Podiatry Fee and Utilization Guidelines for Auto Insurance



No. A-5/98
- Auto
Property & Casualty
[To the attention of all insurance companies licensed
to transact automobile insurance in Ontario]

The Ontario Insurance Commission (OIC) has issued the Professional Fee Guideline - Podiatrists (Fee Guideline) and the Podiatry Utilization Guideline (Utilization Guideline) as a result of recommendations made by the industry's Bill 59 Fees Committee (the Committee) and the Ontario Podiatric Medical Association (OPMA).


The recommendations deal with podiatry fee and utilization guidelines regarding auto insurance accident claimants, and present an improved co-ordinated approach by the parties to ensure better management of the treatments provided to claimants and to facilitate claimants' timely return to normal activities, including work.


The guidelines were originally published in the March 7, 1998 edition of The Ontario Gazette. The Fee Guideline was issued by the Commissioner of Insurance 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 March 7, 1998. The Utilization Guideline was also issued by the Commissioner of Insurance who is authorized under Section 268.3 of the Insurance Act (Act) to issue guidelines on the interpretation and operation of the SABS. It applies to all accidents occurring on or after March 7, 1998.

The insurance industry and the OPMA 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 guideline to insurers' DR Coordinators, Claims and Adjusting Departments


Guidelines issued under the Act are important information documents. The OIC, therefore, urges insurance companies to ensure that copies of the attached Podiatry Utilization Guideline are provided to their claims and adjusting staff as well as to their Alternative Dispute Resolution (ADR) Co-ordinators. Insurers should note that this Utilization Guideline will be incorporated in the next Dispute Resolution Practice Code update issued by the OIC.



Insurers' Guide to Orthotics


At the request of the OPMA and the insurance industry, we are enclosing, for the information of property and casualty insurers, a copy of its Insurers' Guide to Orthotics.

Dina Palozzi
Commissioner of Insurance
March 9, 1998


Attachments (HTML):



  1. Professional Fee Guideline - Podiatrists
  2. Podiatry Utilization Guideline
  3. Insurers' Guide to Orthotics

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