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4 comments:

  1. During your years at FSCO there had been an industry trend to move toward creating preferred provider treatment networks by insurers. This trend continues today. What are the potential risks to the industry with these programs?

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  2. There are probably more benefits for insurers than risks. There is a risk that claimants will be unhappy with the treatment provided by a preferred provider and would translate into reputation risk. There is also a risk that over time some preferred providers loses their independence and objectivity depending on how much of their business is directed to them from insurers. That is the preception of some assessors that conduct third party medical assessments for the industry.

    However, the Statutory Accident Benefits Schedule mitigates some of those risks. Section 46 sets out disclosure requirements with respect to these types of arrangements. The notice that the insurer must provide their claimants must inform a claimant that they are free to decline a referral to a preferred provider and may revoke consent even after accepting.

    ReplyDelete
    Replies
    1. Thank you for your reply.

      This notice that you mention under Section 46; does the claimant have to have this in their possession prior to attending the clinic or are they able to be presented with this notice and sign it at the clinic during their first visit?

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  3. Section 46(2) of the SABS states that the insurer shall not refer the insured person unless the insurer has first given the insured person a notice. That seems to suggest that the claimant should receive the notice before attending the clinic. I understand that isn't always practical and that some insurers have the clinic provide the notice when the claimant first attends but before treatment begins. I don't know whether that fully meets the regulatory requirements but to me the timing isn't that critical since the claimant can revoke consent at any time. What's more important is the content of the notice.

    ReplyDelete

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