Auto insurance regulatory changes
Download
1 / 23

- PowerPoint PPT Presentation


  • 151 Views
  • Updated On :

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about '' - cai


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Agenda l.jpg
Agenda

  • Regulation changes

  • Diagnostic and Treatment Protocols

  • Scenarios

  • Injury Management Consultants (IMC)

  • The Forms

  • The Fees

  • Certified Examiners

  • Implementation


Regulatory changes l.jpg
Regulatory Changes

  • The Premium Grid

  • Dispute Resolution Process

  • Automobile Accident Insurance Benefits

  • Diagnostic and Treatment Protocols

  • Minor Injury


Regulatory changes4 l.jpg
Regulatory Changes

  • Why

  • The Goal

    • To assist Albertans recover more effectively

  • Benefits

    • Patients/clients

    • Practitioners

    • Insurers


Benefits of regulatory changes l.jpg
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


Benefits of regulatory changes6 l.jpg
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”


Benefits of regulatory changes7 l.jpg
Benefits of Regulatory Changes

  • Insurers

    • Consistency of DTP

      • More reliable diagnoses and treatment

    • Reduced involvement with practitioners

      • Communication through standardized forms

    • Cost reduction


Diagnostic and treatment protocols l.jpg
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


The process l.jpg
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


Diagnostic and treatment protocols10 l.jpg
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


Diagnostic protocols l.jpg
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


Diagnostic protocols12 l.jpg
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


Treatment protocols l.jpg
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


Injury management consultant l.jpg
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


Injury management consultant16 l.jpg
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


Forms l.jpg
Forms

  • Notice of Loss and Proof of Claim

  • Treatment Plan

  • Confirmation of services provided

  • Progress report

  • Concluding report

  • IMC referral form


Slide18 l.jpg
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


Slide19 l.jpg
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


Certified examiners l.jpg
Certified Examiners

  • Who are they?

    • Medical Doctors

  • Qualifications

    • Eligibility by College of Physicians &Surgeons

  • Role

    • Opinion on Minor Injury


Minor injury definitions l.jpg
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


Implementation l.jpg
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”


Contact information l.jpg
Contact Information

  • Web site

    • www.autoinsurance.gov.ab.ca

  • Senior Medical Advisory to Superintendent


ad