Government Notices Respecting Corporations

Certificate of Dissolution

Notice Is Hereby Given that a certificate of dissolution under the Business Corporations Act, has been endorsed. The effective date of dissolution precedes the corporation listings.

B. G. Hawton
Director, Companies and Personal Property Security Branch
(6886) 39

Notice of Default in Complying with the Corporations Information Act

Notice Is Hereby Given under subsection 241 (3) of the Business Corporations Act that unless the corporations listed hereunder comply with the filing requirements under the Corporations Information Act within 90 days of this notice orders dissolving the corporation(s) will be issued. The effective date precedes the corporation listings.

B. G. Hawton
Director, Companies and Personal Property Security Branch
(6883) 39

Cancellation of Certificate of Incorporation (Business Corporations Act)

Notice Is Hereby Given that by orders under subsection 241 (4) of the Business Corporations Act, the certificates of incorporation set out hereunder have been cancelled and corporation(s) have been dissolved. The effective date of cancellation precedes the corporation listing.

B. G. Hawton
Director, Companies and Personal Property Security Branch
(6882) 39

Notice of Default in Complying with the Corporations Tax Act

The Director has been notified by the Minister of Finance that the following corporations are in default in complying with the Corporations Tax Act.

Notice Is Hereby Given under subsection 241 (1) of the Business Corporations Act, that unless the corporations listed hereunder comply with the requirements of the Corporations Tax Act within 90 days of this notice, orders will be made dissolving the defaulting corporations. All enquiries concerning this notice are to be directed to Corporations Tax Branch, Ministry of Finance, 33 King Street West, Oshawa, Ontario L1H 8H6.

B. G. Hawton
Director, Companies and Personal Property Security Branch
(6885) 39

Cancellation of Certificate of Incorporation (Corporations Tax Act Defaulters)

Notice Is Hereby Given that, under subsection 241 (4) of the Business Corporations Act, the Certificates of Incorporation of the corporations named hereunder have been cancelled by an Order dated 1 September, 2003 for default in complying with the provisions of the Corporations Tax Act, and the said corporations have been dissolved on that date.

B. G. Hawton
Director, Companies and Personal Property Security Branch
(6884) 39

Co-operative Corporations Act (Certificate of Amendment of Articles Issued)

Notice Is Hereby Given that, under the Co-operative Corporations Act, amendment to article have been effected as follows:

John M. Harper,
Director, Compliance Branch,
Licensing and Compliance Division
by delegated authority from the Superintendent of Financial Services
(6889) 39

Financial Services Commission of Ontario

Guideline On Designated Assessment Centre Selection Process
Superintendent’s Guideline No. 04/03

September 2003

Introduction

Regulation 313/03, which comes into effect on October 1, 2003, changes the process under section 53 of the Statutory Accident Benefits Schedule (Sabs) for selecting a Designated Assessment Centre (Dac) to conduct a designated assessment. Effective October 1, 2003, the Sabs no longer requires a claimant to be assessed at the DAC closest to his or her residence.

Section 53 of the Sabs, as amended effective October 1, 2003, is attached to this Guideline for reference.

This Guideline defines the process by which the Superintendent will select a Dac under section 53 of the Sabs.

Notification/Termination

In the event that a benefit is disputed by an insurance company, the insurance company is required to give the claimant an explanation of benefits payable, and notice of assessment, denial, reduction or termination of benefits through the provision of the following forms as appropriate:

• OCF-9 Explanation of Benefits Payable by Insurance Company
• OCF-17 Notice of Stoppage of Weekly Benefits and Request for Assessment
• OCF-20 Catastrophic Impairment Determination and Request for Assessment

These forms are also to be used by a claimant who wishes to dispute the insurance company’s assessment, denial, reduction or termination of benefits and be assessed at a Dac.

Both the OCF-9 and the OCF-17 provide a general overview of the claimant’s right to dispute.

Selection of a DAC by Agreement of Insurer and Claimant

As amended, section 53 of the Sabs requires that if an insurer receives a notice of a claimant’s request for a Dac assessment, or determines that a Dac assessment is required under the Sabs, the insurer and the claimant should attempt to jointly select the Dac.

The selection is to be made no later than the second business day after the insurer or the claimant, as the case may be, receives notice from the other that a Dac assessment is required under the Sabs.

If the insurer and the claimant do jointly select a DAC, the insurer will initiate the referral to the DAC and indicate on a DAC Referral, Plan, and Summary Form (OCF-11) that the DAC referral is being made jointly by the insurer and the claimant.

If the DAC is unable to begin the assessment within 14 days from the date of receiving the request for assessment, the parties will attempt to jointly select another DAC, subject to the provisions of the Sabs.

Superintendent Selection of a DAC

The Superintendent will select a DAC if:

• the insurer and the claimant do not jointly select a DAC within two business days; or
• the DAC jointly selected by the parties is unable to begin an assessment within 14 days of the request for an assessment, and the parties ask the Superintendent to select another Dac.

Superintendent’s Protocol for DAC Selection Process

1. In the event that the insurer and the claimant do not jointly select a DAC, the insurer must request that the Superintendent select a DAC on behalf of the parties.
2. The insurer representative is required to initiate the process via the DAC Selection Request form that can be downloaded (in WordPerfect or Word format) from the DAC Selection page on FSCO’s website at www.fsco.gov.on.ca
3. The insurer representative is required to complete the request and certify that the information is accurate. The insurer will attach the request to an e-mail and send it to FSCO at dacselection@fsco.gov.on.ca.
4. Within two business days, FSCO will send to the insurer representative, via e-mail, a confirmation certificate specifying the Dac selected. Each certificate will have a FSCO file number that can be used for verification.
5. The insurer must initiate a referral to the specified DAC by completing an OCF-11, printing a copy of the confirmation certificate, and attaching the copy of the certificate to the OCF-11. The insurer is also required to ensure the claimant or the claimant’s legal representative receives a copy of the certificate.
6. Insurers and claimants are prohibited from using this process to make more than one request for selection of a DAC unless one of the following conditions applies:
   1. The DAC previously selected by the Superintendent has declared a conflict of interest that is not being waived by the parties; or
   2. The DAC previously selected by the Superintendent is unable to conduct the assessment within the required time frame; or
   3. The claimant is being sent for an additional assessment as required by the Sabs (e.g. subsequent disability assessment or multiple treatment plans), and the parties do not jointly select a Dac in the manner required by the Sabs.

