Statutory Accident Benefits Schedule (SABS) & HCAI Question


#1

I have a question about the benefits provided by the Automotive Insurance Policy under the Statutory Accident Benefits Schedule (SABS). Let me begin by apologizing for the acronym alphabet soup.

Background:
Typically, when you are injured in an automotive accident, you can see a medical professional for an assessment/treatment. If the accident is NOT minor (your injuries fall outside the Minor Injury Guideline), the treating professional completes an form called an OCF-18. That form highlights the injuries that you sustained from the accident, as well as the assessment/treatment sessions to be provided to you by the medical professional completing the OCF-18 form. Only medical professionals who are registered with the online organization known as “Health Claims for Auto Insurance HCAI” are permitted to submit the OCF-18 forms.

The Question:
I want to see a medical professional NOT registered with HCAI. I would like to pay for the assessment/treatment out of my own pocket, and get reimbursed from the auto insurance company. My auto insurance company has told me that is NOT possible, but it doesn’t sit right with me. Is that correct? If so, it puts severe constraints on who a patient can see for treatment of injuries sustained in an automotive accident. Can someone please confirm?

Thanks


#2

Why?

Registration seems to be a government requirement,


Registration seems to be free.


#3

Because my audiologist is not registered… Nor does it make sense from a business perspective… Likewise an acupuncturist isnt registered.

Regardless of why is it legally allowed?


#4

#5

#6

Tom,

Ontario’s motor vehicle accident insurance system is out of control in terms of complexity of regulations that seem to change every other year. You are in a world that is rule by regulations so it is entirely possible what they are telling you is true. When you are in the world of auto insurance, and they are the ones who will pay for treatment, you have to follow their regulations. Your rights are severely curtailed in these situations because your treatment is being paid by the auto insurer.

This forum is focused on disability insurance claims and we don’t address issues related to the various provincial auto insurance claim systems, unless it relates to the intersection of a motor vehicle accident claim and an outside long-term disability claim, cpp disability, etc. You should consult an Ontario personal injury lawyer who could likely answer your question.


David Brannen

Disability Lawyer with Resolute Legal

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