Auto Insurance Regulatory Changes

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Auto Insurance Regulatory Changes
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Agenda

• Regulation changes
• Diagnostic and Treatment Protocols
• Scenarios
• Injury Management Consultants (IMC)
• The Forms
• The Fees
• Certified Examiners
• Implementation

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Regulatory Changes

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

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Regulatory Changes

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

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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

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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

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Benefits of Regulatory Changes

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

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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

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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

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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

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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

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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

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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

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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

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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

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Forms

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

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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

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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

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Certified Examiners

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

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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

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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

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Contact Information

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