Section 53 of the Statutory Accident Benefits Schedule as amended effective October 1, 2003

53. (1) A designated assessment shall be conducted by a designated assessment centre selected in accordance with this section.

(1.1) A designated assessment must be conducted by a designated assessment centre that,

1. is authorized to assess impairments of the type sustained by the insured person; and
2. is authorized to conduct the type of designated assessment that is required.

(1.2) A designated assessment must be conducted by a designated assessment centre that is located within,

1. 30 kilometres of the insured person’s residence, if,
   1. the insured person’s residence is located in the City of Toronto or the regional municipality of Durham, Halton, Peel or York, and
   2. a designated assessment centre that complies with subsection (1.1) is located within 30 kilometres of the insured person’s residence; or
2. 50 kilometres of the insured person’s residence, if,
   1. the insured person’s residence is not located in the City of Toronto or the regional municipality of Durham, Halton, Peel or York, and
   2. a designated assessment centre that complies with subsection (1.1) is located within 50 kilometres of the insured person’s residence.

(1.3) Subject to subsections (1.1) and (1.2), the insurer and the insured person may jointly select the designated assessment centre if the selection is made not later than the second business day after the insurer or the insured person, as the case may be, receives notice from the other that a designated assessment is required under this Regulation.

(1.4) If the insurer and the insured person do not jointly select the designated assessment centre in accordance with subsection

(1.3), the Superintendent shall, subject to subsections (1.1) and (1.2), select the designated assessment centre.

(2) If the designated assessment centre is selected by the Superintendent, the designated assessment centre shall, before conducting the designated assessment, give the insurer and the insured person notice disclosing any conflict of interest that the centre has relating to the designated assessment.

(3) The designated assessment centre shall give any notice required under subsection (2) in respect of a designated assessment described in subsection 43 (11) within three business days after receipt of the request for the designated assessment.

(4) If a conflict of interest is disclosed under subsection (2),

1. the designated assessment centre shall conduct the designated assessment if the insurer and the insured person agree; or
2. if the insurer and the insured person do not agree, the designated assessment shall be conducted, subject to subsections (1.1), (1.2) and (2), by another designated assessment centre selected by the Superintendent.

(5) For the purposes of clause (4) (b), the insurer and the insured person shall be deemed not to agree in the case of a designated assessment described in subsection 43 (11) unless they agree by the end of the third business day after the day the insurer receives the notice under subsection (2) or the insured person receives the notice under subsection (2), whichever day is later.

[subsections (6), (7) & (8) are revoked]

(9) Except as otherwise required under subsection 43 (11), a designated assessment centre must begin a designated assessment within 14 days after receiving a request for the designated assessment.

(10) If a designated assessment centre is unable to begin a designated assessment within 14 days after receiving the request for the assessment, the insured person or the insurer may re- quire that, subject to subsections (1.1), (1.2) and (2), the designated assessment be conducted by another designated assessment centre selected by the Superintendent.

(10.1) The Superintendent may, with the consent of the Minister, delegate in writing to any person the Superintendent’s authority to select designated assessment centres under this section.

(11) For the purpose of this section, a designated assessment centre has a conflict of interest relating to a designated assessment if,

1. the insurer, the insured person or a lawyer or other representative acting on behalf of the insurer or the insured person has a financial interest in the designated assessment centre; or
2. the designated assessment centre, a related person, an assessor or consultant who will carry out all or part of the designated assessment or a facility owned or control- led, directly or indirectly, in whole or in part, by the centre or a related person,
   1. has provided goods or services to the person to be assessed, other than a previous designated assessment,
   2. prepared or approved a treatment confirmation form under section 37.1, a treatment plan under section 38 or an application for approval of an assessment or examination under section 38.2 for the person to be assessed, or
   3. is identified by a treatment confirmation form, treatment plan or an application for approval of an assessment or examination as a person who will pro- vide goods or services to the person to be assessed.

(12) In clause (11) (b),

“related person” means, in respect of a designated assessment centre, an owner, partner or another person who has a financial interest in the designated assessment centre, but does not include a person who has a financial interest in the designated assessment centre by reason only of being a creditor deals at arm’s length with the designated assessment centre.

Professional Services Guideline
Superintendent’s Guideline No. 05/03

September 2003

Introduction

This Guideline is pursuant to section 268.3 (1) of the Insurance Act for the purposes of subsections 14 (4), 15 (6), 17 (2) and 24 (2) of the Statutory Accident Benefits Schedule - Accidents on or After November 1, 1996 (Sabs), and applies to expenses for health care services rendered on or after November 1, 2003.

Purpose

This Guideline sets out the maximum fee payable by automobile insurers under the Sabs for the services of any of the health care professions or health care providers listed in this Guideline. These maximum fees are applicable to:

• a medical benefit under clauses 14 (2) (a), (b), or (h) of the Sabs;
• a rehabilitation benefit under clauses 15 (5) (a) to (g) or (l) of the Sabs;
• case management services under subsection 17 (1) of the Sabs; or
• conducting an examination or assessment or provision of a certificate, report or treatment plan under subsection 24 (1) of the Sabs.

Maximum Fees

Automobile insurers are not liable to pay for expenses related to professional services rendered to an insured person that exceed the following maximum hourly rates:

Fees for Completion of Forms

Automobile insurers are not liable to pay expenses that exceed the following maximum fees for the completion for certain accident benefit forms by members of the health professions and health care providers listed in this Guideline, (These maximum fees do not apply to the assessments related to the completion of these forms).

Revoking of Existing Fee, Utilization and Treatment Guidelines

With the release of this Guideline and the revised Pre-Approved Guidelines for Whiplash Associated Disorder Grade I and Grade II Injuries With or Without Complaint of Back Pain, the following guidelines, previously released by the Superintendent of Financial Services, the Ontario Commissioner of Insurance, the Financial Services Commission of Ontario, or the Ontario Insurance Commission are revoked:

1. Professional Fee Guidelines - Occupational Therapists, February 3, 2001, Professional Fee Guideline No. 1/01
2. Occupational Therapy Utilization Guidelines for Uncomplicated Soft Tissue Injuries, February, 3, 2001, Superintendent’s Guideline No 1/01
3. Professional Fee Guideline - Podiatrists, March 9, 1998,
4. Professional Fees Guideline - Physiotherapists, November 24, 1997
5. Physiotherapy Utilization Guidelines for Soft Tissue Disorders of the Spine, November 24, 1997, Commissioner’s Guideline No.2/97
6. Professional Fee Guidelines - Speech-Language Pathologists, March 31, 2001, Professional Fee Guideline No.2/01.

