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Auto Insurance Regulatory Changes

Auto Insurance Regulatory Changes. Agenda. Regulation changes Diagnostic and Treatment Protocols Scenarios Injury Management Consultants (IMC) The Forms The Fees Certified Examiners Implementation. Regulatory Changes. The Premium Grid Dispute Resolution Process

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Auto Insurance Regulatory Changes

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  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. 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

  15. 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

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

  17. 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

  18. 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

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

  20. 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

  21. 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”

  22. Contact Information • Web site • www.autoinsurance.gov.ab.ca • Senior Medical Advisory to Superintendent • larry.ohlhauser@gov.ab.ca • 780.423.9952

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