No. A-06/06
Property & Casualty
– Auto
Adjustment to the Professional Services Guideline, Pre-Approved Framework Guidelines, and Additional Health Professional Issues
To the attention of all insurance companies licensed
to transact automobile insurance in Ontario
With this Bulletin, the Financial Services Commission of Ontario (FSCO) is releasing an adjustment to the Professional Services Guideline, the Pre-Approved Framework Guideline for Whiplash Associated Disorder Grade I Injuries With or Without Complaint of Back Symptoms (PAF Guideline WAD I) and the Pre-Approved Framework Guideline for Whiplash Associated Disorder Grade II Injuries With or Without Complaint of Back Symptoms (PAF Guideline WAD II).
Revised Professional Services Guideline and PAF Guidelines
The revised Professional Services Guideline released with this Bulletin increases the maximum hourly rates by 2.2% for services rendered on or after July 1, 2006. Maximums payable for the completion of forms will not be increased pending the completion of the Health Claims for Auto Insurance (HCAI) project.
The payment fees outlined in Appendix A for both the PAF Guidelines: WAD I and WAD II are also being increased by 2.2% for services rendered on or after July 1, 2006.
The 2.2% increase reflects the change in the Consumer Price Index for consumer prices in Canada (All-items) during 2005.
The Superintendent’s Professional Services Guideline No. 01/05 continues to apply to expenses related to services rendered between July 1, 2005 and June 30, 2006.
The Superintendent’s PAF Guideline for WAD I Injuries No. 01/06 and PAF Guideline for WAD II Injuries No. 02/06 continue to apply to goods and services rendered between March 1, 2006 and June 30, 2006.
Application to Services Rendered or Forms Completed Before July 1st but Invoiced After July 1, 2006
The previous Professional Services Guideline No. 01/05 and PAF Guideline for WAD I Injuries No. 01/06 and PAF Guideline for WAD II Injuries No. 02/06 will continue to apply to services rendered or forms completed prior to July 1, 2006 whether they are billed before or after July 1, 2006.
Application to Services Approved Before July 1, 2006
The Professional Services Guideline, PAF Guideline for WAD I Injuries and PAF Guideline for WAD II Injuries released with this Bulletin apply to services rendered on or after July 1, 2006 even if approved prior to July 1, 2006.
Consultation Between Claimant’s Health Professional and Insurer Examiner
Insurers and health professionals should be aware that a claimant’s consent to share health information between their health care provider and the insurer’s health professional conducting an insurer examination as set out in Ontario Claim Forms (OCF) 3, 5, 19 and 22 is not intended to apply to a consultation between these two health professionals pursuant to sections 24(1) 9 and 24.1(1) 2 of the Statutory Accident Benefits Schedule - On or After November 1, 1996 (SABS). A separate express consent from the claimant is required prior to any such consultation.
Please note that, in addition to Ontario Claim Forms (OCF) 3, 5, 19 and 22 as noted, the same also applies to OCF-18 (reference to which was inadvertently omitted).
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Psychological Associates
Insurers are reminded that psychological associates are members of a health profession governed by the College of Psychologists of Ontario. Psychological associates may sign and submit an OCF-22 Application for Approval of Assessment or Examination pursuant to the SABS in accordance with their scope of practice.
Copies of Guidelines and Forms
Copies of the revised Professional Services Guideline and the PAF Guidelines: WAD I and WAD II referred to in this Bulletin are attached and will be published in the June 24, 2006 edition of The Ontario Gazette. The Guidelines can also be downloaded from the FSCO Web site at: www.fsco.gov.on.ca.
Bob Christie
Chief Executive Officer and
Superintendent of Financial Services
June 9, 2006
Attachments:
Financial Services Commission of Ontario