The Financial Services Commission of Ontario (FSCO) has issued the Professional Fee Guideline - Occupational Therapists (Fee Guideline) and the Occupational Therapy Utilization Guidelines (Utilization Guidelines) as a result of recommendations made by the Insurance Bureau of Canada (IBC) and the Ontario Society of Occupational Therapists (OSOT).
The recommendations deal with occupational therapy fees and utilization guidelines regarding auto insurance accident claimants, and present an improved co-ordinated approach by the parties to ensure better management of the services provided to claimants and to facilitate claimants’ timely return to normal activities, including work.
Both guidelines were published in the February 3, 2001, edition of The Ontario Gazette. The Fee Guideline has been issued by the Superintendent of Financial Services who is authorized under Subsections 14 (4), 15 (6), 17 (2) and 24 (2) of the Statutory Accident Benefits Schedule - Accidents on or After November 1, 1996 (SABS) to issue professional fees guidelines. It applies to expenses incurred on or after February 3, 2001. The Utilization Guidelines have also been issued by the Superintendent of Financial Services who is authorized under Section 268.3 of the Insurance Act (Act) to issue guidelines on the interpretation and operation of the SABS. They apply to all accidents occurring on or after February 3, 2001.
The insurance industry and the OSOT have agreed to review the issues or the impact of the guidelines – should either party request a review – 18 months after the publication of the guidelines dealing with these matters. It was also agreed that an automatic review will be made three years after the issuing of such guidelines.
Distribution of Occupational Therapy Utilization Guidelines to ADR coordinators, claims and adjusting departments
Guidelines issued under the Act are important information documents. FSCO, therefore, urges insurance companies to ensure that copies of the attached Occupational Therapy Utilization Guidelines are provided to their claims and adjusting staff as well as to their Alternative Dispute Resolution (ADR) Co-ordinators. Insurers should note that these guidelines will be incorporated into the next Dispute Resolution Practice Code update.
Dina Palozzi
Chief Executive Officer and
Superintendent of Financial Services
February 5, 2001
Attachments (PDF):
- Professional Fee Guideline – Occupational Therapists
- Occupational Therapy Utilization Guidelines