Auto Insurance Regulatory Changes - PowerPoint PPT Presentation

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Auto Insurance Regulatory Changes

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Automobile Accident Insurance Benefits. Diagnostic and ... Does include contractile and inert tissue. Whiplash. Whiplash Associated Disorder. WAD I and II ... – PowerPoint PPT presentation

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Title: Auto Insurance Regulatory Changes


1
Auto Insurance Regulatory Changes
2
Agenda
  • Regulation changes
  • Diagnostic and Treatment Protocols
  • Scenarios
  • Injury Management Consultants (IMC)
  • The Forms
  • The Fees
  • Certified Examiners
  • Implementation

3
Regulatory Changes
  • The Premium Grid
  • Dispute Resolution Process
  • Automobile Accident Insurance Benefits
  • Diagnostic and Treatment Protocols
  • Minor Injury

4
Regulatory Changes
  • Why
  • The Goal
  • To assist Albertans recover more effectively
  • Benefits
  • Patients/clients
  • Practitioners
  • Insurers

5
Benefits of Regulatory Changes
  • Patient/client
  • Clinical
  • With practitioner in charge of their recovery
  • Entitled to best practices
  • Expert Consultation
  • Financial
  • No financial barriers within DTP
  • Insurer first pay (after public healthcare)
  • Increase in Sect B benefits

6
Benefits of Regulatory Changes
  • Practitioner
  • Focus on patient/client recovery
  • Standardized processes
  • Clinical
  • Administrative
  • No pre-authorization from insurers for DTP
  • Opportunity to update best practice

7
Benefits of Regulatory Changes
  • Insurers
  • Consistency of DTP
  • More reliable diagnoses and treatment
  • Reduced involvement with practitioners
  • Communication through standardized forms
  • Cost reduction

8
Diagnostic and Treatment Protocols
  • Principles
  • The focus of the system must be on the client
  • Early and accurate diagnosis important
  • Treatment based on best evidence
  • No financial barriers to treatments under the
    protocols (first 12 weeks)
  • Consultation expertise available
  • Outcomes measured

9
The Process
  • Report to the Insurance committee
  • Engage a working group
  • Develop a Continuum of Care
  • Evidence-based
  • Consensus of the working group
  • Insurance committee prepared regulations
  • Seek feedback from stakeholders
  • Regulations passed
  • Develop an implementation plan

10
Diagnostic and Treatment Protocols
  • Injuries include
  • Strains
  • Injury to one or more muscles
  • Sprains
  • Injury to ligaments, tendons or both
  • Does include contractile and inert tissue
  • Whiplash
  • Whiplash Associated Disorder
  • WAD I and II

11
Diagnostic Protocols
  • Evidence Based Practice
  • Conscientious, explicit and judicious use
  • Current best practice
  • Care of a patient
  • Integrating individual clinical expertise
  • Best available clinical evidence
  • From systematic research
  • Reference ICD 10 - CA

12
Diagnostic Protocols
  • History
  • Mechanism of injury
  • Current symptoms
  • Relevant past history
  • Affect of injury on physical function
  • Examination
  • General and relevant regional exam
  • MSK and Neurological
  • Assessing pain
  • Relevant investigations

13
Treatment Protocols
  • Using Evidence Based Practice
  • Treatment plan with expected outcomes
  • Education
  • Managing inflammation and pain
  • Maintenance of flexibility, strength and function
  • Encouragement of self care
  • Limit number of pre-approved visits to providers

14
(No Transcript)
15
Injury Management Consultant
  • Who are they?
  • Physical Therapist, Chiropractor, MD
  • Qualifications
  • Active practice
  • Biopsychosocial model working knowledge
  • Assessment of acute and chronic pain
  • Managing rehabilitation of MVA individuals
  • DTP understanding
  • Prescribe course of education

16
Injury Management Consultant
  • Role
  • To assist in treatment of the patient/client
  • Review, assess, report
  • Referral
  • Uncertain about diagnosis
  • Not resolving appropriately
  • Not resolved by 90 days
  • After 90 days
  • Assessment
  • Opinion

17
Forms
  • Notice of Loss and Proof of Claim
  • Treatment Plan
  • Confirmation of services provided
  • Progress report
  • Concluding report
  • IMC referral form

18
Fees
  • Initial assessment of injury
  • Not included in treatment visits
  • Completion of Notice form
  • Administrative fee
  • Treatment plan
  • Progress report
  • Concluding report
  • Injury Management Consultant referral
  • Assessment and form completed

19
Fees
  • Requests for information from IMC
  • Files
  • Summary by practitioner
  • Treatment fees under the DTP
  • Per 15 minute units
  • Maximum authorized for payment, 10/21
  • Injury Management Consultation
  • Assessment and report
  • No shows

20
Certified Examiners
  • Who are they?
  • Medical Doctors
  • Qualifications
  • Eligibility by College of Physicians Surgeons
  • Role
  • Opinion on Minor Injury

21
Minor injury definitions
  • Minor injury
  • Strain, Sprain, WAD I or II
  • Primary factor in impairment
  • Serious impairment
  • Physical or cognitive
  • Essential tasks of employment, training,
  • Normal activities of daily living
  • Ongoing since the accident
  • Expected not to improve substantially
  • Based on an assessment by a Certified Medical
    Examiner
  • Using diagnostic and treatment protocols

22
Implementation
  • Effective October 1, 2004
  • Information binders to all practitioners
  • CD ROM
  • Web site
  • Information
  • FAQ
  • Senior Medical Advisory
  • Working group to be established
  • Maintenance of best practice

23
Contact Information
  • Web site
  • www.autoinsurance.gov.ab.ca
  • Senior Medical Advisory to Superintendent
  • larry.ohlhauser_at_gov.ab.ca
  • 780.423.9952
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