AUTO INSURANCE AND WSIB
Resources to help you navigate practice issues within auto insurance and WSIB.
Workplace Safety and Insurance Board (WSIB):
The WSIB is an agency of the Ontario Government Ministry of Labour. Its mandate is set out in the Workplace Safety and Insurance Act, 1997 (WSIA). Physiotherapists who treat WSIB claimants should be aware of their obligations under the law.
New WSIB MSK POC – Webinar Recording
WSIB launched a new MSK POC on April 4, 2023. OPA and WSIB hosted a webinar about the new WSIB MSK POC. All OPA members have exclusive access to this webinar recording. Non-members can purchase the recording for $25+HST here.
Login to access recording.
WORKPLACE SAFETY AND INSURANCE BOARD (WSIB) CONTINUED
WSIB FFS Increase
Login to access information about the increase.
Programs of Care (POC)
Programs of Care are multi-week interventions after the onset of an injury with the goal to prevent chronicity and return to pre-injury strength and function. The WSIB has created detailed programs listing best practices/treatments for the following types of injuries.
- Musculoskeletal Program of Care
- Shoulder Program of Care
- Program of Care for Low Back
- Program of Care for Mild Traumatic Brain Injuries
- Program of Care for Noise Induced Hearing Loss
You must be registered with the WSIB to deliver (and be paid for) services to injured workers through the WSIB including POCs. Complete the Health Professional’s Registration Application.
Programs of Care also require that the provider bill electronically. Visit Telus Health to register for online billing.
Fair Practices Commission
The Fair Practices Commission is the organizational ombudsman for the Workplace Safety and Insurance Board. They are the organization that you (client, physiotherapist or otherwise) should contact if you are dissatisfied, have complaints/concerns or require service for any other issues concerning the WSIB and their decisions rendered. The Commission provides an independent, neutral and confidential service for injured workers, employers and service providers with complaints about the service they receive at the WSIB. The Commission also tracks complaint trends, identifies systemic issues and recommends improvements to the WSIB. Workers, employers and service providers can contact the Commission by telephone or in writing.
QUESTIONS ABOUT AUTO INSURANCE, THE WSIB AND PHYSIOTHERAPY IN ONTARIO?
OPA staff would be pleased to answer any member questions. Contact Amy Hondronicols, Director, Practice, Policy and Member Services.
Not a member? Join now.
AUTO INSURANCE
Webinar
OPA and the Private Practice Division (PPD) collaborated to deliver a one hour webinar on auto insurance and HCAI. Topics covered in this webinar include:
- HCAI coding
- Recording outcome measures on claim forms
- Billing
- Working with multiple providers
- Service provider license
Login to view the webinar recording and the FAQs.
Financial Services Commission of Ontario (FSCO)
FSCO is a regulatory agency of the Ontario Government Ministry of Finance. Its mandate is to regulate the insurance industry in Ontario, including auto insurance.
SERVICE PROVIDER LICENSING
As of December 1, 2014, facilities require a Service Provider Licence issued by FSCO to invoice and receive payment directly from automobile insurers.
LICENCED HEALTH SERVICE PROVIDER TOOLKIT FOR EXAMINATION
Selected for an examination? Read the Coalition of Health Professional Associations in Automobile Insurance Services toolkit to prepare. The toolkit includes sample policies that address key competencies identified in the regulations and guidelines.
Coalition Toolkit for Service Provider Examination and Audits
Use this Coalition Sample Policies word document to tailor sample policies for your facility.
RESOURCES FOR NON-FSCO-LICENCED SERVICE PROVIDERS
Providers may continue to submit assessment/treatment plans through the Health Claims for Auto Insurance (HCAI) system without a FSCO licence. Additional information and resources for non-licenced service providers coming soon.
Health Claims for Auto Insurance (HCAI)
HCAI is an electronic system for transmitting auto insurance health claim forms- OCF18, OCF21, OCF23, and OCF 3- between insurers and health care clinics/practices in Ontario. Learn about registering and how to use HCAI, including step-by-step instructions for completing forms.
HCAI Bootcamp
Those who are new to using the Health Claims for Auto Insurance (HCAI) platform can access the HCAI Bootcamp which is a 3-part webinar series that covers a variety of fundamental topics including setting up providers and users, service provider licensing, authorization of OCF signatures and a live HCAI demo of the steps for submitting a treatment plan and an invoice.
Coding
Auto insurance forms use the Canadian Institute of Health Information’s coding system for both injuries (ICD-10 codes) and treatment interventions (CCI codes). Learn more about coding including how to code for remove/virtual services in HCAI. A treatment and injury code resource for physiotherapists is coming soon.
COMPLETE CODING LISTS
Injury Codes ICD-10-CA
GAP codes (goods, administration, and other codes)
MIG Codes (for OCF-23 and OCF-21C)
OCF 23 AND/OR OCF 21C TREATMENT CODE REJECTED?
Read the Physiotherapy Today article, HCAI Rejected a Valid Treatment Code, by Viivi Riis, with full size images, to uncover important MIG coding tips.
Legislation, Regulation and Guidelines
Statutory Accident Benefits Schedule
The Statutory Accident Benefits Schedule (SABS) is the regulation outlining the rules and processes for making claims for any benefits (including physiotherapy) under automobile insurance in Ontario.
Minor Injury Guideline (Superintendent’s Guideline No .01/14)
A patient may be appropriate for treatment within the MIG if their impairment is predominantly a minor injury as defined in the Statutory Accident Benefits Schedule.
Auto Insurance Fees (Superintendent’s Guideline No. 03/14)
HCAI Guideline (Superintendent’s Guideline No 01/17)
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