Revised Assessment Guide for Medical/Rehabilitation Designated

The Financial Services Commission of Ontario (FSCO) is pleased to provide, for your information, the revised Assessment Guide for Medical/Rehabilitation (Med/Rehab) Designated Assessment Centres (DACs); an update on the Cancellation Fee Schedule for Disability Assessments; and, a revised Roster of DACs, which includes the DACs authorized to conduct Med/Rehab Assessments.

The Minister’s Committee on the DAC System, whose mandate is to assist DACs in providing neutral, comprehensive, timely and cost-effective assessments, has recommended the implementation of the revised Assessment Guide for Med/Rehab DAC referrals received after September 15, 2000.

The Minister's Committee has been able to successfully address several systemic issues through this Assessment Guide including:

• Instructing the Med/Rehab DACs to focus the assessment on the issues in dispute (as identified on the OCF18/59) and not broadening the scope of the assessment unnecessarily.
  
  
• Instructing the Med/Rehab DACs to comment retrospectively on treatment plans that remain in dispute which have either commenced or been completed. This is a change from past DAC practices. All parties should be aware that this provision applies only to the treatment plans that remain in dispute. This retrospective assessment provision is not an opportunity to seek a DAC opinion on the reasonableness and necessity of treatment plans that have been previously agreed to by the insurer.
  
  
• Providing the DAC with an option to conduct a "paper review" when the reasonableness of the "Estimated Cost" of the treatment plan is the only issue in dispute. This provision is to be used at the sole discretion of the DAC and can only be considered under very specific circumstances as outlined in the Assessment Guide.

A fundamental change in this Assessment Guide is the establishment of baseline human resource criteria for all types of Med/Rehab DACs. In the past, although all Med/Rehab DACs mobilized multi-disciplined teams in their assessments, there were no minimum standards set regarding the team complement.

The Guide requires that all Med/Rehab DACs have sufficient physical and human resources to provide an opinion on the most commonly prescribed medical and/or rehabilitation goods and services required by a claimant as a result of a motor vehicle accident.

DAC assessors are now required to demonstrate five years of relevant assessment experience in addition to an active practice treating relevant patient populations. The new requirements ensure that each DAC assessment is conducted by rostered practitioners who approach their DAC responsibilities with a perspective acquired from maintaining a balanced, active practice.

The revised Assessment Guide, attached to this document, is entitled Medical/ Rehabilitation Designated Assessment Centre Assessment Guide: A guide to conducting Medical and Rehabilitation DAC assessments (September 2000) and replaces Ontario Insurance Commission Guidelines for Designated Assessment Centres to Conduct Assessments for Accidents on or after November 1, 1996 as amended, June 1998 for med/rehab assessments only.

Effective May 15, 2000, the Minister’s Committee introduced, on a six-month trial basis, a Cancellation Fee Schedule for Disability Assessments that applies to those types of assessments that are terminated before the first DAC appointment is held. This newly established pre-assessment Cancellation Fee Schedule is designed to ensure that the cancellation fee is based upon a realistic determination of the amount of work and expense that is incurred by a DAC up to that point in time.

It was the intent on the Minister’s Committee to introduce this Cancellation Fee Schedule for Medical and Rehabilitation DAC assessments upon the release of the new Med/Rehab Assessment Guide. It has been recommended by the Minister’s Committee that the introduction of the Cancellation Fee Schedule for Medical and Rehabilitation DAC assessments be delayed until the six-month trial period of the Cancellation Fee Schedule for Disability assessment has concluded. By that time the Minister’s Committee will have had an opportunity to make the necessary revisions to the model before it is implemented for Medical and Rehabilitation DAC assessments.

In order to properly assess the impact of the Cancellation Fee Schedule and to make the necessary adjustments, it is important for all of the stakeholders to provide their feedback. I encourage you to submit your written comments regarding the Cancellation Fee Schedule to the Minister’s Committee through FSCO’s Accident Benefit Analysis Unit as soon as possible.

The attached revised DAC roster entitled Roster of Designated Assessment Centres in the Province of Ontario dated September 2000, identifies all of the DAC locations in the province including those that have met the new requirements of the Med/Rehab Assessment Guide. Please note that there have also been changes to the names and mailing addresses of some of the Disability DACs since the release of the last printed Roster dated April, 2000. Changes to the Roster are made on an on-going basis and users of the system should always refer to the most up-to-date version of the DAC Roster, posted on FSCO’s website at www.fsco.gov.on.ca

These new documents reflect the ongoing commitment of FSCO and the Minister’s Committee to ensure that the DAC system is fair, accessible, timely and cost-effective.

Please ensure that the information contained in this bulletin is brought to the attention of your ADR Coordinator.

Questions about this bulletin should be directed to FSCO's Accident Benefits Analysis Unit at 416-790-7137 or 1-800-668-0128 extension 7137. The fax number is (416) 590-7265. Written feedback regarding the Cancellation Fee Schedule for Disability DAC assessments can be faxed to the above number or forwarded to:

Accident Benefits Analysis Unit
Financial Services Commission of Ontario
5160 Yonge Street, Box 85
North York ON M2N 6L9

Dina Palozzi
Chief Executive Officer and
Superintendent of Financial Services
August 25, 2000