Therapists feel the bite from Bill 15

by Donald Horne 09 Dec 2014

 Bill 15 was crafted to root out insurance fraud, especially in the health care field – but it may be a case of friendly fire that is forcing occupational therapists to abandon the field.


“Because of that, I know some OTs (occupational therapists) who have already left the field, and I’m at the point where it’s really not worthwhile anymore to provide any direct OT services,” said Teresa Riverso, an OT who told Insurance Business that she is considering changing her focus to medical legal work and life care plans. “What this new licensing has done – and I’m sure it will crack down on some of the fraud that is out there – is impacting the full providers more than it is the clinics.”


Bill 15 – passed last month by the Ontario Legislature – included provisions recommended by the Anti-Fraud Task Force to help reduce and if possible eliminate fraud that has permeated the health care and towing industries in the Greater Toronto Area.


Unfortunately for Riverso and those like her in the occupational therapy profession, it has taken away chunk of money from their income.


“It is really steering me away from doing any work related to direct OT services for people injured in motor vehicle accidents,” she said. “And if I’m feeling that way, then obviously others are as well – and we’re not just talking OTs, but social workers and speech and language pathologists.”


The Rehab Alliance is trying to deal directly with a lot of these issues with the Minister of Finance and FSCO, but those meetings have been less than satisfactory, said Rivero.


“I know the meeting they had with the minister resulted in ‘Well, let’s wait and see what happens by April,’ which is when our renewal date for our licensing is supposed to happen,” she said. “In terms of FSCO, it is basically the same kind of response – take it or leave it.”


Riverso said she knows that the government is currently keeping track of a number of situations that are arising out of this new licensing process, and how it is impacting the services, “and I assume that by April they will have a number of cases to draw upon to use as an example for what the impact really is.”


The real danger to come is that as providers leave the sector, claimants won’t be getting the services they need.


“And if they aren’t getting the services they need, they will have to turn more so to clinic environments, and that is not necessarily the best place for them to go,” said Riverso. “And for some patients it is just physically impossible.”


Riverso is part of the auto insurance sector of her professional association, the Rehab Alliance, and an important message brokers should be sending their clients is the need to have a minimum of $100,000 coverage for rehabilitation on their auto policy.


“On top of that, the whole issue of having our rehab benefits basically cut in half – I don’t know if you’ve checked your auto insurance policy lately – but if you don’t buy up to the $100,000 of rehab, you are only allowed $50,000,” said Riverso, “and you can imagine how quickly you would go through that if God forbid you or a family member needed access to physiotherapy or chiropractic or an OT.”


But the real pain for Riverso are the changes to service providers to bill insurance companies for treatment provided included in Bill 15.


“In order for us to be able to bill insurance companies for treatments that we provide to claimants who have been involved in motor vehicle accidents, we now have to be licensed,” she said, “and that license carries with it a charge of $337, and then on top of that there is $218 for every location (office) that we have. And there is an additional cost of $15 per claimant that we billed for in the previous year. (continued.)

“To give you an example, in my particular case, it was just under $700 total, because I do a lot of medical legal work, so I don’t have a lot of claimants per se, but a friend of mine who is also an occupational therapist, their bill was around $1,000 to get her license for the privilege of billing insurance companies.”


That has resulted in a lot of providers like Riverso reducing referrals, and in other cases, forcing people out of the sector altogether.


And then there is the 50 per cent bite for those therapists who choose to go through clinics come billing time.


“The therapists have been approached by clinics to go through them, so that they are the ones who are doing the billing instead of us who are the providers,” said Riverso. “Unfortunately for us that means – in one particular case that I have been approached on – the clinic would take basically 50 per cent for billing I would do for the services I would provide.


“So we have the insurance companies that are taking this particular fee for licensing, we have clinics that are taking a greater portion of our billings in order for us as providers to be billing through them instead of billing directly,” she said. “If we don’t get our license we have to provide our bills to the claimant, who then submits it on our behalf to their lawyer – which means we may or may not get paid, because once a claimant receives that funding, they don’t necessarily turn it over to the provider – and that has historically happened on a number of occasions that I am aware of personally.”


