With this Bulletin, the Financial Services Commission of Ontario (FSCO) is releasing a revised Minor Injury Guideline (MIG) that becomes effective on November 1, 2011.
The revised MIG provides direction for billing practices when a claimant changes health practitioners within the MIG, and direction on the integration of extended health care benefits with the MIG.
FSCO has received inquiries asking for direction on payments to more than one health practitioner when a claimant changes practitioners within the MIG. The first practitioner often bills for the entire Block amount for treatments leaving the claimant with no funds for additional treatment under that Block with their new practitioner. To address this issue the MIG has been amended to provide that where a claimant changes health practitioners, the first health practitioner may only bill 25% of the amount otherwise payable for a Block for each week or part week in which that health practitioner provided treatment under the Block.
FSCO has also received inquiries regarding extended health care benefits (EHCB) payments under the MIG. The SABS rules regarding EHCB carriers as first payers have not changed; therefore benefits covered by EHCB must first be exhausted. However, amounts covered by other sources do not reduce the overall $3,500 cap for medical and rehabilitation benefits.
Authority
The MIG is issued pursuant to section 268.3 of the Insurance Act for the purposes of the SABS.
Copies of the MIG
A copy of the revised MIG is attached. The revised MIG is also available on FSCO’s website at www.fsco.gov.on.ca. The revised MIG will also be published in a forthcoming edition of The Ontario Gazette.
Philip Howell
Chief Executive Officer and
Superintendent of Financial Services
October 19, 2011
Attachments:
- Minor Injury Guideline No. 02/11
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