FSCO temporarily suspends HCAI at request of insurers

Financial Services Commission of Ontario (FSCO) has temporarily suspended the Health Claims for Auto Insurance Guideline (HCAI) at the request of the Insurance Bureau of Canada (IBC).

In a letter to the Ontario insurance regulator dated Mar. 10, 2008, IBC recommended the suspension of the operations of HCAI by the close of the business day on Mar. 12.

IBC’s letter confirmed many Ontario insurers were experiencing serious disruptions in their claims adjustment process as a result of technical problems encountered by HCAI.

HCAI, which employs new technology that cost insurers up to Cdn$20 million to build, was designed to represent a significant upgrade over the standardized, paper-based, medical-rehab insurance system implemented in 2001.

All health care practitioners were required by Ontario law to submit claims to insurers through HCAI’s electronic claims-processing system.

“Most users are confronting persistent and pervasive difficulties in accessing and using the system, while a minority is having relatively few issues,” IBC president and CEO Mark Yakabuski wrote in a letter to Bob Christie, FSCO’s CEO and superintendent of financial services.

“Based on information we have obtained from Ontario auto insurers and other users, IBC is concerned that HCAI is impeding normal claims adjustment and might have implications for the provision of care to injury claimants.”

In order to protect the interests of consumers, providers, facilities and insurers — and to enable HCAI Processing to focus on resolving these difficulties without undue delay — FSCO temporarily suspended operation of the HCAI guideline “until further notice.”

“The future operation of HCAI will be reviewed in consultation with insurers, providers and other stakeholders,” Christie noted in the bulletin. •