Add on top of that insurance companies that are now clamping down on travel expenses.


“Historically I have been able to charge for my travel time and my mileage to a claimant,” said Riverso. “Because as OTs our work is out in the community; it is not that the clients come to us – we go to their homes. This impacts us as it basically reduces our hourly rate.”


Travel is expected to be a part of the cost of business now, and although it has always been a rule, insurance companies had been lax in enforcing it, she said.


But not anymore – and that has created an unlevel playing field for those who work in a clinic setting and those who choose to do the home care visits.


“Those who work in a clinic setting do not have that affect them – but we all work under the set FSCO rate,” said Riverso. “For example, I was just asked to go see someone in Stoney Creek (Hamilton) for an assessment for a clinic. If I’m not allowed to claim my travel time – especially during rush hour – you’re looking at a minimum of an hour to an hour-and-a-half each way, three hours total. If I’m getting $100 an hour from FSCO, what does that work out to?”


Auto insurance mess hasn’t happened by accident

Government, doctors, lawyers, the industry all played part





It’s not easy achieving a perfect state of ineptitude where so many auto accident victims are maltreated by so many people and institutions. Doing so takes real effort.

Let’s start at the top with the lawmakers, the people who govern Ontario.

With the insurance industry’s lobbying efforts paying off, our lawmakers gutted no-fault benefits in 2010.

Medical and rehabilitation benefits for most victims injured in accidents saw the maximum reduced to $3,500.

That’s the lowest in the country.

For serious injuries the maximum was reduced from $100,000 to $50,000.

That’s not money going into accident victims’ pockets; it’s money used to pay for medical and rehabilitation treatments.

Never resting, our lawmakers are in the process of lowering the interest rate to 1.4% on money owed by insurance companies to accident victims.

That this might encourage insurance companies to hold onto victims’ money longer, earning higher investment returns on it, seems to have escaped the attention of our lawmakers.

But enough about them.

Lawyers have a role to play in our mess of a system.

Many lawyers take on cases they are ill-equipped to handle.

Perhaps they don’t have the time or the required skills.

Too many lawyers take on car accident cases and let them languish, not aggressively moving them along.

Some miss limitation periods resulting in lawsuits being dismissed for tardiness or delay.

Some don’t prepare their clients adequately for examinations for discovery or prepare themselves adequately for mediations.

Too many don’t take basic steps to examine or question the qualifications or expertise of expert witnesses hired by insurance companies or defence lawyers.

Speaking of defence/insurer expert witnesses, too many health care professionals sell their souls to insurance companies, providing them with biased opinions used by insurance companies to deny or delay legitimate accident claims.

What ever happened to the Hippocratic Oath?

But we have regulators to ensure the system works, don’t we?

Heath care regulators such as the College of Physicians and Surgeons of Ontario (CPSO) don’t adequately control members who commit misconduct while churning out “expert” reports for insurance companies.

And when the CPSO decides to warn physicians about their inadequacies in assessing accident victims, they do so privately.

Then there is the Financial Services Commission of Ontario (FSCO) which regulates Ontario’s insurance industry.

Their arbitrators do an excellent job providing justice in individual cases where accident victims force their insurers to arbitration.

But what has FSCO ever done in an attempt to curtail industry abuses?

Of course, I couldn’t leave this topic without mentioning the insurance industry itself.

Through its lobby arm, the Insurance Bureau of Canada, the industry never misses an opportunity to remind the public and lawmakers about the massive fraud being engineered by accident victims.

Never mind that estimates for fraud never seem to budge or that the job of clamping down on fraud should be that of the industry.

Never mind that the fraud engineered by organized crime or crime rings with staged accidents has nothing to do with legitimate accident victims.

The industry continues marching to its own beat, continuously pushing lawmakers to reform the law to benefit insurance companies, to the detriment of accident victims.