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DAC Communiqué - March 1999

This update is designed to provide information on the activities of the Minister's Committee on the Designated Assessment Centre (DAC) System. This issue provides an update on electronic reporting; clarifies the rates on the Assessment of Attendant Care Needs (Form 1); introduces the General Guideline 4: Ensuring Neutrality in the Designated Assessment Centre System; introduces the Complaint Management & Discipline Protocol; reminds DACs to notify the ABAU of changes in DAC ownership, facilities and staff, maintain up-to-date practice summaries of their roster members, and to ensure Year 2000 readiness; and, reviews recent arbitration decisions.

ELECTRONIC REPORTING

After months of hard work, we are pleased to report that 99.9% of all DACs are now reporting their activity summaries electronically or have made arrangements to report through other on-line DAC facilities. With each DAC now reporting their activity on a monthly basis, the DAC Committee hopes to be able to report on the 1998 statistics by the end of the first quarter in 1999.

Additionally, the staff of the Accident Benefit Analysis Unit (ABAU) are in the final stages of entering the overwhelming backlog of over 10,000 activity reports that have been submitted to the Financial Services Commission in paper format for 1996 and 1997. Delays in entering this information have been numerous, including late submissions and either incomplete or incorrect filings. It is anticipated that a statistical analysis for 1996 and 1997 will also be available by the end of the first quarter in 1999.

A special thanks to Tony Toy and the staff of the ABAU for their diligence and hard work with this initiative.

ASSESSMENT OF ATTENDANT CARE NEEDS (FORM 1)

Rate Clarification under Bill 59

Over the past few months, the ABAU has received inquiries regarding the Assessment of Attendant Care Needs (Form 1) and the rates that apply to the three levels of care. The confusion was caused by a printing error on the Form 1 with the wrong hourly rates. The printing company was notified of this error and has reprinted the form.

To prevent any future confusion, this Communiqué confirms the hourly rates to be used for Part 1, 2, 3 of the Assessment of Attendant Care Needs (Form 1) as follows:

  • Part 1: $ 9.00 per hour
  • Part 2: $ 7.00 per hour
  • Part 3: $15.00 per hour

GENERAL GUIDELINE 4: ENSURING NEUTRALITY IN THE DESIGNATED ASSESSMENT CENTRE SYSTEM

General Guideline 4: Ensuring Neutrality in the Designated Assessment Centre System has been issued to address specific practices which aim to ensure that DACs not only be neutral, but maintain at all times the transparency of the DAC process.

This Guideline addresses the issues of verbal and written communication, provides a direction to DACs on post-assessment treatment or examination(s), and clarifies when a DAC should provide an addendum to a DAC report.

The Guideline further requires that a DAC should only issue a final written report when all of the scheduled components of a DAC assessment have been completed .

DACs are asked to reproduce this General Guideline and send a copy to the claimant and insurer with the letter confirming the assessment date.

COMPLAINT MANAGEMENT & DISCIPLINE PROTOCOL

The DAC Committee has established a process to deal with complaints regarding DACs that fail to conduct assessments as set out in the Operational Procedures, General Guidelines and Assessment Protocols.

Specifically, the ABAU and the Operations Subcommittee will review complaints related to compliance with the principles of neutrality and unbiased behaviour, compliance with conflict of interest rules, and compliance with capability and service requirements.

Resulting action from the ABAU and the Operations Subcommittee may vary from education to discipline. The objective of the complaint management process is to resolve systemic problems rather than to unnecessarily sanction DACs.

REMINDERS TO DACS

Notice Of DAC Changes In Facilities And Ownership

Designated Assessment Centres are reminded that, pursuant to the Operating Procedures 1: Moving a DAC Facility, the Accident Benefits Analysis Unit must be notified in advance of any changes of address, changes in names or ownership as well as plans to purchase or sell facilities which currently conduct assessments.

General Guideline 2: Production Requests

DACs are reminded that they are required to have up-to-date DAC Assessor Practice Summaries Forms for all staff who currently conduct assessments on their roster.

Additionally, the ABAU is asking each DAC to ensure that copies of these summaries are sent to the ABAU to enable the maintenance of an up-to-date roster for each DAC facility.

Please note that it is the DAC's responsibility to ensure that their roster staff have the required assessment experience, are in good standing with their professional association or college, and the association/college recognizes them as registered/qualified to conduct assessments in their identified area of practice.

ABAU will review the Practice Summaries for their completeness and identify any limitations/restrictions in the scope of practice.

Year 2000 Responsibilities

DACs may face the same technological difficulties with the new millennium approaching as other business systems. DACs are reminded that they should be reviewing both their information
technology as well as all aspects of their business that rely on computer technology for operation. This may include diagnostic equipment, telephone systems, electronic lifts and entryways as well as a host of other functions.

It is each DAC's responsibility to ensure that they are working with electronic systems that are Year 2000 compatible and that they are prepared to deal with any interruptions in business that may occur. Please note that all software provided by the Financial Services Commission to DACs is Year 2000 compliant. If a DAC identifies potential trouble with their system(s), they must develop a process to address these deficiencies.

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:<https://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.

Appeal Decision P98-00022

A DAC plays an important role in resolving disputes over the level of treatment required by a claimant.

Director's Delegate David Draper commented on the role a DAC can have as a neutral assessor. The DAC involved in this case helped to address a conflict involving the amount of treatment required by a claimant following a motor vehicle accident. In this situation, Director's Delegate Draper found that the DAC's evidence was helpful in address what level of treatment was reasonable and necessary for this claimant.

Case A98-00161

DACs are conducted for the benefit of both the claimant and the insured and may affect the ability of a party to proceed to arbitration.

Arbitrator Guy Jones discusses the nature of the DAC process and the ability to proceed to mediation/ arbitration if one has failed to make oneself reasonably available for an assessment pursuant to s.50(C) of the SABS. He found that Disability Assessments are not simply a right for the insured but are assessments conducted for the benefit of both parties. The arbitrator was concerned about what appeared to be a total disregard for the DAC system by the insured and found that she was barred from proceeding to arbitration for failing to attend the assessment.

March, 1999

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