FSCO outlines caps for auto insurer payments to health providers

The Financial Services Commission of Ontario has issued new guidelines for the maximum expenses payable by automobile insurers under the SABS related to the services of health care professions or health care providers.The maximums apply to services rendered on or after July 1, 2006.The maximums are applicable to medical benefits, rehabilitation benefits, case management services, or conducting an examination or assessment or provision of a certificate, report or treatment plan under subsection 24 (1) of the SABS. Automobile insurers are not liable to pay for expenses related to professional services rendered to an insured person that exceed the specific maximum hourly rates set out below.The list is to be read as follows:

Health care professional maximum hourly rate excluding catastrophic impairments (hourly rate including catastrophic impairments):

Chiropractors — $99.78 ($119.74) Massage Therapists — $51.47 ($78.78) Occupational Therapists — $88.23 ($106.08) Physiotherapists — $88.23 ($106.08) Podiatrists — $88.23 ($106.08) Psychologists and Psychological Associates — $132.34 ($158.59) Speech Language Pathologists — $99.26 ($118.68) Registered Nurses, Registered Practical Nurses and Nurse Practitioners — $80.87 ($96.63)

Unregulated Providers: Case Managers — $51.47 ($78.78) Kinesiologists — $51.47 ($78.78) Family Counsellors — $51.47 ($78.78) Psychometrists — $51.47 ($78.78) Rehabilitation Counsellors — $51.47 ($78.78) Vocational Counsellors — $51.47 ($78.78)

According to FSCO guidelines, automobile insurers are not liable to pay for expenses related to the completion of certain accident benefit forms by the health professionals and providers listed in this guideline that exceed the maximums set out below: Disability Certificate (OCF-3) $63.72 Treatment Plan Form (OCF-18) $63.72 Form 1 – Assessment of Attendant Care Needs $63.72 Automobile Insurance Standard Invoice (OCF-21) $0 Application for Approval of an Assessment or Examination (OCF-22) $63.72

More information is available on the FSCO Web site at:http://www.fsco.gov.on.ca/english/pubs/bulletins/autobulletins/2006/a-06_06-1.pdf