Posts Tagged ‘Alliance of Community Medical and Rehabilitation Providers’
The Financial Services Commission of Ontario (FSCO) has released a bulletin announcing changes to the Statutory Accident Benefits Schedule (SABS), service provider regulations, administrative penalties and eligibility for transportation expenses.
Below are the highlights:
- Effective December 1, 2014, both licensed and unlicensed service providers and provide goods and service to auto insurance claimants. Licensed service providers can receive payment directly from insurers, which unlicensed service providers cannot. Unlicensed providers must complete the OCF-21 form (Auto Insurance Standard Invoice) on HCAI, print it, and provide a copy to the claimant.
- Effective January 1, 2015, the current interest rate of 1% per month, compounded monthly, will continue to apply. However, once a mediation proceeding has commenced, the interest rate will then change to the prejudgement interest rate described in the Courts of Justice Act for past pecuniary loss. This will be calculated from the date on which a mediation proceeding commenced and ending on the date a settlement is reached or a decision is issued. The current prejudgement interest rate is 1.3% per annum.
- It is now considered to be an unfair or deceptive act or practice if an unlicensed provider advertises as a licensed provider.
- There is now an exemption allowing licensed service providers to seek direct payment for a listed expense provided under the SABS from anyone other than an insurer.
- Specifies penalties for non-compliance with the newly added requirements.
- Reminds insurers that “authorized transportation expenses” apply only expenses incurred by the insured person or an aide. It notes that service provider mileage costs are subject to FSCO’s Professional Service Guidelines, which states that insurers are not liable for any other costs beyond what is permitted under the Professional Service Guideline.
The bulletin can be read in full at the following link:
Smitiuch Injury Law to be Gold Sponsor at Hamilton Health Sciences Centre’s 21st Annual Conference on Neurobehavioural Rehabilitation in Acquired Brain Injury
Smitiuch Injury Law is pleased to be a Gold Sponsor for this important event. It will be held on May 8 and 9, 2014, at the Hamilton Convention Centre.
We encourage all ABI Rehabilitation Professionals, Psychologists, Physicians, Program Planners, Insurance and Advocates to attend.
You can obtain a copy of the brochure by clicking on the link below:
The Government of Ontario has filed regulations governing health care clinics and assessment centres who provide services paid for by automobile insurers.
The following was reported on Willie Handler’s Blog this morning. Mr. Handler formerly worked in auto insurance regulatory policy for the Ontario government.
The Ontario Government filed new regulations as part of the process to eventually license health care clinics and assessment centres operating in the auto insurance sector. The regulations cover a public registry of licenced facilities (Regulation 350/13), licensing of providers (Regulation 348/13) and requirements of the principle representative of each licensed facility (Regulation 349/13). The report recommending a licensing system was made by the Automobile Insurance Anti-Fraud Task Force in 2012.
The public register of licensed and former licensed service provider’s licence to be maintained must contain the following information about each licensee and former licensee:
1. The name in which the service.
2. The licence number.
3. The licensee’s mailing address in Ontario.
4. The date on which the licence was issued.
5. Whether the licence is in good standing or is suspended.
6. Any conditions that apply to the licence.
7. Any periods of time during which the licence was suspended.
8. Any periods of time during which the licence was revoked.
9. The name of the licensee’s principal representative.
10. The address of every facility, branch or location in Ontario of the licensee.
Eligibility criteria for facilities
A service provider’s licence may be issued to an applicant if all of the following requirements relating to the applicant’s business systems and practices and the management of its operations are satisfied:
1. The applicant has a mailing address in Ontario that is not a post office box.
2. The applicant has an email address.
3. The application includes the particulars of the individual to be designated as the service provider’s principal representative.
4. The principal representative has provided an attestation on the applicant’s behalf relating to the applicant and the application and relating to the applicant’s compliance with the Act.
5. The application includes the particulars of each facility, branch or location in Ontario that the applicant operates or intends to operate.
6. The applicant must agree to bill insurance companies through HCAI.
In determining whether an applicant is not suitable to hold a service provider’s licence, the Superintendent is required to have regard to the following circumstances:
1. Based on past conduct of the applicant, there are reasonable grounds for the belief that the applicant will not carry out in accordance with the law or with integrity and honesty the completion or submission to an insurer, reports, forms, plans, invoices or other documentation or information authorized under the SABS.
2. Whether, having regard to the past conduct of any of the following persons, there are reasonable grounds for the belief that the applicant’s business systems and practices and the management of its operations will not be carried on in accordance with the law or with integrity and honesty:
- The applicant.
- If the applicant is a corporation, a director, officer or shareholder of the corporation.
- If the applicant is a partnership, a partner of the partnership.
- If the applicant is a sole proprietorship, the sole proprietor.
- The person to be designated as the applicant’s principal representative.
- An employee, agent or contractor of the applicant.
3. Based on past conduct, there are reasonable grounds for the belief that the applicant’s business systems and practices and the management of its operations will not be carried on in accordance with the law or with integrity and honesty.
4. Whether anyone associated with the business is engaged in a business or undertaking that would jeopardize the applicant’s integrity and honesty in relation to the applicant’s business.
5. Whether anyone associated with the business has made a false statement or has provided false or deceptive information to the Superintendent, with respect to the application for a licence, or in response to a request for information by the Superintendent.
Eligibility criteria for principal representatives
An individual who satisfies the following criteria is eligible to be designated by a licensed service provider as its principal representative:
1. The individual has the following status in relation to the licensee:
- If the licensee is a corporation, he or she is a director or officer of the corporation.
- If the licensee is a partnership, other than a limited partnership, he or she is a partner.