The Professional Fee Guidelines - Psychologists, Professional Fee Guideline No. 3/01, issued March 31, 2001, expired on December 31, 2001.

Pre-Approved Framework Guideline For Whiplash Associated Disorder Grade I Injuries With Or Without Complaint Of Back Symptoms
Superintendent’s Guideline No. 06/03

September 2003

1. Introduction

   This Guideline is issued pursuant to Section 268.3 of the Insurance Act for the purposes of the Statutory Accident Benefits Schedule (Sabs).

   This Guideline is effective for new Treatment Confirmation Forms submitted by a initiating health practitioner on or after November 1, 2003, and replaces Pre-approved Framework Guideline for Whiplash Associated Disorder Grade I Injuries With or Without Complaint of Back Symptoms Superintendent’s Guideline No. 01/03, July 2003.

   This Guideline is intended to set out what goods and services may be provided without insurer approval to an insured person described below who has sustained a Whiplash Associated Disorder Grade I as described below, with or without back pain, and the cost of such services payable by the insured person’s insurer.

   This Guideline reflects a consensus between regulated health professionals and insurers and will be subject to review and revision as required over time.

2. Impairments that come within this Guideline

   Subject to the exceptions listed in Section 3, below, an insured person’s impairment comes within this Guideline if, after being assessed within 21 days of the accident, the insured person is determined to have an injury that:

   1. resulted from an acceleration-deceleration mechanism of energy transfer to the neck, presents as a complaint of neck pain, stiffness, or tenderness only, with no physical signs, and therefore meets the criteria for “Whiplash Associated Disorder Grade I” (also known as “Wad I”) set out in the Société de l’assurance automobile du Québec’s Task Force Report titled Redefining “Whiplash” and its Management, published in the April 15,1995 edition of Spine, and/ or a complex of common symptoms associated with whiplash;^{footnote 1[1]}
   2. may include a complaint of non-radicular back pain associated with the Wad I; and
   3. is of sufficient severity that it requires the physical treatment interventions provided under this Guideline.

   An insured person who has sustained an impairment covered by this Guideline may exhibit other common symptoms including: shoulder pain; referred arm pain (not from radiculopathy); dizziness; tinnitus; headache; difficulties with hearing and memory acuity; dysphagia; and temporomandibular joint pain. These additional symptoms would not exclude an impairment from this Guideline unless they require separate treatment from that provided under this Guideline.

3. Impairments that do not come within this Guideline

   An insured person’s impairment does not come within this Guideline if:

   1. the insured person’s impairment comes within the Wad Ii Preapproved Framework Guideline; or
   2. despite being assessed within 21 days of the injury as having an injury described in Section 2, there are specific pre-existing occupational, functional or medical circumstances of the insured person that:
      1. significantly distinguish the insured person’s needs from the needs of other persons with similar impairments that come within this Guideline; and
      2. constitute compelling reasons why other proposed goods or services are preferable to those provided for under this Guideline.

4. Role of the initiating health practitioner

   The initiating health practitioner:

   1. is a health practitioner as defined by the Sabs who is authorized by law to treat the injury and has the ability to deliver all the goods and services provided for in this Guideline;
   2. initiates treatment by submitting a Treatment Confirmation Form;
   3. provides a significant portion of the goods and services;
   4. may co-ordinate the provision of any goods and services covered by this Guideline and provided to the insured person by another regulated health professional, or directly supervise the provision of any additional goods and services to the insured person by an unregulated health provider, where such treatment is needed by the insured person and is provided under this Guideline;
   5. shall have overall accountability for:
      1. assessing the need for and implementing goods and services such that the treatment elements in this Guideline are addressed as required and appropriate;
      2. ensuring the use of the most appropriate provider(s);
      3. documenting, communicating and billing as required by the Guideline;
      4. reporting outcomes to the insured person and insurer when treatment is inappropriate or ceases;
      5. participating in monitoring the effectiveness of the Guideline by fully completing the forms required by this Guideline; and
   6. determines the presence of any barriers which might delay recovery.

5. Providers covered by this Guideline

   The initiating health practitioner may include treatment by other providers in the Treatment Confirmation Form. This Guideline covers treatment by the initiating health practitioner and other providers, including unregulated providers where the treatment is directly supervised by a regulated health professional and is not a controlled act as defined by the Regulated Health Professions Act, 1991.

6. Switching initiating health practitioners

   If for any reason, an insured person receiving treatment under this Guideline wishes to change his or her initiating health practitioner, the insured person and the new practitioner must inform the insurer through submission of a new Treatment Confirmation Form. In the new Treatment Confirmation Form, the insured person will give consent for the insurer to contact the original initiating health practitioner to determine what goods and services referred to in the original Treatment Confirmation Form have not been provided and the insurer will then fill in this amount in Part 9 of the Form.

7. Treatment covered by this Guideline

   There will typically be one Treatment Confirmation Form which will be prepared by the initiating health practitioner.

   Treatment commences with the first assessment of the insured person by the initiating health practitioner.

   Treatment will have a duration of up to 28 days.

   Regulated health professionals are expected to assess the insured person, develop a plan of treatment and provide up to 9 monitoring/treatment sessions for insured persons covered by this Guideline.

   The focus of the Guideline is on maintaining normal activities and reducing the risk of chronicity.

   From the outset, the insured person will be encouraged to maintain normal activities. The emphasis in the first week will be on assessment, education, reassurance, and pain control. Throughout treatment, emphasis will be put on the insured person’s being in charge of his or her recovery and on carrying on with normal activities. The frequency of provider interventions will diminish as the insured person progresses.

   If prescription medication is needed, a referral to a physician or nurse practitioner is necessary. Regulated health professionals may provide general information on the use of over-the-counter medications, but insured persons should be encouraged to consult a physician, nurse practitioner, or pharmacist on the specific use of these medications.

   The course of treatment may involve the following: reassurance, pain control, mobilization/manipulation, education, and activation (normal daily activities and active exercise).

