Revised Health Claims for Auto Insurance (HCAI) Guideline – Including the Assessment of Attendant Care Needs Form (Form 1)

Bulletin

No. A-04/18

Property &

Casualty

- Auto

To the attention of all insurance companies licensed to transact
automobile insurance and service providers in Ontario

NOTE: The bulletins that are posted on this website are provided for historical reference purposes. The information in these bulletins is accurate on the date the information is published, but is subject to change and may be replaced by more recent bulletins.

An order that is made regarding a licence holder reflects a situation at a particular point in time. The status of a licence holder can change. Readers should check the current status of a person's or entity's licence on the Licensing Link section of FSCO's website. Readers may also wish to contact the person or entity directly to get additional information or clarification about the events that resulted in the order.

These bulletins may include forms that are no longer up-to-date or accurate. Readers should visit the forms section of the FSCO website, to ensure they are using the most recent version of a FSCO form.

With this Bulletin, the Financial Services Commission of Ontario (FSCO) is releasing a revised Health Claims for Auto Insurance (HCAI) Guideline – Superintendent’s Guideline No. 02/18 (revised Guideline). This revised Guideline comes into effect October 1, 2018. It replaces the previously issued Guideline – Superintendent’s Guideline No. 01/17 issued in August 2017.

Mandatory use of HCAI for Form 1

FSCO released a Bulletin on January 4, 2018 informing insurers and health care providers that effective October 1, 2018, they must use HCAI for submitting and processing the Assessment of Attendant Care Needs Form (Form 1).

All facilities enrolled with HCAI must submit Form 1 to insurers electronically, using either a Practice Management System (PMS) that is integrated with HCAI or the HCAI web channel.

The revised Guideline reflects these changes to submission requirements.

Invoices for attendant care services will continue to be submitted and processed outside of the HCAI system.

Assessment of Attendant Care Needs Form (Form 1)

Form 1 is a Superintendent-approved form required when an injured claimant applies for attendant care benefits in accordance with the Statutory Accident Benefits Schedule (SABS) subsection 42(1). It is used for accidents that occur on or after March 31, 2008.

An occupational therapist or registered nurse must complete the form. It sets out the claimant’s specific attendant care needs and the associated monthly cost following an accident. The completed Form 1 is submitted to an auto insurance company.

HCAI Information

Support resources and educational material concerning Form 1 and its submission in HCAI are available at www.hcaiinfo.ca .

Facilities and regulated health professionals that are not enrolled in HCAI must enroll with HCAI for the electronic submission of Form 1. Additional information on the HCAI enrolment process can be found on the HCAI website provided above.