Some additional fees will be chargeable in specified circumstances. Upon completion of treatment, a final report will be prepared for the insurer which will indicate the insured person’s outcomes from treatment.
The PAF Guidelines represent a consensus agreement between auto insurers and health care providers and may be revised over time based on the parties’ experience.
The PAF Guidelines are effective for all accidents occurring on and after October 1, 2003.
Bryan P. Davies
Chief Executive Officer and
Superintendent of Financial Services
July 14, 2003
- Pre-approved Framework Guideline for Whiplash Associated Disorder Grade I Injuries With or Without Complaint of Back Symptoms Size: 91 kb
- Pre-approved Framework Guideline for Whiplash Associated Disorder Grade II Injuries With or Without Complaint of Back Symptoms Size: 361 kb