   Education materials titled Getting the Facts About Whiplash, developed by regulated health professionals and the insurance industry, will be provided by the initiating health practitioner to all insured persons covered by this Guideline. This material may be found in Appendix D.

   The importance of positive messaging is recognized, and it is therefore expected that, at the initial visit and assessment and at subsequent visits, the insured person will be provided with:

   • education regarding “hurt does not equal harm;” and
   • reassurance that most people with Wad I and associated complaints of back symptoms recover within the first few weeks following the injury.

   Not all individuals with Wad I will require any or all of the goods and services included within this Guideline. The provider is responsible for determining the need for goods and services and whether the prescribed goods and services are producing significant progress toward recovery and should be continued under the Guideline. If the insured person has recovered before the completion of the treatment outlined in this Guideline, the insured person should be discharged from treatment.

8. Supplementary goods and/or services

   Without prior insurer approval, the initiating health practitioner may provide supplementary goods and/or services where they are needed for the management of one or more minor soft tissue injury/ies which:

   1. resulted from the same accident as the Wad I and requires treatment;
   2. is/are unrelated to the Wad I with or without back pain and its common symptoms;
   3. is/are not of sufficient severity to exclude the insured person’s impairment from this Guideline; and
   4. can be fully treated by the provider within the time frame of this Guideline.

   The impairment addressed and the services and/or goods must be specified on the Treatment Confirmation Form and the maximum total cost payable by the insurer for the goods and services provided under this section is $120.

9. Treatment deemed insufficient or inappropriate

   If the initiating health practitioner determines that the treatment under this Guideline is no longer appropriate or sufficient for the insured person because the insured person is not making sufficient progress towards recovery, the initiating health practitioner will advise the insurer and the insured person (using the Wad I/Wad Ii Paf

   Discharge & Status Report form). The initiating health practitioner’s options then are as follows:

   1. submit a Treatment Plan;
   2. submit a Treatment Plan and make a referral to the insured person’s physician or another regulated health professional; or
   3. make a referral to the insured person’s physician or other health care professional. While treatment/referral decisions are being considered, the initiating health practitioner may:
   4. stop the treatment where it is not appropriate (or no longer needed);

   or

   5. continue treatment until a decision is reached on the action recommended by the initiating health practitioner or until the end of the treatment covered by this Guideline.

   The Sabs provides that an insurer may reject a Treatment Plan that provides for goods and services to be received during any period in which the insured person is receiving goods and services under this Guideline and the insurer’s determination is not subject to dispute.

   However, the Sabs also provides that nothing prevents an insured person, while receiving goods and services under this Guideline, from submitting a Treatment Plan applicable to a period other than the period covered by this Guideline. If the insurer does not approve the Treatment Plan within the time period prescribed in the Sabs, that dispute may proceed to a Designated Assessment Centre for review.

10. Completing the treatment under this Guideline

    Upon completion of treatment, the initiating health practitioner will prepare a final report which will indicate the insured person’s outcomes from treatment.

    If an insured person elects to end treatment under this Guideline, the insured person may only resume treatment at a later date if this will not extend the overall duration and expenditure limits of the Guideline.

    When an insured person is receiving treatment under the Guideline, the termination options are:

    1. Resolved and discharged within 4 weeks (Wad I/Wad Ii Paf Discharge & Status Report form completed by initiating health practitioner);
    2. Condition improving, but improvement is insufficient at the end of the treatment (further or other treatment beyond the Guideline is dependent upon the Treatment Plan application and approval process of the Sabs);
    3. Not resolving (decision made as soon as possible) and the initiating health practitioner completes the Wad I/Wad Ii Paf Discharge & Status Report form and discharges insured person;
    4. Insured person unreasonably fails to participate in treatment. This may be inferred from the insured person’s non-attendance at 2 consecutive appointments or 4 appointments overall without a reasonable explanation. Provider required to complete Wad I/ Wad Ii Paf Discharge & Status Report form; or
    5. Insured person withdraws consent.

11. Reporting requirement for initiating health practitioners

    The initiating health practitioner is expected to establish clinical outcome goals for the insured person receiving treatment under this Guideline that are consistent with the goals of return to normal activities in the early stages of recovery and reducing the risk of chronicity.

    Throughout the course of treatment the initiating health practitioner is expected to use appropriate measures/indicators to evaluate progress towards achievement of these goals.

    For the purposes of documenting the impact of the Guidelines on an insured person whose impairment comes within this Guideline and contributing to the overall evaluation of the Guideline, the initiating health practitioner must complete the Wad I/Wad Ii Paf Discharge & Status Report form.

12. Provider reimbursement

    An initiating health practitioner who provides a good and/or service to an insured person in accordance with the Guideline must submit a Treatment Confirmation Form not later than 5 business days after first seeing the insured person.

    The Sabs provides that the insurer must confirm to the initiating health practitioner no later than 5 business days after receiving the Treatment Confirmation Form, that the auto insurance policy referenced to in the Treatment Confirmation Form was in force on the date of the accident.

    Payment to the initiating health practitioner may be denied due to coverage issues or exclusions set out in the Sabs.

    The insurer’s payment will follow receipt of a completed Treatment Confirmation Form, Application for Accident Benefits and Auto Insurance Standard Invoice, Version C. The insurer is not obliged to make payment until after the insurer has received an Application for Accident Benefits.

    In the case of the final invoice, the insurer’s payment will follow receipt of a Wadi/Wad Ii Paf Discharge & Status Report and Auto Insurance Standard Invoice, Version C.

13. Content of appendices

    Appendix A sets out the payment schedule in chart form.

    Appendix B sets out an overview of the expected course of treatment for an insured person whose impairment comes within this Guideline.

    Providers will individualize these treatment directives for the needs of each insured person.

    Appendix C sets out what goods/services an insurer is not obliged to fund pursuant to this Guideline for an insured person whose impairment comes within this Guideline.

    Appendix D contains the educational brochure titled Getting the Facts About Whiplash.

Appendix A - Wad I Payment Schedule

Health care providers are entitled to the following payments for treatment of an insured person whose impairment comes within this Guideline. Fees are payable where the insured person has received any treatment in that block, including where treatment has been discontinued.

