With this Bulletin, the Financial Services Commission of Ontario (FSCO) is releasing a revised Health Claims for Auto Insurance (HCAI) Guideline – Superintendent’s Guideline No. 02/18 (revised Guideline). This revised Guideline comes into effect October 1, 2018. It replaces the previously issued Guideline – Superintendent’s Guideline No. 01/17 issued in August 2017.
Mandatory use of HCAI for Form 1
FSCO released a Bulletin on January 4, 2018 informing insurers and health care providers that effective October 1, 2018, they must use HCAI for submitting and processing the Assessment of Attendant Care Needs Form (Form 1).
All facilities enrolled with HCAI must submit Form 1 to insurers electronically, using either a Practice Management System (PMS) that is integrated with HCAI or the HCAI web channel.
The revised Guideline reflects these changes to submission requirements.
Invoices for attendant care services will continue to be submitted and processed outside of the HCAI system.
Assessment of Attendant Care Needs Form (Form 1)
Form 1 is a Superintendent-approved form required when an injured claimant applies for attendant care benefits in accordance with the Statutory Accident Benefits Schedule (SABS) subsection 42(1). It is used for accidents that occur on or after March 31, 2008.
An occupational therapist or registered nurse must complete the form. It sets out the claimant’s specific attendant care needs and the associated monthly cost following an accident. The completed Form 1 is submitted to an auto insurance company.
Support resources and educational material concerning Form 1 and its submission in HCAI are available at
Facilities and regulated health professionals that are not enrolled in HCAI must enroll with HCAI for the electronic submission of Form 1. Additional information on the HCAI enrolment process can be found on the HCAI website provided above.
Copies of the HCAI Guideline
The revised Guideline Size: ## kb is available on FSCO’s website
and will be published in a forthcoming edition of The Ontario Gazette.
Chief Executive Officer and
Superintendent of Financial Services
September 20, 2018