To the attention of all insurance companies licensed to transact
automobile insurance in Ontario
The Ontario Insurance Commission (OIC) has issued the Professional Fee Guideline - Physiotherapists (Fee Guideline) and the Physiotherapy Utilization Guidelines for Soft Tissue Disorders of the Spine (Utilization Guideline) as a result of recommendations made by the industry’s Bill 59 Fees Committee (the Committee) and the Ontario Physiotherapy Association (OPA).
The recommendations deal with physiotherapy fees and utilization guidelines with respect to auto insurance accident claimants and presents an improved co-ordinated approach by the parties to ensure better management of the treatments provided to claimants and to facilitate claimants’ timely return to normal activities, including work.
Copies of the report outlining the joint recommendations, entitled Joint Report to the Bill 59 Fees Committee, may be obtained by physiotherapists from the OPA and by insurers from the Insurance Bureau of Canada.
The guidelines were originally published in the November 22, 1997 edition of The Ontario Gazette. The Fee Guideline was issued by the Commissioner of Insurance who is authorized under Subsections 14 (4), 15 (6), 17 (2) and 24 (2) of the Statutory Accident Benefits Schedule - Accidents on or After November 1, 1996 (SABS) to issue professional fees guidelines. It applies to expenses incurred on or after November 22, 1997. The Utilization Guidelines were also issued by the Commissioner of Insurance who is authorized under Section 268.3 of the Insurance Act (Act) to issue guidelines on the interpretation and operation of the SABS. They apply to all accidents occurring on or after November 22, 1997.
The insurance industry and the OPA have agreed to review the issues or the impact of the guidelines -- should either party request a review -- 18 months after the publication of the guidelines dealing with these matters. It was also agreed that an automatic review will be made three years after the issuing of such guidelines.
Distribution of Physiotherapy Guideline to DR Coordinators, Claims and Adjusting Departments
Guidelines issued under the Insurance Act are important information documents. The OIC, therefore, urges insurance companies to ensure that copies of the attached Physiotherapy Utilization Guidelines for Soft Tissue Disorders of the Spine are provided to their claims and adjusting staff as well as to their Alternative Dispute Resolution (ADR) Co-ordinators. Insurers should note that these Guidelines will be incorporated into the next Dispute Resolution Practice Code update.
Commissioner of Insurance
November 24, 1997