Professional Services Guideline, Designated Assessment Centre Fee Guideline, Psychological Assessment and Treatment Guideline

The revised Professional Services Guideline establishes new maximum amounts payable by insurers for expenses related to the services of any of the health care professions and providers listed in the Guideline.

Some other highlights of the Guideline are set out below:

• Hourly rates for treatment of claimants with catastrophic injuries have been added. These rates apply to services rendered after the insured person has been determined to have sustained the catastrophic injury.
   
• The separate maximum hourly rate for Masters of Psychology has been removed and psychological associates and psychologists are now subject to the same maximum hourly rate, to reflect the fact that the College of Psychologists of Ontario, the governing body of psychologists and psychological associates, treats both designations as equal.
   
• A fee of up to $62 is payable for completion of an Application for Approval of an Assessment or Examination (OCF-22). The fee will only be payable following the approval by the insurer of any assessment or examination proposed in the OCF-22, or the determination by a Designated Assessment Centre (DAC) that any assessment or examination proposed in the OCF-22 is reasonably required.
   
• Collateral benefits reasonably available for any services to which this Guideline or Superintendent’s Professional Services Guideline No. 05/03 applies are to be deducted from the maximums established in the Guideline.

Unregulated Providers

In order to address questions over which providers fall into the unregulated provider category, the revised Guideline specifically identifies all providers that are subject to the unregulated provider hourly rates.

Unregulated providers and other regulated providers not listed in the revised Guideline (e.g., social workers and physicians) are not covered by the Guideline. The amount payable for services not covered by the Guideline is to be determined by the parties involved.

Expenses for regulated and unregulated providers identified in the Guideline are payable according to their professional designation and not by the services they provide. For example, case management services provided by an occupational therapist are payable at the occupational therapist rate and not at the case manager rate.

Application of revised Professional Services Guideline

The Superintendent’s revised Professional Services Guideline applies to expenses related to services rendered on or after February 1, 2004. The Superintendent's Professional Services Guideline No. 05/03 continues to apply to expenses related to services rendered between November 1, 2003 and January 31, 2004, with the following exception: expenses related to services provided pursuant to treatment plans approved before September 18, 2003 are payable at the rates set out in the treatment plans as approved, whether such services are rendered before or after November 1, 2003.

Insurers are not prohibited from paying above any maximum fee or hourly rate established in the Professional Services Guideline.

The Professional Services Guideline does not apply to fees charged by Designated Assessment Centres (DACs). A separate fee schedule, outlined below, will apply to DACs.

2. Designated Assessment Centre Fee Guideline

In order to provide greater predictability and to stabilize costs within the DAC system, FSCO is issuing the Designated Assessment Centre Fee Guideline for assessments conducted under section 24 of the Statutory Accident Benefits Schedule - Accidents on or after November 1, 1996 (SABS) (Ontario Regulation 403/96).

This Guideline applies to all DAC assessments other than Fast-Track Medical and Rehabilitation DACs, Residual Earning Capacity DACs, and assessments for claimants with brain or spinal cord impairments.

This Fee Guideline will be effective for all requests for assessment received by a DAC on or after March 1, 2004.

3. Psychology Assessment and Treatment Guidelines

The Psychology Assessment and Treatment Guidelines, March 31, 2001, Superintendent’s Guideline No. 2/01 are hereby revoked as the Insurance Bureau of Canada and Ontario Psychological Association have not reached an agreement to continue their application.

Copies of Guidelines

 

Attachments (PDF):

• Professional Services Guideline  Size: 61 kb​
• Designated Assessment Centre Fee Guideline  Size: 24 kb​