Funding and Auto Insurance

Getting Started

Following a Motor Vehicle accident your insurance company will send you a package of forms. These forms must be completed before funding of treatment can begin. It is important for you to complete and submit the OCF 1, found in the package, to your adjuster prior to starting treatment. We recommend that you complete the entire package as quickly as possible to expedite your claim review.

Your therapist at the Orthopaedic Therapy Clinic can assist you in completing the following forms:

OCF 3 – Disability Certificate: This form may be filled in by your physiotherapist or physician.

OCF-18 or 23 Treatment Plan: These forms are used to request funds for your therapy. They can be completed by your physiotherapist or your Registered Massage Therapist in conjunction with the physiotherapist.  

Your therapist will explain to you which treatment plan is appropriate for your injury. The OCF 23 is used for injuries that  are designated as relatively more minor (Minor Injury Guideline). Once approved this treatment plan entitles you to a maximum of 12 weeks of physiotherapy and $400 in additional goods and services i.e. massage therapy.

The OCF 18 treatment plan is used for more severe injuries or injuries where pre-existing conditions may delay recovery. It can also be submitted if further treatment is required once the OCF 23 treatment plan has expired. The OCF-18 treatment plan requires the therapist to estimate the number of treatments you require and the length of time you may be on therapy. It is subject to a higher threshold for approval.

Information to bring to your first appointment

To be able to complete these forms you will need to bring us the following information:

  • Insurance company name
  • Policy number
  • Policy holder name (if not in your name)
  • Date of birth of client and policy holder
  • Claim number (if you have been assigned one)
  • Insurance adjuster contact information
  • Date of accident.
  • Extended health benefit policy number and insurance name
  • Photo-ID ( we are required to have a copy of a government issued photo-id)
  • A credit card[1]

[1] Our policy for direct billing is to keep a credit card number on file for any therapy charges that are not paid for by the insurer. You will be provided receipts for these charges.

If you have been on treatment at another clinic Please bring the following additional information:

    • Name and contact information of your therapist at the other clinic
    • Fees submitted by this clinic if available. If not available we will contact the clinic to find out where you are in your treatment plan.

What do I submit?

OCF 3 – This form outlines your injuries and contains sections that both you and your health practitioner must complete. Once your therapist or physician has completed their section you will include it in the submission package that you send to your insurer.

OCF-18 and 23 Treatment Plans – Once these forms are completed by your therapist you will be asked to sign the treatment plan. These forms will be submitted directly by The Orthopaedic Therapy Clinic to your adjuster.

Approval

Once submitted we must wait for approval from the insurer. If treatment begins prior to approval there is a risk that you may have to pay for these visits if the insurer does not agree with the plan[2]. Check with us or your insurer to determine if your treatment plan has been approved and to determine when you can book your follow-up treatment. Your adjuster will respond to our submitted OCF 23 or OCF 18 within 5 business days and 10 business days, respectively.

Treatment

OCF 23 (Minor Injury Guideline) – This plan requires the therapist to review treatment in 4 week blocks. If you no longer require treatment or have been inconsistent in your attendance it is likely that you will be discharged at these reviews.

[2] If you have extended health benefits this may not be an issue. See the payment info section below for further clarification.

The initial treatment plan covers 12 weeks of treatment. If you require treatment beyond the initial treatment plan your therapist will submit an additional treatment plan requesting additional funds.

OCF 18 – This plan does not specify a timeline for review however your therapist will schedule regular reviews to determine your progress and requirement for ongoing therapy. If you no longer require treatment or have been inconsistent in your attendance it is likely that you will be discharged at these reviews.

If you require treatment beyond the initial treatment plan your therapist will submit another treatment plan requesting additional funds.

Booking appointments

We recommend that you book a series of appointments to ensure you are able to get the intensive therapy that you require. Discuss the frequency and the plan with your therapist and book 2-4 weeks in advance.

Payment

Auto insurance legislation requires that your Extended Health Benefits (EHBs) are used prior to accessing the auto insurance funding. If you have more than one source of EHBs i.e. personal and spousal, we are required to bill both insurers.

Whenever possible we will bill your EHB insurer directly to streamline the process of coordinating both funding streams.   Unfortunately not all EHB insurers allow direct billing. Depending on your insurers requirements we will follow one of procedures listed below:

1. The OTC will directly bill your EHB insurer and then submit any unpaid balances directly to the MVA insurer. 

To bill your insurance company directly we require you to leave a credit card number and authorize us to charge any unpaid portions from your EHB and auto insurance to your credit card. You will be notified within 24 hours that this charge has been applied to your card.

2. Bill you directly for the EHB portion of your treatment and then OTC will submit to the MVA insurer 

If the EHB insurer does not allow direct payment we will ask you to pay us directly for treatment. You will be given a receipt to submit to your EHB insurer. During this period you should submit any unpaid portion directly to your auto insurer.

Once your EHB benefits have been exhausted we can submit your remaining fees directly to the auto insurer when you bring in the statement outlining what was paid or not paid by your EHB. We are required to have a copy of the EHB statement on file before we can bill your auto insurer.

Complexity of Coordinating Benefits

Although we work to coordinate the billing process the requirements to bill your EHB insurer first increases the complexity of coordinating benefits. The relationship is between you and your EHB insurer and Privacy legislation limits the information we can get on your behalf.

Even when direct billing is allowed the process does not always go smoothly. Invoices can be misplaced; cheques can go directly to you, billing information is not provided, etc. When this process goes astray our only option is to bill you directly and as such we need your help in managing this process.

While you are receiving treatment and for a few months after completion, we ask that you check your insurance payments to determine if you have received reimbursement for treatment that should have come directly to the OTC. This process is more complex as many of us receive our EHB payments through direct deposit. When a direct deposit is made or a cheque is received bring in the statement from the insurer and we will help you to sort out the application of this payment.

Additional therapy costs

Auto insurance physiotherapy rates and OCF 18

The MVA insurer may limit their payments of physiotherapy to $95/hour. The Orthopaedic Therapy Clinic’s current hourly rate is $130/hour. Please note that if the MVA insurer does not pay the full amount the outstanding balance will be transferred back to you. This does not apply to an OCF 23 (MIG) as the insurer provides a block payment.

Auto insurance massage therapy rates

For the OCF 18 auto-insurance will pay a maximum fee of $58.19 for a one hour massage. Our fee for this service is $100. The difference between the two fees plus tax will be charged to your credit card on file. A receipt will be provided. This fee may be covered by your EHB.

For the OCF 23 (Minor Injury Guideline) auto insurance mandates a maximum fee of $400 for additional goods and services i.e. massage, theraband. There are no additional fees for massage. However based on this amount you will be eligible for approximately 4 massage treatments. If you require treatment beyond the $400 it may be appropriate to submit another treatment plan. As the plan is reaching completion discuss with your Registered Massage Therapist whether an OCF18 should be submitted.