DAC Communiqué - April 2000

Information Communiqués should be circulated amongst all DAC Clinical and Administrative staff. They are intended to keep DAC staff informed on current issues and to provide information on the activities of the Minister's Committee on the Designated Assessment Centre System (DAC Committee).

This issue provides an update on the revised DAC Assessment Guidelines; notifies of the impending release of the new Medical/ Rehabilitation Assessment Guideline; notifies of the status of a Cancellation Fee model for Disability and Medical/ Rehabilitation DACs; highlights recent roster activity; addresses non-DACable issues under the SABS; reviews recent arbitration decisions; speaks to referring claimants to the closest DAC centre; and responds to recent questions to the DAC Committee and the ABAU.

Disability DAC Assessment Guideline - Update

Further to the report given in the December 1999 Communique, the ABAU staff have been busy reviewing the submissions from existing Disability DACs to ensure they meet the base physical and human resource requirements of the new Assessment Guideline.

Although it was initially reported that the review phase would be completed by the end of January 2000, the process
has taken longer as a result of the number of proposals received and the need for additional information for a number of the submissions.

We are pleased to announce that this review process is almost complete and a new roster, along with the implementation of the new Disability DAC Guideline, will be released in April, 2000.

New Medical & Rehabilitation Assessment Guideline

The DAC Committee is pleased to advise that the implementation draft of the Medical/ Rehabilitation Assessment Guideline is complete.

The Guideline for the Med/Rehab DACs, once implemented by the rostered providers, will assist in ensuring Med/Rehab DACs provide assessments that are consistent with the SABS, comprehensive, well supported and documented, and useful to the parties in helping them resolve their dispute.

The Guideline establishes base criteria for all types of Med/Rehab DACs. In the past, although all Med/Rehab DACs mobilized multi-discipline teams in their
assessments, there were no minimum
standards set for which type of health care professionals that should be included on the core or on-call team.

New Med/ Rehab Assessment Guideline (Continued)

The Guideline outlines a common process for 'intake' (processing the referral request and generating an assessment plan), assessment (applying the appropriate 'Med/Rehab test') and reporting (accessible and useful to both parties).

The Guideline also focuses in on what questions the DAC assessment should answer and provides direction on how to identify the DACable issues that are in dispute. It also instructs the DACs to comment on the reasonability and necessity of past treatment and to provide an opinion on the cost of treatment.

It is proposed that the implementation process will be completed by May 2000.

Cancellation Fees for Disability and Medical & Rehabilitation DACs

The DAC Committee has completed its work establishing a fee model for disability and medical/ rehabilitation assessments that are cancelled before the first appointment. The model is designed to ensure that every cancellation fee is based upon a realistic determination of the amount of work and expenses incurred by the DAC up to that point in time.

These expenses have become an issue within the DAC system in that, although no DAC report is produced, the DAC has provided some service to the parties and have incurred real business expenses.

The Pre-Assessment Cancellation Fee model represents a staged process to be used in the calculation of a cancellation fee. The cancellation fee is calculated on a cumulative basis where the amount of the fee depends upon what stage of the intake process the assessment is cancelled.

The Fee Schedule will be introduced on a 6 month trial basis in conjunction with enactment of the Disability and Med/Rehab Assessment Guidelines. Once tested, the Fee Schedule will be reviewed and amended, if needed, before being introduced on a permanent basis.

Recent Roster Activity

The following DAC facilities have requested that they be removed from the active roster since the last communique was issued in December 1999:

DAC #1016 (Dr. J.K. Houston)
DAC #1024 (Dr. M. Macartney-Filgate)
DAC #1043 (Dr. E. Sheffman)
DAC #1044 (Dr. W.G. Snow)
DAC #2006 (Dr. L. Freedman)
DAC #2034 (Dr. K. Travis)
DAC #3006 (Dr. G. Delaney)
DAC #3023 (Dr. E, White)
DAC #5008 (Wellness House)

The DAC Committee wishes to thank them for their contribution to the DAC system since 1994.

The DAC Committee continues to monitor the system to ensure that any withdrawals/ mergers do not result in any service issues. Revised pages of the DAC roster will be issued when the new Disability DAC roster is issued in April, 2000.

