Conflict of Interest Guideline, New Residual Earning Capacity Assessment DAC, Reminder About Case Management Costs

To the attention of all insurance companies in the Province
of Ontario licensed to transact auto insurance

 

With this Bulletin, the Ontario Insurance Commission (OIC) is providing insurers with a copy of the new Guideline Respecting Conflict of Interest in the Provision of Medical and Rehabilitation Services; announcing the appointment of a new residual earning capacity designated assessment centre (DAC); and issuing a reminder note about how to deal with the costs associated with case management of claimants who have suffered personal injuries in motor vehicle accidents.

1. NEW GUIDELINE
   
   To clarify what constitutes a conflict of interest in decisions about medical and rehabilitation services, the Ontario Insurance Commission (OIC) released the Guideline Respecting Conflict of Interest in the Provision of Medical and Rehabilitation Services (guideline).
   
   The guideline was developed in consultation with the industry, and is in response to the need among insurers, health care providers and lawyers for a clearer understanding of the Statutory Accident Benefits Schedule (SABS) conflict of interest provisions.
   
   The guideline first appeared in the August 23, 1997 edition of The Ontario Gazette and was issued by the Commissioner of Insurance who is authorized under section 268.3 of the Insurance Act to issue guidelines on the interpretation and operation of the SABS.

Distribution of Guideline to DR Co-ordinators, Claims and Adjusting Departments

Because of the importance of this and other guidelines, the OIC urges insurers to ensure that copies of this guideline are provided to their claims and adjusting staff as well as to their Dispute Resolution co-ordinators who should note that the attached guideline becomes B 10-1 of the Dispute Resolution Practice Code.

The OIC will also be providing copies of this guideline to all DACs as well as to associations representing professional health care providers.

2. APPOINTMENT OF NEW RESIDUAL EARNING CAPACITYASSESSMENT DAC.
   
   The OIC has appointed the Ontario March of Dimes, South Central Region, in Hamilton as an additional residual earning capacity assessment DAC, effective August 18, 1997.  The appointment is the result of a public tendering process to meet residual earning capacity assessment needs in the south central region of the province.  Although this appointment falls under the SABS of the previous automobile insurance system (Bill 164), the Commissioner of Insurance sought the recommendations of the Minister’s Committee on the DAC system prior to making this appointment. 
   
   The full details of the appointee are:
   
   South Central Ontario Region:
   
   Ontario March of Dimes, South Central Region
   225 King William Street, 5th floor
   Hamilton, ON L8L 1B1
   Tel: (905) 522-2253
   Fax: (905) 522-2351
   
   The last edition of the OIC-published  Designated Assessment Centre Revised Roster, dated November, 1996, will be updated and released in the near future.
   
   
3. REMINDER NOTE ON CASE MANAGEMENT EXPENSES
   
   Insurers are reminded that the costs associated with case managers, retained or hired directly by an insurance company to assist in managing a claim file, should be allocated as an expense and not as a rehabilitation benefit.
   
   Case management services that are recommended in a treatment plan and approved by the insurer, and/or where explicit approval for these services is obtained from the claimant, should be allocated to the rehabilitation benefit.

Dina Palozzi
Commissioner

August 26, 1997

Attachment:

• Guideline Respecting Conflict of Interest in the Provision of Medical and Rehabilitation Services