Appendix B - Wad I Course of treatment

Appendix C - Goods and services not covered in the Guideline

An insurer is not obliged to pay pursuant to this Guideline for the following goods/services rendered to an insured person with an impairment that comes within this Guideline:

• Cervical pillows;
• Advice supporting inactivity or bedrest;
• Injections of anesthetics, sterile water or steroids to the neck;
• Soft collar;
• Spray and stretch; and
• Magnetic necklaces.

Appendix D - Getting the Facts about Whiplash

Getting the facts about Whiplash: Grades I and II

People injured in car accidents sometimes experience a strain of the neck muscles and surrounding soft tissue, known commonly as whiplash. This injury often occurs when a vehicle is hit from the rear or the side, causing a sharp and sudden movement of the head and neck. Whiplash may result in tender muscles (Grade I) or limited neck movement (Grade II). This type of injury is usually temporary and most people who experience it make a complete recovery. If you have suffered a whiplash injury, knowing more about the condition can help you participate in your own recovery. This brochure summarizes current scientific research related to Grade I and II whiplash injuries.

Understanding Whiplash

• Most whiplash injuries are not serious and heal fully.
• Signs of serious neck injury, such as fracture, are usually evident in early assessments. Health care professionals trained to treat whiplash are alert for these signs.
• Pain, stiffness and other symptoms of Grades I or II whiplash typically start within the first 2 days after the accident. A later onset of symptoms does not indicate a more serious injury.
• Many people experience no disruption to their normal activities after a whiplash injury. Those who do usually improve after a few days or weeks and return safely to their daily activities.
• Just as the soreness and stiffness of a sprained ankle may linger, a neck strain can also feel achy, stiff or tender for days or weeks. While some patients get better quickly, symptoms can persist over a longer period of time. For most cases of Grades I and II whiplash, these symptoms gradually decrease with a return to activity.

Daily Activity and Whiplash

• Continuing normal activities is very important to recovery.
• Resting for more than a day or two usually does not help the injury and may instead prolong pain and disability. For whiplash injuries, it appears that “rest makes rusty.”
• Injured muscles can get stiff and weak when they’re not used. This can add to pain and can delay recovery.
• A return to normal activity may be assisted by active treatment and exercises.
• Cervical collars, or “neck braces,” prevent motion and may add to stiffness and pain. These devices are generally not recommended, as they have shown little or no benefit.
• Returning to activity maintains the health of soft-tissues and keeps them flexible - speeding recovery. Physical exercise also releases body chemicals that help to reduce pain in a natural way.
• To prevent development of chronic pain, it is important to start moving as soon as possible.

Tips For Return To Activity

• Avoid sitting in one position for long periods.
• Periodically stand and stretch.
• Sit at your workstation so that the upper part of your arm rests close to your body, and your back and feet are well supported.
• Adjust the seat when driving so that your elbows and knees are loosely bent.
• When shopping or carrying items, use a cart or hold things close to the body for support.
• Avoid contact sports or strenuous exercise for the first few weeks to prevent further injury. Ask your health professional about other sporting or recreational activities.
• Make your sleeping bed comfortable. The pillow should be adjusted to support the neck at a comfortable height.

Treating Whiplash

• Research indicates that successful whiplash treatment requires patient cooperation and active efforts to resume daily activity.
• A treating health care professional will assess your whiplash injuries, and discuss options for treatment and control of pain.
• Although prescription medications are usually unnecessary, temporary use of mild over-the-counter medication may be suggested, in addition to ice or heat.
• Your treating health care professional may recommend appropriate physical treatment.

Avoiding Chronic Pain

• Some whiplash sufferers are reluctant to return to activity, fearing it will make the injury worse. Pain or tenderness may cause them to overestimate the extent of physical damage.
• If your health professional suggests a return to activity, accept the advice and act on it.
• Stay connected with family, friends and co-workers. Social withdrawal can contribute to depression and the development of chronic pain.
• If you are discouraged or depressed about your recovery, talk to your health professional.
• Focus on getting on with your life, rather than on the injury!

Preventing Another Whiplash Injury

• Properly adjusting the height of your car seat head restraint (head rest) will help prevent whiplash injury in an accident. In an ideal adjustment, the top of the head should be in line with the top of the head restraint and there should be no more than 2 to 5 cm between the back of the head and the head restraint.

This brochure provides general information about whiplash injuries. It does not replace advice from a qualified health care professional who can properly assess a whiplash injury and recommend treatment.

The information highlights the latest available scientific research on whiplash and has been endorsed by the following groups:

Insurance Bureau of Canada (Ibc)
Ontario Chiropractic Association (Oca)
Ontario Massage Therapist Association (Omta)
Ontario Physiotherapy Association (Opa)
Ontario Society of Occupational Therapists (Osot)

Pre-Approved Framework Guideline For Whiplash Associated Disorder Grade Ii Injuries
With Or Without Complaint Of Back Symptoms
Superintendent’s Guideline No. 07/03

September 2003

1. Introduction

   This Guideline is issued pursuant to Section 268.3 of the Insurance Act for the purposes of the Statutory Accident Benefits Schedule (Sabs).

   This Guideline is effective for new Treatment Confirmation Form submitted by a initiating health practitioner on or after November 1, 2003, and replaces Pre-approved Framework Guideline for Whiplash Associated Disorder Grade II Injuries With or Without Complaint of Back Symptoms Superintendent’s Guideline No. 02/03, July 2003.

   This Guideline is intended to set out what goods and services may be provided without insurer approval to an insured person who has sustained a Whiplash Associated Disorder Grade II as described below, with or without back pain, and the cost of such services payable by the insured person’s insurer.

   This Guideline reflects a consensus between regulated health professionals and insurers and will be subject to review and revision as required over time.

2. Impairments that come within this Guideline

   Subject to the exceptions listed in Section 3, below, an insured person’s impairment comes within this Guideline if, after being assessed within 28 days of the accident, the insured person is determined to have sustained an injury that:

   1. resulted from an acceleration-deceleration mechanism of energy transfer to the neck, presents as a complaint of neck pain, stiffness, or tenderness, and musculoskeletal sign(s), including decreased range of motion and point tenderness, and therefore meets the criteria for “Whiplash Associated Disorder Grade II” (also known as “Wad Ii”) set out in the Société de l’assurance automobile du Québec’s Task Force Report titled Redefining “Whiplash” and its Management, published in the April 15, 1995 edition of Spine;
   2. may include a complaint of non-radicular back symptoms associatedwith the Wad Ii; and
   3. is of sufficient severity that it requires the physical treatment interventions provided under this Guideline.

