What are Healthcare Practitioners?

Health Practitioners are regulated by the Statutory Accident Benefits Schedule (SABS), which is a regulation under the Insurance Act of Ontario.  They can assess you and fill out an Assessment and Treatment Plan (OCF 18) or a Treatment Confirmation Form (OCF 23). They are authorized to sign off on these 2 forms via HCAI (Http://home.hcainfo.ca/inded/php) and they submit your treatment plan electronically.   The SABS (Statutory Accident Benefits Schedule has listed 9 Regulated Health Professions of the Ontario Government's Classification system to act as "Health Practitioners." “health practitioner” means, in respect of a particular impairment, (a) a physician, (b) a chiropractor, if the impairment is one that a chiropractor is authorized by law to treat, (c) a dentist, if the impairment is one that a dentist is authorized by law to treat, (d) an occupational therapist, if the impairment is one that an occupational therapist is authorized by law to treat, (e) an optometrist, if the impairment is one that an optometrist is authorized by law to treat, (f) a psychologist, if the impairment is one that a psychologist is authorized by law to treat, (g) a physiotherapist, if the impairment is one that a physiotherapist is authorized by law to treat, (h) a registered nurse with an extended certificate of registration, if the impairment is one that the nurse is authorized by law to treat, or (i) a speech-language pathologist, if the impairment is one that a speech-language pathologist is authorized by law to treat; (“praticien de la santé”) Source: s.3(1)  https://www.ontario.ca/laws/regulation/100034  

What are Regulated Health Professionals?

These practitioners must be registered members of a regulated health profession.  They are authorized to provide goods and services but are NOT authorized to sign off on any Treatment Plans.  They MUST obtain a Health Practitioner's signature to certify the Treatment Plan.   “regulated health profession” means a profession governed by a College as defined in the Regulated Health Professions Act, 1991 or the Ontario College of Social Workers and Social Service Workers under the Social Work and Social Service Work Act, 1998; (“profession de la santé réglementée) “regulated health professional” means a member of a regulated health profession; (“professionnel de la santé réglementé”) Source: s.3(1)  https://www.ontario.ca/laws/regulation/100034  

What are Unregulated Health Professionals?

If you can’t find the therapy in the Registered Health Professionals list above and this therapy has been recommended by your Health Practitioner or Regulated Health Professional this may be why: Some Health Professionals that graduate from accredited post secondary Institutions such as (College or University) or respected private institutions obtain Certifications in their respective trades. They are part of their appropriate governing Association but their professions currently do not have a Registered College in Ontario. (Such as Athletic Therapy, Canadian Athletic Therapists Association)  Consult with your Insurance Adjustor as these therapists may be able to use their association or schooling registration number to join HCAI.  If they are able to join HCAI then the same rules apply and they will need to find a Health Practitioner to authorize the OCF form and oversee the care provided.  

What are Supportive Services?

Supportive Services may be provided through an Occupational Therapist. They are provided to promote, improve, conserve, or restore mental &/or physical well-being of MVA Victims.  These services include, but are not limited to: house and automobile accessibility modifications, house repair, homemaker visits, special transportation, home delivered meals, health equipment and the like.  These services do not come from a central agency. They are provided by an individual.  

What is an Insurer's Preferred Provider Network (PPN); also known as "Insurance Preferred Health Care Providers"?

It consists of groups of insurer-selected health care providers who deliver programs of care to claimants who have sustained certain types of injuries in a motor vehicle accident.

  • It involves a contractual relationship between the insurer and the health practitioner, often including pre-arranged prices for service.
  • A claimant’s participation in the PPN will result from an insurer’s referral.

Note:

  • A claimant’s participation in a PPN is completely voluntary and if they choose NOT to participate, their entitlement to accidents benefits under the SABS is not affected.
  • A claimant has the right to choose his/her own service provider.
  • Claimants should be informed of their options under the SABS, if they choose not to participate in the PPN.
  • A claimant may withdraw from a program of care with a PPN at any time, without penalty and continues to be entitled to their full benefits in accordance with the SABS.
  • If a claimant is being treated by a PPN, insurers must ensure that the services provided by the PPN meet a level that is equal to, or greater than, that care prescribed in the SABS or a Pre-approved Framework (PAF) Guideline under the SABS.

 Source:  Best Practices for Preferred Provider Networks (PPN); https://www.fsco.gov.on.ca/en/auto/autobulletins/2006/Pages/a-08_06.aspx   The following link provides the HCAI List of Healthcare Providers  (Talk to your Health Practitioner if a therapy is not present on this list as there may be ways to have the therapy covered by your AB benefits);   http://www.hcaiinfo.ca/Health_Care_Facility_Provider/documents/appendices/Appendix_E.pdf