- If the licensee is a limited partnership, he or she is a general partner or a director or officer of a corporation that is a general partner.
- If the licensee is a sole proprietorship, he or she is the sole proprietor.
- If the licensee is not a corporation, a partnership or a sole proprietorship, he or she is responsible for the day-to-day control and management of the licensee.
2. The individual has the authority to make decisions on behalf of the licensee with respect to matters related to the licence and matters related to the licensee’s compliance with the Act and to communicate with the Superintendent about those matters.
3. The individual has the authority to exercise the powers and perform the duties described above.
Powers and duties of principal representatives
1. Take reasonable steps to ensure that the licensee complies with the Act.
2. Take reasonable steps to ensure that the licensee’s business systems and practices and the management of the licensee’s operations are carried on in accordance with the law and with integrity and honesty.
3. Ensure that the licensee takes reasonable steps to deal with any contravention of the Act.
4. Make recommendations to the licensee regarding changes in its business systems and practices and the management of its operations, as necessary, to ensure that these standards are achieved.
5. Take reasonable steps to ensure that a system of supervision is in place to ensure that these standards are achieved.
6. Provide such attestations on the licensee’s behalf relating to the licensee and relating to its compliance with the Act, as may be required by the Superintendent and within the time required by the Superintendent.
The Financial Services Commission of Ontario (FSCO) has released an updated Professional Services Guideline for 2013.
According to the FSCO website, “The hourly rates are unchanged from the 2012 level. This is in line with the auto insurance rate reduction strategy outlined in the government’s 2013 Spring Budget.” It has also added a category for kinesiologists, who are now regulated health professionals in Ontario.
A copy of the 2013 Professional Services Guideline is available by clicking here.
The Ontario Government has announced its strategy to reduce auto insurance premiums.
A news release, issued on April 30, 2013, identifies that the Government will be introducing legislation to address the following:
- Require a premium reduction of 15 per cent on average.
- Require insurers to offer lower premiums to consumers with safe driving records.
- Provide the Superintendent of Financial Services with the authority to require insurers to file new rates.
- Expand and modernize the Superintendent’s investigation and enforcement authority, focusing on fraud prevention.
- Give the Financial Services Commission of Ontario the authority to license and oversee health clinics and practitioners who invoice auto insurers.
- Make the Superintendent’s Guidelines, incorporated by reference in the Statutory Accident Benefits Schedule, binding.
The news release can be read in its entirety by clicking here.
The Ontario Trial Lawyers Association (OTLA) and Alliance of Community Medical and Rehabilitation Providers has launched a massive media campaign against proposed changes to the definition of a catastrophic impairment for victims of motor vehicle accidents.
The changes being considered, already posted on our blog (you can access this blog article by clicking here), would significantly reduce the number of accident victims with serious injuries from having their claims deemed as catastrophic.
For example, a paraplegic who is able walk just a short distance would not be deemed catastrophic, even though their medical and rehabilitation needs would be very significant. Under the proposed changes, these individuals would have to pay for any treatment beyond the non-catastrophic medical and rehabilitation benefits limit of $50,000.00. Most rehabilitation services are not covered under OHIP.
If an individual’s injuries are deemed “catastrophic” their accident limits change as follows:
- Medical and Rehabilitation benefits increase from $50,000.00 over 10 years to $1,000,000.00 over a lifetime
- Attendant Care benefits increase from $36,000.00 over two years (to a maximum of $3,000.00 per month) to $1,000,000.00 over a lifetime (to a maximum of $6,000.00 per month)
- The right to the services of a case manager to help coordinate their medical and rehabilitation needs
- Housekeeping and Home Maintenance benefits (available for non-catastrophically injured victims, but only if optional benefits were purchased under their insurance policy)
The advertisement will run in major newspapers across Ontario over the course of this week and the next.
Please click on the link below to see the advertisement.
These changes would be in addition to the massive cutbacks to accident benefits implemented in September 2010. Auto insurers are currently reporting significant profit margins.
We encourage all concerned individuals to contact their local Member of Provincial Parliament (MPP) immediately to express their concerns with these proposed changes.
An article in today’s Toronto Star addresses the issue of an increase in denials of treatment plans by auto insurers for people who are injured in automobile accidents.
It is reported that the Ontario Government intends to hold public hearings on auto insurance.
You can read the entire article by clicking here.
The Toronto Star has published an article about the need to find balance between fighting fradulent accident benefits claims and providing necessary goods and services for legitimaely injured clients.
You can read this article by clicking here.
An interesting article has been posted by the Alliance of Community Medical and Rehabilitation Providers on The Health Professional website.
Based on a survey of health professionals across Ontario it noted the following trends with insurer’s response to applications for medical and rehabilitation benefits:
- A significant increase in the number of accident victims who are running out of benefits before they are fully recovered
- Health care service denials have escalated
- Victims are waiting longer to receive treatment and services
- Many accident victims are now NOT being assessed
- Victims are waiting longer to receive treatment and services
The article quotes Dr. Donna Ouchterlony, medical director of the Brain Injury Clinic at St. Michael’s Hospital, as stating that, “Since September, we are seeing more and more patients with serious injuries whose insurers are outright denying treatment, and when funding is approved, it is no longer nearly enough.”
The Alliance makes a number of recommendations:
- Re-instate the benefits that were in place prior to last September
- Allow the cap on assessments to be exceeded in certain circumstances
- Withdraw the right of insurance adjusters to deny medical claims without an independent medical opinion
- Freeze premiums
- Require more openness and transparency, with insurers having to release financial and operations data for their auto insurance lines
The full version of the article can be found by clicking here.