Navigating the complex Statutory Accident Benefits system to get treatment after a car accident
For almost two decades Focus Physiotherapy has been providing injured Ontarians with treatment following all types injuries. For slip and fall, work, overuse, sports injuries and car accidents Focus Physiotherapy has become a trusted partner in the rehabilitation and recovery process for people who value quality care.
At Focus Physiotherapy we are skilled in providing treatment within many different frameworks, OHIP, Work Benefits, Private Pay, and WSIB are some areas where our team navigates various administrative processes to ensure our patients obtain seamless treatment.
Yet the most complicated treatment administration system is the auto insurance system. So we felt it useful to outline how our experienced team of office administrators both at the clinic and off-site work diligently to assist things going smoothly for you minimizing stress during your rehabilitation so you can put more focus on your recovery.
Navigating the Claims Process:
As someone who has been involved in a car accident you under a lot of pressure. Having to arrange for new transportation, dealing with disruptions in your life and a decreased ability to care for yourself and loved ones takes a toll on your well-being. These stressors, when trying to get your life back on track, are not welcome.
Focus Physiotherapy has processes in place to assist you during this time.
Dealing with unfamiliar insurance forms, the claims process is complicated and can be confusing. Our team has experience in this arena and will assist you in filling out all the necessary accident benefit applications for your auto insurer.
Also, if your insurer has not yet sent you the accident benefit forms upon your arrival with us, we will provide you with them. These forms are called OCF forms, and although they are intimidating, our staff can go through them with you and help.
Your Initial Assessment:
Our team will perform a thorough evaluation and outline a treatment program that will result in the greatest potential for recovery. This treatment plan is submitted to your auto insurer for approval. If your auto insurer has not yet received your accident application, this will delay a response; our team will help you avoid this.
We will take the time to clarify any questions any of your insurers may have about your injuries and treatment, and the insurers will require answers before approving your program.
Your catastrophic injuries may require us to participate in case management meetings that would include a case manager and other members of your healthcare team. Our office can attend these meetings with you and make presentations to ensure your rehabilitation needs are conveyed.
For serious and complex cases where you are unable to leave home due to traumatic brain injuries or multiple fractures, we can provide treatment at home before beginning a clinic-based treatment program.
Our in home registered physiotherapist will ensure all relevant issues and barriers are conveyed to the members of the clinic-based rehabilitation team to ensure your progression to a clinic-based program takes you to the next level of recovery.
Our team will submit a treatment plan for approval to your auto insurer. This first treatment program will be the outline for services to be rendered during the initial stages of your recovery. Within the framework of the accident benefits schedule, invoices submitted to your insurers will be based on this program.
As you recover, you may require new treatment programs to be presented that take into consideration your changing needs. Our team will develop these new programs with you, taking into account your physical abilities, your goals and your circumstance.
Decreasing Your Administrative Burden:
Focus Physiotherapy staff will work to process and help with your auto insurance claim paperwork. Here is how our experience can benefit you:
- Following your car accident our team will coordinate and communicate with all the different insurance companies that by law will fund your rehabilitation.
- In Ontario, when a person is injured in a car accident the auto insurer is NOT the first insurance company to pay for your treatment.
- YOUR work insurance is the first payee; the auto insurer then covers any shortfall.
- Our office managers will obtain the policy numbers of your work insurance(s), determine if you have any additional coverage through a parent or spouse, and then coordinate all submissions to your work insurance(s).
- Since different work insurances have different claims and submission processes, our team will call your work insurance companies on your behalf to confirm their particular submission process and requirements. We check and verify the process to minimize delays for you.
- For any services rendered, we will first submit invoices for treatment to your work insurer. Your primary work insurer will review the submissions; they will assess your claim and determine if payment is to be issued, to whom, and for how much. If your work insurer pays us directly, we should receive payment in four to six weeks. Your insurer may submit reimbursement to you directly for our services at which point you must forward the payment and statements to us.
- If you have another work insurance through a spouse or parent, the process is repeated.
- It is only after all private insurers have processed invoices that the auto insurer will receive an invoice for any difference. This process can take over 90 days and scheduled on a monthly basis.
As a patient of Focus Physiotherapy, we will do our best to ensure as seamless a submission process as possible. Providing us with any paperwork, statements and payments involving your treatments, enables us to ensure smooth handling of your rehabilitation paperwork.
Many clinics are unable or unwilling to provide this level of administrative support during your recovery. Focus Physiotherapy goes this extra mile to reduce the stress involved in your recovery.
Your physical recovery from a severe and catastrophic car accident or a minor car accident have the same administrative requirements and burdens. Patients who are less stressed, and with greater support can focus more on their recovery. Focus Physiotherapy is your partner in your recovery from an auto accident. We take on these extra duties to optimize your potential for a full recovery.
