Technical Difficulties

About five weeks after insurers and medical health professionals switched over to Ontario’s new Health Claims for Auto Insurance (HCAI), Financial Services Commission of Ontario (FSCO) temporarily suspended the HCAI Guideline at the request of the Insurance Bureau of Canada (IBC).

In a letter to the Ontario insurance regulator dated Mar. 10, 2008, IBC recommended the suspension of the operations of HCAI by the close of the business day on Mar. 12. IBC’s letter confirmed many insurers are experiencing serious disruptions in their claims adjustment process as a result of technical problems encountered by HCAI.

Prior to the suspension, a number of adjusters were experiencing problems with the system.

“I am pleased that the IBC has listened to the stakeholders, acknowledged the system deficiencies and suspended the use of the product before more time and money is invested or lost,” Tammy Norn, regional director of Ontario casualty at CGI, said.

HCAI, a system that cost insurers up to $20 million to build, was designed to represent a significant upgrade over the standardized, paper-based, medical-rehab insurance system implemented in 2001.

Insurers and medical health professionals were required by FSCO to sign on to the system as of Feb. 1, 2008.

“Most users are confronting persistent and pervasive difficulties in accessing and using the system, while a minority is having relatively few issues,” IBC president and CEO Mark Yakabuski wrote in a letter to Bob Christie, FSCO’s CEO and superintendent of financial services. “Based on information we have obtained from Ontario auto insurers and other users, IBC is concerned that HCAI is impeding normal claims adjustment and might have implications for the provision of care to injury claimants.”

Slowing down adjusters

Adjusters have commented that the system was extremely slow to work in.

“Prior to it being suspended, there were many days that we were not able to use it during regular business hours,” Franca Reale, Ontario automobile manager of Cunningham Lindsey Canada, said. “We have a call centre that is open and works 24/7. Therefore we at Cunningham Lindsey used the services of some of our employees that worked during the night in order to print some of the OCF forms for some of our adjusters.”

In order to protect the interests of consumers, providers, facilities and insurers — and to enable HCAI Processing to focus on resolving these difficulties without undue delay — the operation of the guideline has been temporarily suspended, Christie wrote in a FSCO bulletin. FSCO’s bulletin says the suspension “continues to be in effect until further notice.”

The system was suspended indefinitely in order to re-work the system, in light of considerable ongoing system problems, Teresa Mitchell, a senior adjuster at Crawford & Company (Canada), said.

“This gives adjusters a reprieve as using the system was quite frustrating and time-consuming,” she said. “This means a return to the pre-Feb. 1, 2008 format of document delivery, being mail, courier, fax, email or personal delivery. So, AB adjusters: Be prepared for the onslaught of documents, and get that date-stamp inked!”

However, any documents submitted to HCAI and referred to in the Guideline prior to 4 p. m. on Mar. 12 still needed to be processed. Unfortunately, for some adjusters this could prove difficult.

“Some adjusters are experiencing an inability to access HCAI, while others have been suspended as users, resulting in a possibility of non-compliance in responding within the required timelines,” Mitchell said. “These individuals continue to work with HCAI to regain access to the system.”

Even prior to the suspension of HCAI, adjusters were receiving email notices from HCAI regarding various aspects of the system being off-line or unavailable. This caused problems for the adjuster — when an aspect of the system is off-line or not available, it prohibits the adjuster form working on that file until the problem is remedied, Mitchell added.

Changing the Guideline

IBC is addressing the technical issues and working with FSCO to develop a Guideline to enable resumption of the system on a voluntary basis, Michael Smith, general manager of HCAI Processing, the central agency that oversees the HCAI process, said. Work is being done on the HCAI system itself to address the technical issues.

“Once these issues are resolved, we expect that HCAI will be able to return to full operations,” Smith said. “Although it would be imprudent to set a date at this time.”

The first few months of any new project is fraught with issues and HCAI is no exception. But with time, the ‘bugs’ should be worked out and adjusters will become more adept and comfortable using the system, Mitchell commented before the suspension.

Still positives to the system

Despite the setbacks and technical difficulties encountered by users, many still have positive comments to make about the system, especially as it relates to HCAI’s potential to bring significant efficiencies to managing first party injury claims.

“Currently we are spending much more time dealing with the forms, but I still believe if and when IBC fixes all of the issues and the treatment facilities submit forms to the proper insurer/adjuster, it will save staff adjusters time in the long run, however, for this to work each group — insurers, HCAI, treatment centres — will have to work hard at it and work together,” Norn said.

Ontario has the most complex auto accident benefits system. HCAI is able to collect all the information it requires for the IBC Statistical Analysis, meaning that all reports will accurately reflect what is happening on Ontario accident benefits. “Consumers continually question why their rates are so high, and by having accurate stats, the industry can show where the majority of the premium dollars are spent, and why,” Mitchell noted.

The system is a very useful tool, not only to manage workflow, but to also keep track of what is being paid out on claims.

“Take the technical issues away, it’s a fantastic system … and I think the insurance industry as a whole will benefit from it — from the statistical data that can be gathered,” Norn said.