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Archive for November 2011

A Story of One Man’s Struggles with his Accident Benefits Insurer

There is a very interesting story on one man’s struggle to get his accident benefits in a timely manner after a horrific crash with very serious injuries.

Unfortunately, his story is all too common for many individuals who are injured in motor vehicle accidents.

To read this article, click here.

FSCO Revises HCAI Guidelines

The Financial Services Commission of Ontario (FSCO) has released a bulletin which will revise the guidelines for the Health Claims for Automobile Insurance (HCAI) system, effective December 1, 2011.

These changes include:

  • Health care professionals will only be able to invoice the insurer at the completion of their treatment plan, or once every 30 days if the treatment extends beyond a month;
  • A statement that repeated and/or deliberate submission of duplicate invoices and invoices for non-approved goods and services may be considered by HCAI to constitute a contravention of HCAI’s terms and conditions and result in suspension or revocation of the health care provider’s access to HCAI;
  • A section on recordkeeping has been added to the new Guideline as an extension of Property and Casualty Auto Bulletin A-02/11, Insurer Rights and Responsibilities to Challenge Questionable or Abusive Claims; and
  • Changes have been made to the Appendix 3 Validation Rules in order to provide more clarity for the user.

The bulletin also notes that, effective July 1, 2012, FSCO will issue an amended OCF-21 form that will provide that the “Plan Number” of the OCF-18 or OCF-23 to which the OCF-21
refers is a mandatory field.  This is the unique number generated by the HCAI system when the OCF-18 or OCF-23 to which the OCF-21 refers is submitted, and will enable insurers to properly reconcile invoices.

To read the FSCO Bulletin in full, click here.

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