Non Dacable Accident Benefits Under the SABs

Over the past few issues, this communique has addressed the importance of appropriate referral questions and the importance of understanding the legislative requirements of a DAC.

There have been a number of inquiries to the DAC Hotline wherein DACs have expressed concern that they are being asked to address issues which fall outside of their jurisdiction. If a dispute should arise about the entitlement to, or the amount of, a benefit payable on these non-DACable issues, the issue must be brought directly to mediation. These issues are not to be addressed by a DAC.

For clarity, there is no mechanism by which Transportation expenses or Other Expenses under Part VI of the Schedule (Lost Educational Expenses, Expenses of Visitors, Housekeeping and Home Maintenance, Damage to Clothing, Glasses, Hearing Aids, Cost of Examinations) can be sent to a DAC to help in the resolution of the dispute. These issues must proceed directly to mediation.

Arbitration & Appeal Decisions

The DAC Committee believes that DACs will better understand the important role they play in the dispute resolution process by providing examples of how arbitrators have used DAC reports in the decision-making process. DAC assessors should be aware of these decisions and follow best practices as outlined in the DAC Guidelines in conducting and completing their assessments.

Copies of FSCO's arbitration and appeal decisions are available on the FSCO website at: <http://www.fsco.gov.on.ca>

To access these decisions, users are required to obtain a user name and password from the Arbitrations Unit at (416) 590-7202. There is no cost to access these decisions.

Arbitration Decision A98-001436

Part-time versus Full Time Employment
consideration in the calculation of a Residual Earning Capacity

In this decision, Arbitrator Seife discussed the responsibilities of a REC DAC pursuant to s.30 of the SABS.

The arbitrator stated that while neither party challenged the individual assessment results of the claimant's medical condition, the claimant argued that the DAC results failed to consider the differences between full and part-time employment and further failed to satisfy, pursuant to s.30 of the schedule, that the employment exists in the claimant's area.

The arbitrator found that part time employment can be considered in the calculation of the claimant's REC, but found the information provided in the DAC report about the availability of that employment was unreliable. As a result, the arbitrator found the claimant's REC to be zero.

Arbitration Decision A96-001355

DAC Reports and an insurer's obligation to pay pending the resolution of a dispute

This decision, authored by arbitrator McMahon, provides a lengthy discussion regarding the roles that DACs fill in the dispute resolution continuum, and how the DAC assessment impacts the "pay pending resolution" provisions of the SABS.

While the discussion is too lengthy to summarize in this communique, the arbitrator states that the insurer's decision not to conduct a medical/ rehabilitation DAC assessment was a decision that deprived the parties of the timely guidance that underpins the whole system, and exposes each party to responsibility for significant treatment expenses that could have been avoided.

Identifying the Appropriate DAC

ABAU continues to receive hotline questions on "closest-DAC issues" involving general inquiries, conflict of interest inquiries, and DACs qualified to conduct particular assessment types.

The insurer must make the referral to the DAC closest to the claimant's residence that is qualified to conduct the required assessment. Insurers should not be by-passing DAC centres on the assumption there may be a conflict of interest or on the belief that the DAC had some prior involvement with the claimant.

It is the responsibility of the DAC to determine whether a conflict of interest exists and, once declared, the parties can either waive the conflict and proceed with the assessment or have the DAC return the referral.

DAC Information Binder

The DAC Committee distributed, with the last communique, a Table of Contents to facilitate the assembly of a DAC Information Binder at each DAC facility.

DACs are reminded that they should be undertaking the assembly of these manuals.

We've Had Questions:

Does the DAC Committee have a policy on whether a party can audio or video record a DAC assessment?

It is up to the individual DAC centres to decide whether they will allow audio or video recording of DAC assessments. The DAC Committee currently has no position regarding the recording of DAC assessments.

DACs should be cautioned, however, that any such policy should be global in nature and apply equally to any DAC assessmentconducted at their facility.

When do case management expenses become a DACable issue?

There have been a number of inquires regarding whether or not case management is an issue which can be the subject of a DAC assessment under s.43 of the SABS.

DACs are reminded that, pursuant to s.17 of the SABS, case management expenses are only available to those claimants who have been found to have sustained a catastrophic impairment.

A DAC should only conduct a medical/ rehabilitation assessment on case management expenses in those cases where the entitlement to case management expenses has already been determined.

April 2000

 
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