   An insured person who has sustained an impairment covered by this Guideline may also exhibit other common symptoms including: shoulder pain; referred arm pain (not from radiculopathy); dizziness; tinnitus; headache; difficulties with hearing and memory acuity; dysphagia; and temporomandibular joint pain. These additional symptoms would not exclude an impairment from this Guideline unless they require separate treatment from that provided under this Guideline.

3. Impairments that do not come within this Guideline

   An insured person’s impairment does not come within this Guideline if:

   1. The insured person’s impairment comes within the Wad I Preapproved Framework Guideline; or
   2. despite being assessed withing 28 days of the injury as having an injury described in Section 2, there are specific pre-existing occupational, functional or medical circumstances of the insured person that:
      1. significantly distinguish the insured person’s needs from the needs of other persons with similar impairments that come within this Guideline; and
      2. constitute compelling reasons why other proposed goods or services are preferable to those provided for under this Guideline.

4. Responsibilities of the initiating health practitioner

   The initiating health practitioner:

   1. is a health practitioner as defined by the Sabs who is authorized by law to treat the injury and has the ability to deliver all the goods/ services provided for in this Guideline;
   2. initiates treatment by submitting a Treatment Confirmation Form;
   3. provides a significant portion of the goods and services;
   4. may co-ordinate the provision of any goods and services covered by this Guideline and provided to the insured person by another regulated health professional, or directly supervise the provision of any additional goods and services to the insured person by an unregulated provider, where such treatment is needed by the insured person and is provided under this Guideline;
   5. shall have overall accountability for:
      1. assessing the need for and implementing goods and services such that the treatment elements in this Guideline are addressed as required and appropriate;
      2. ensuring the use of the most appropriate provider(s);
      3. documenting, communicating and billing as required by the Guideline;
      4. reporting outcomes to the insured person and insurer when treatment is inappropriate or ceases;
      5. participating in monitoring the effectiveness of the Guideline by fully completing the forms required by this Guideline; and
   6. determines the presence of any barriers which might delay recovery.

5. Providers covered by this Guideline

   The initiating health practitioner may include treatment by other providers in the Treatment Confirmation Form. This Guideline covers treatment by the initiating health practitioner and other providers, including unregulated providers where the treatment is directly supervised by a regulated health professional and is not a controlled act as defined by the Regulated Health Professions Act, 1991.

6. Switching initiating health practitioners

   If for any reason an insured person receiving treatment under this Guideline wishes to change his or her initiating health practitioner, the insured person and the new practitioner must inform the insurer through submission of a new Treatment Confirmation Form. In the new Treatment Confirmation Form, the insured person will give consent for the insurer to contact the original initiating health practitioner to determine what goods and services referred to in the original Treatment Confirmation Form have not been provided and the insurer will then fill in this amount in Part 9 of the form.

7. Treatment/assessments covered by this Guideline

   There will typically be one Treatment Confirmation Form which will be prepared by the initiating health practitioner.

   The treatment commences with the insured person’s first assessment by the initiating health practitioner. If treatment is initiated during the first 7 days following an accident, the duration of treatment will be 7 weeks. If treatment is initiated between 8 and 28 days following an accident, the duration of treatment will be 6 weeks.

   In the first week of treatment under the Guideline emphasis will be on assessment, education, reassurance and pain control and may include physician referral for prescription medication.

   The course of treatment may involve the following: reassurance, pain control, mobilization/manipulation, education, and activation (normal daily activities and active exercise).

   Education materials titled Getting the Facts About Whiplash, developed by regulated health professionals and the insurance industry, will be provided by the initiating health practitioner to all insured persons covered by this Guideline. This material may be found in Appendix E.

   The importance of positive messaging is recognized, and it is therefore expected that, at the initial visit and assessment and at subsequent visits, the insured person will be provided with:

   • education regarding “hurt does not equal harm;” and
   • reassurance that most people with Wad Ii and associated complaints of back symptoms recover within the first few weeks following the injury.

   Emphasis will be on the insured person’s responsibility for his or her recovery and the return to normal activities. The frequency of goods and services will diminish as the insured person progresses.

   If prescription medication is needed, a referral to a physician or nurse practitioner is necessary. Regulated health professionals may provide general information on the use of over-the-counter medications, but insured persons should be encouraged to consult a physician, nurse practitioner, or pharmacist on the specific use of these medications.

   Not all individuals with Wad Ii will require any or all of the goods and services included within this Guideline. The provider is responsible for determining the need for goods and services and whether the prescribed goods and services are producing significant progress toward recovery and should be continued under the Guideline. If the insured person has recovered before the completion of the treatment outlined in this Guideline, the insured person should be discharged from treatment.

8. Ancillary goods or services (Sabs s. 37.2)

   With prior insurer approval, certain ancillary goods or services may be proposed by the initiating health practitioner or family physician or insurer and carried out by a regulated health professional while the insured person continues to be covered by this Guideline. Prior approval from the insurer must be requested on a separate Treatment Confirmation Form. If the insurer does not give its approval within 5 business days, as outlined in the Sabs, that dispute may proceed to a Designated Assessment Centre for review. If the insurer fails to respond within the prescribed time period, the insurer must pay for the ancillary goods or services delivered under the Treatment Confirmation Form.

   For the purposes of this Guideline, ancillary goods or services which may be requested are an Activities of Normal Life Intervention (Anli), in order to identify and evaluate areas of functional difficulty or barriers to recovery due to the Wad Ii or back pain and to implement strategies for recovery. An Anli is not an assessment for the purpose of determining eligibility for housekeeping, attendant care or weekly benefits.

   The insured person must be present during the Anli (excluding reporting back).

   The Anli will take no more than 4 hours for the regulated health professional to complete, including preparation of the report (not includingtravel time/mileage).

   The regulated health professional must report back to the initiating health practitioner (where not the same person), insurer, insured person and family physician and comment on assessment findings, treatment interventions provided and recommendations.

   If, upon completion of the Anli, the regulated health professional identifies a need for further goods and services, she or he will complete a Treatment Plan and submit the request to the insurer.

