With this Bulletin, the Financial Services Commission of Ontario is clarifying the Professional Services Guideline and issuing two new Superintendent’s Guidelines.
Application of Professional Services Guideline
This Bulletin clarifies the application of Superintendent’s Guideline No. 05/03, titled Professional Services Guideline, issued on September 18, 2003.
The Professional Services Guideline’s maximum hourly rates and maximum fees apply only to the expenses described in the Guideline for services rendered by health care providers listed in the Guideline. The Guideline reference to “Unregulated Providers” is meant to identify only health care providers who are not regulated under the Regulated Health Professions Act, 1991 (e.g., kinesiologists, and case managers who are not otherwise members of a profession regulated under the Regulated Health Professions Act, 1991).
As well, providers who provide services that are not health care services (e.g., social workers, driving instructors) do not fall under the “Unregulated Providers” category.
The Professional Services Guideline does not apply to treatment plans approved before September 18, 2003. Insurers are expected to pay for goods and services provided pursuant to treatment plans approved before September 18, 2003, at the rates set out in the treatment plans as approved, whether such goods and services are rendered before or after November 1, 2003.
Insurers are not prohibited from paying above any maximum fee or hourly rate set out in the Professional Services Guideline.
The Professional Services Guideline does not apply to fees charged by Designated Assessment Centres.
Superintendent’s Guideline: Conflicts of Interest in the Designated Assessment Centre (DAC) Selection Process, and Reporting Obligations for DACs Assessing Treatment Plans
The Superintendent of Financial Services is issuing a Guideline to address possible conflict of interest situations arising in the new DAC selection process (Section 53 of the revised Statutory Accident Benefits Schedule).
The Guideline also deals with the reports to be delivered by DACs concerning treatment plans in circumstances where the DAC has determined that the insured person’s impairment does not come within a Pre-approved Framework Guideline.
The Guideline (No. 08/03) is attached.
Superintendent’s Guideline: Insurers’ Delivery of Documents to Insured Persons
The Superintendent of Financial Services is issuing a Guideline to describe the circumstances in which a health care provider may act as an insured person’s authorized representative for the limited purpose of receiving certain documents from an insurer if specific conditions have been met.
The Guideline (No. 09/03) is attached.
Questions about this Bulletin should be directed to FSCO’s Automobile Insurance Policy Unit by calling the DAC Hotline at 416-590-7137 or 1-800-668-0128, extension 7137, or by fax to (416) 590-7265. You may also write to FSCO at:
Automobile Insurance Policy Unit
Financial Services Commission of Ontario
5160 Yonge Street, Box 85
North York Ontario
Bryan P. Davies
Chief Executive Officer and Superintendent of Financial Services
October 30, 2003