ACOT has been asked to distribute the following information on automobile insurance regulatory changes that will affect OTs working in this area. If you have questions about the following information please contact the Office of the Superintendent of Insurance at (780) 643-2237 or firstname.lastname@example.org.
Summary of Insurance Reform Measures that Apply to Occupational Therapists
In the summer of 2020, government engaged a number of stakeholders in the insurance, legal, and medical communities regarding potential reforms to Alberta’s automobile insurance system. Among the stakeholders that participated in discussions with government were the Alberta College of Occupational Therapists and the Society of Alberta Occupational Therapists.
Following that engagement, in October 2020, government introduced several automobile insurance reform measures that focus on making insurance rates more affordable, improving care, and expanding insurance options available to Alberta drivers. Some of those measure affect occupational therapists, and the purpose of this document is to outline the changes relevant to occupational therapists.
In addition to these reforms, government is also considering the recommendation made by the Automobile Insurance Advisory Committee that Alberta transition to a privately-delivered pure no-fault insurance system, and is using the recommendation as a basis for further engagement with Albertans and stakeholders on possible fundamental reforms to Alberta’s automobile insurance system.
For more details and information about Alberta’s automobile insurance reform measures, please visit government’s automobile insurance reform web page.
2020 Automobile Insurance Regulatory Amendments
- Diagnostic and Treatment Protocols Regulation
The Diagnostic and Treatment Protocols Regulation (DTPR) was introduced in 2004. It establishes diagnostic and treatment protocols for Albertans who have sustained sprains, strains and certain types of whiplash injuries in automobile collisions. This process is meant to ensure timely access to diagnosis and treatment, with minimal administrative and financial barriers for patients.
The following amendments were made to the DTPR:
Under the DTPR, “health care practitioner” means a chiropractor, physical therapist, or physician. Health care practitioners treating injured Albertans under the DTPR are permitted to refer their patients for adjunct therapy to be provided by another health professional.
An amendment to the DTPR defines “adjunct therapy” to include therapy provided by any of the following: a dentist, an occupational therapist, or a psychologist.
Adjunct therapy is being defined in this way to ensure that healthcare practitioners understand that they have the ability to refer their patients for further therapy, when medically necessary, by a psychologist, dentist, or occupational therapist.
Furthermore, the DTPR was amended to provide an aggregate $1,000 limit on adjunct therapy provided by any combination of dentists, psychologists or occupational therapists, and to clarify that these adjunct therapies do not count towards the 10 or 21 treatment visits otherwise permitted under the DTPR.
- Automobile Accident Insurance Benefits Regulation
The Automobile Accident Insurance Benefits Regulation (AAIBR) allows Albertans injured in automobile collisions to access up to $50,000 in no-fault medical, treatment, death, and total disability benefits for expenses incurred for up to two years following a collision. These benefits are also known as “Section B – Accident Benefits”.
The AAIBR sets soft caps for psychological, physical therapy, and occupational therapy services before an insurer can require a claimant to attend a non-attending physician examination, to determine whether or not the claimant requires additional treatment.
The following amendments were made to the AAIBR:
The soft cap threshold for occupational therapy services has increased to $750.
The AAIBR was also amended to clarify that the $50,000 medical benefits available to an Albertan injured in a collision includes any medically necessary equipment, home modifications, or vehicle modifications.
Questions and Answers
Q. Are these changes retroactive/what is the effective date?
A. All regulatory changes provided in this summary document have immediate effect as of November 1, 2020, and are applicable to both new and existing claims, including AAIBR claims, provided that benefits under the AAIBR have not already been used up in their entirety. This means, for example, that the adjunct therapy provisions in the DTPR and clarification adjustments to the AAIBR apply to traffic injuries that were sustained before November 1, 2020 and remain ongoing.
Q. What were the levels of benefits under the DTPR and AAIBR before the November 1, 2020 changes?
A. Prior to the changes, there was no aggregate $1,000 available for adjunct therapy under the DTPR. Additionally, the soft cap threshold for occupational therapy services under the AAIBR was set at $600.
Q. Were these benefits available before the November 1, 2020 changes?
A. The $1,000 limit for adjunct therapy under the DTPR is an expansion of treatment benefits available for injured Albertans, which was previously not available. The $1,000 aggregate limit ensures that adjunct therapy services no longer count towards the 10 or 21 treatment visits otherwise permitted under the DTPR. Additionally, clarification was included that Section B – Accident Benefits can be used for any medically necessary equipment, vehicle modifications and home modifications.
For more information regarding the recently announced automobile insurance regulatory changes, please see the Superintendent of Insurance Interpretation Bulletin. Additionally, if you have any questions regarding the changes, please contact the Office of the Superintendent of Insurance at (780) 643-2237 or email@example.com.