9. Supplementary goods and/or services

   Without prior insurer approval, the initiating health practitioner may provide supplementary goods and/or services where they are needed for the management of one or more minor soft tissue injury/ies which:

   1. resulted from the same accident as the Wad Ii and requires treatment;
   2. is/are unrelated to the Wad Ii with or without back pain and its common symptoms;
   3. is/are not of sufficient severity to exclude the insured person’s impairment under this Guideline; and
   4. can be fully treated by the provider within the time frame of this Guideline.

   The impairment addressed and the services and/or goods must be specified by the initiating health practitioner on a Treatment Confirmation Form and the maximum total cost payable by the insurer for the goods and services provided under this section is $160.

10. Treatment deemed insufficient or inappropriate

    If the initiating health practitioner determines that treatment under this Guideline is no longer appropriate or sufficient for the insured person because the insured person is not making sufficient progress towards recovery, the initiating health practitioner will advise the insurer and the insured person (using the Wad I/Wad Ii Paf Discharge & Status Report form). The initiating health practitioner’s options then are the following:

    1. submit a Treatment Plan; or
    2. submit a Treatment Plan and make a referral to the insured person’s physician or another regulated health professional; or
    3. with insurer agreement, extend treatment under this Guideline for no more than 4 visits and 2 weeks beyond end of regular duration and at a price determined by the insurer and initiating health practitioner; or
    4. make a referral to the insured person’s physician or another regulated health professional.

    While treatment/referral decisions are being considered, the initiating health practitioner may:

    5. stop the treatment where it is not appropriate (or no longer needed);

    or

    6. continue treatment until a decision is reached on the action recommended by the initiating health practitioner.

    The Sabs provides that an insurer may reject a Treatment Plan that provides for goods and services to be received during any period in which the insured person is receiving goods and services under this Guideline and the insurer’s determination is not subject to dispute.

    However, the Sabs also provides that nothing prevents an insured person, while receiving goods and services under this Guideline, from submitting a Treatment Plan applicable to a period other than the period covered by this Guideline. If the insurer does not approve the Treatment Plan within the time period prescribed in the Sabs, that dispute may proceed to a Designated Assessment Centre for review.

11. Completing the treatment under this Guideline

    Upon completion of treatment, the initiating health practitioner will prepare a final report which will indicate the insured person’s outcomes from treatment.

    If an insured person elects to end treatment under this Guideline, he or she may only resume treatment at a later date if this will not extend the overall duration and expenditure limits of the Guideline.

    When an insured person is receiving treatment under the Guideline, the termination options are:

    1. Resolved and discharged within 6 weeks (Wad I/Wad Ii Paf Discharge & Status Report completed by initiating health practitioner);
    2. Condition improving, but improvement is insufficient at the end of the treatment (further or other treatment beyond the Guideline is dependent upon the Treatment Plan application and approval process of the Sabs);
    3. Not resolving (decision made as soon as possible) and the initiating health practitioner completes the Wad I/Wad Ii Paf Discharge & Status Report form and discharges the insured person;
    4. Insured person unreasonably fails to participate in treatment. This may be inferred from the insured person’s non-attendance at 2consecutive appointments or 4 appointments overall without a reasonable explanation. Provider required to complete Wad I/ Wad Ii Paf Discharge & Status Report form; or
    5. Insured person withdraws consent.

12. Reporting requirement for initiating health practitioners

    The initiating health practitioner is expected to establish clinical outcome goals for the insured person receiving treatment under this Guideline that are consistent with the goals of return to normal activities in the early stages of recovery and reducing the risk of chronicity. Throughout the course of treatment the initiating health practitioner is expected to use appropriate measures/indicators to evaluate progress towards achievement of these goals.

    For the purposes of documenting the impact of the Guidelines on an insured person whose impairment comes within this Guideline and contributing to the overall evaluation of the Guideline, the initiating health practitioner must complete the Wad I/Wad Ii Paf Discharge & Status Report form.

13. Provider reimbursement

    An initiating health practitioner who provides a good and/or service to an insured person in accordance with the Guideline must submit a Treatment Confirmation Form not later than 5 business days after first seeing the insured person.

    The Sabs provides that the insurer must confirm to the initiating health practitioner no later than 5 business days after receiving the Treatment Confirmation Form, that the auto insurance policy referenced in the Treatment Confirmation Form was in force on the date of the accident.

    Payment to the initiating health practitioner may be denied due to coverage issues or exclusions set out in the Sabs.

    The insurer’s payment will follow receipt of a completed Treatment Confirmation Form, Application for Accident Benefits and Auto Insurance Standard Invoice, Version C. The insurer is not obliged to make payment until after the insurer has received an Application for Accident Benefits.

    In the case of the final invoice, the insurer’s payment will follow receipt of a Wadi/Wad Ii Paf Discharge & Status Report and Auto Insurance Standard Invoice, Version C.

    Where an x-ray service is provided to an insured person whose impairment comes within this Guideline by a chiropractor who is an initiating health practitioner, that service is payable without insurer approval and subject to the reimbursement schedule outlined in Appendix D to this Guideline.

14. Content of appendices

    Appendix A sets out the payment schedule in chart form.

    Appendix B sets out an overview of the expected course of treatment for an insured person whose impairment comes within this Guideline. Providers will individualize these treatment directives for the needs of each insured person.

    Appendix C sets out what goods/services an insurer is not obliged to fund pursuant to this Guideline for an insured person whose impairment comes within this Guideline.

    Appendix D outlines the payment schedule for x-rays provided pursuant to this Guideline for an insured person whose impairment comes within this Guideline. Any other x-ray service is subject to insurer approval.

    Appendix E contains the educational brochure titled Getting the Facts About Whiplash.

Appendix A - Wad Ii Payment Schedule

Health care providers are entitled to the following reimbursement for treatment of an insured person whose impairment comes within this Guideline. Fees are payable where the insured person has received any treatment in that week including where treatment has been discontinued.

Appendix B - Wad Ii Course of treatment

Appendix C - Goods and services not covered in the Guideline

An Insurer is not obliged to pay pursuant to this Guideline for the following goods/services rendered to an insured person with an impairment that comes within this Guideline:

• Cervical pillows;
• Advice supporting inactivity or bedrest;
• Injections of anaesthetics, sterile water or steroids to the neck;
• Soft collar for more than 2 days;
• Spray and stretch; and
• Magnetic necklaces.

Note: Adjunct passive modalities (transcutaneous electrical nerve stimulation, ultrasound, massage, heat/cold application, short term bedrest) are included in the funding where part of strategy promoting activation and return to mobility.

Appendix D - Payment Schedule for X-Rays

X-ray services for an insured person with an impairment that comes within this Guideline are payable under the following circumstances:

• X-rays listed below do not require insurer approval, but fees may not exceed those listed in table below. Any other x-rays require insurer/ DAC approval.
• No other comparable x-rays have been taken by another health practitioner or facility since the accident.
• Any available funding from Ohip or collateral insurance is utilized before the insurer is billed.
• The insured person displays one or more of the following characteristics:
• Suspicion of bony injury;
• Suspicion of degenerative changes, instability, or other conditions of sufficient severity that counter indications to one or more interventions must be ruled out;
• Suspicion of rheumatoid arthritis;
• Suspicion of osteoporosis; or
• History of cancer.

Appendix E - Getting the Facts about Whiplash

Getting the facts about Whiplash: Grades I and II

People injured in car accidents sometimes experience a strain of the neck muscles and surrounding soft tissue, known commonly as whiplash.

This injury often occurs when a vehicle is hit from the rear or the side, causing a sharp and sudden movement of the head and neck. Whiplash may result in tender muscles (Grade I) or limited neck movement (Grade II). This type of injury is usually temporary and most people who experience it make a complete recovery. If you have suffered a whiplash injury, knowing more about the condition can help you participate in your own recovery. This brochure summarizes current scientific research related to Grade I and II whiplash injuries.

Understanding Whiplash

• Most whiplash injuries are not serious and heal fully.
• Signs of serious neck injury, such as fracture, are usually evident in early assessments. Health care professionals trained to treat whiplash are alert for these signs.
• Pain, stiffness and other symptoms of Grades I or II whiplash typically start within the first 2 days after the accident. A later onset of symptoms does not indicate a more serious injury.
• Many people experience no disruption to their normal activities after a whiplash injury. Those who do usually improve after a few days or weeks and return safely to their daily activities.
• Just as the soreness and stiffness of a sprained ankle may linger, a neck strain can also feel achy, stiff or tender for days or weeks. While some patients get better quickly, symptoms can persist over a longer period of time. For most cases of Grades I and II whiplash, these symptoms gradually decrease with a return to activity.

Daily Activity and Whiplash

• Continuing normal activities is very important to recovery.
• Resting for more than a day or two usually does not help the injury and may instead prolong pain and disability. For whiplash injuries, it appears that “rest makes rusty.”
• Injured muscles can get stiff and weak when they’re not used. This can add to pain and can delay recovery.
• A return to normal activity may be assisted by active treatment and exercises.
• Cervical collars, or “neck braces,” prevent motion and may add to stiffness and pain. These devices are generally not recommended, as they have shown little or no benefit.
• Returning to activity maintains the health of soft-tissues and keeps them flexible - speeding recovery. Physical exercise also releases body chemicals that help to reduce pain in a natural way.
• To prevent development of chronic pain, it is important to start moving as soon as possible.

Tips For Return To Activity

• Avoid sitting in one position for long periods.
• Periodically stand and stretch.
• Sit at your workstation so that the upper part of your arm rests close to your body, and your back and feet are well supported.
• Adjust the seat when driving so that your elbows and knees are loosely bent.
• When shopping or carrying items, use a cart or hold things close to the body for support.
• Avoid contact sports or strenuous exercise for the first few weeks to prevent further injury. Ask your health professional about other sporting or recreational activities.
• Make your sleeping bed comfortable. The pillow should be adjusted to support the neck at a comfortable height.

Treating Whiplash

• Research indicates that successful whiplash treatment requires patient cooperation and active efforts to resume daily activity.
• A treating health care professional will assess your whiplash injuries, and discuss options for treatment and control of pain.
• Although prescription medications are usually unnecessary, temporary use of mild over-the-counter medication may be suggested, in addition to ice or heat.
• Your treating health care professional may recommend appropriate physical treatment.

Avoiding Chronic Pain

• Some whiplash sufferers are reluctant to return to activity, fearing it will make the injury worse. Pain or tenderness may cause them to overestimate the extent of physical damage.
• If your health professional suggests a return to activity, accept the advice and act on it.
• Stay connected with family, friends and co-workers. Social withdrawal can contribute to depression and the development of chronic pain.
• If you are discouraged or depressed about your recovery, talk to your health professional.
• Focus on getting on with your life, rather than on the injury!

Preventing Another Whiplash Injury

• Properly adjusting the height of your car seat head restraint (head rest) will help prevent whiplash injury in an accident. In an ideal adjustment, the top of the head should be in line with the top of the head restraint and there should be no more than 2 to 5 cm between the back of the head and the head restraint.

This brochure provides general information about whiplash injuries. It does not replace advice from a qualified health care professional who can properly assess a whiplash injury and recommend treatment.

The information highlights the latest available scientific research on whiplash and has been endorsed by the following groups:

Insurance Bureau of Canada (Ibc)
Ontario Chiropractic Association (Oca)
Ontario Massage Therapist Association (Omta)
Ontario Physiotherapy Association (Opa)
Ontario Society of Occupational Therapists (Osot)

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Ministry of the Attorney General

Rules Of Civil Procedure
Rules 53.09(1) and (2), as amended by section 16 of O.Reg.288/99, section 2 of O.Reg. 488/99 and section 4 of O.Reg.263/03

Calculation Of Awards For Future Pecuniary Damages: Trials Commencing After January 1, 2004

The Ministry of the Attorney General publishes discount and gross up rates annually to facilitate the calculation of future pecuniary damage awards. Note: Effective January 17, 2003 the Bank of Canada changed the identifier numbers of the Bonds’ Series set out in the rule that are used to establish the discount and gross up rates. Series #B113911 changed to Series #V121808 and Series #B113867 changed to Series #V121758.

For trials commencing after January 1, 2004, the following rates apply:

Discount Rate

The discount rate to be used in determining future pecuniary damages for the 15 year period following the start of the trial is 2.25%

The rate for any later period covered by the award is 2.5%

Gross Up Rate

The gross up rate to be used to determine future inflation for the first 15 year period following the start of the trial is 3%

The rate for any later period covered by the award is 2.75%

Dated 17 September, 2003

Director
Corporate Planning Branch
Court Services Division
Ministry of the Attorney General
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