Seeking Single Sign-on

As insurers prepare to switch over to Ontario’s new Health Claims for Auto Insurance (HCAI) electronic claims processing system this month, independent adjusters have expressed concerns about technical aspects of the system — particularly with the absence of single sign-on access for independent adjusters.

The main role for adjusters will be to adjudicate forms in HCAI. And although there have been plenty of opportunities for adjusters to learn how to use the system — setting up organizations, setting up users and establishing manager roles in the system — independent adjusters are saying there may have been a lack of communication with them during the initial establishment of the program, which may have resulted in some potential difficulties for adjusters using the system.

“From our perspective, (I) just wish there was consultation with our industry, because we are such a huge part of the insurance industry,” Tammy Norn, the regional director of Ontario casualty at CGI, said. “The [Canadian Independent Adjusters’ Association] really should have had a seat at the table. A lot of the issues we are dealing with now could have been prevented.”

As of Feb. 1, 2008, health care providers and insurers in Ontario will be required to process medical/rehabilitation auto insurance claims electronically through HCAI. In addition to having a number of existing legislative and regulatory obligations to claimants, insurers are required under HCAI regulations developed by FSCO to participate in HCAI.

“As such, insurers were consulted extensively in the design of the HCAI system,” said Michael Smith, general manager of HCAI Processing, the central agency that oversees the HCAI process. “We believe that this consultation process produced very positive outcomes.” Some insurers process claims in-house, others outsource to independent adjusters and still others use a combination of the two. HCAI was created with all claims-handling methods in mind and offers insurers the flexibility to a ccommodate these different ar rangements. Since HCAI’s development, the Insurance Bureau of Canada (IBC) has worked closely with independent adjusters to ensure they are trained and ready to use the system, Smith says. Users will be required to log into

the HCAI system and input the data for an accident benefit file electronically instead of manually on paper. In HCAI, forms assigned to a particular insurance company’s adjuster will be viewed online and printed off. Adjusters working for an insurance company will do their normal due diligence; when they make a decision regarding any aspect of a particular claim file, they will input that decision into HCAI. The system will then notify the health care provider about the insurance adjuster’s decision. Other processes in the auto insurance claims system — following up with a claimant and so forth — continue as usual.

However, it’s not quite so simple for independent adjusters. Although individual health care providers and insurance company adjusters need only a single sign-on to log into the HCAI system, independent adjusters will need to use a different sign-on for each and every insurer with which they do business. In short, an adjuster will have a unique username and password for every insurer with which they are working. This means an independent adjuster will log in and out of multiple user profiles on any given day in order to ensure that all files are being handled and processed. And due to strict timelines, it won’t be a matter of simply logging in once per insurer: it will mean multiple times per day, per insurer.

“We have to go in and check under every (insurance company),” said Franca Reale, the Ontario automobile manager of Cunningham Lindsey Canada. “So, log out, and log back in under the other insurance company, and log back out. We could potentially go in four and five times in a morning and four and five times in an afternoon just to be able to see all the insurance companies we are doing work for.”

Some wonder whether the HCAI system could be set up in such a way that independent adjusters could sign in with a unique username and password and then, once in the system, an adjuster could simply select the insurer for which they are authorized to do work and access the files that way.

“The system is not set up that way,” Norn said. “Obviously, any technical changes [to HCAI would not be] done on the fly, and it’s not something [HCAI is] looking at right away. But ideally, that’s how it would work from an independent adjuster’s perspective.”

Smith noted, however, that with regards to signing into the system, privacy is paramount.

“Insurers are obliged to protect the privacy of claimant information,” he said. “With HCAI, every effort has been made to ensure privacy. Having insurer-specific sign-ons for independent adjusters gives insurers an even greater degree of security and control in this respect. In the unlikely event of sign-on breach, a multi-insurer sign-on would have potentially exposed a number of insurers instead of just one.”

Independent adjusters have also expressed concerns over conflicts in policy. At the moment, regulations dictate that adjusters have a certain number of days — usually 10 business days — to respond to a treatment. Assessments, however, such as those found in OCF22s, are to be completed within three business days. In that time, an adjuster must determine whether or not an assessment is reasonable or necessary.

After reading and reviewing FSCO’s April 2007 bulletin, there does not appear to be any change in Sec. 68(8) of the regulations, Reale noted.

“When an independent adjuster receives a file from an insurer, we must notify all parties in writing that we are handling the file on behalf of the insurer,” she said. “By way of our Sec. 68 letter, all documents are to be re-directed to the particular independent adjuster, or the documents are not deemed received. The bulletin indicates HCAI can receive OCF forms in paper form. It is our understanding that if an independent adjuster provides proper notice under Sec. 68, HCAI would be obligated to provide the forms to the independent adjuster, not the insurer, or else the forms would not be deemed received. We are unsure how HCAI will be able to deal with this situation.”

In another situation, a form might end up in an “unmatched bucket” if HCAI cannot match a form with the corresponding adjuster, which means it’s not in the hands of the appropriate adjuster, but still deemed received by the system, Norn notes.

“So the problem there is [that the process] is in conflict with the current legislation,” Norn said. “It’s deemed received once it hits that unmatched bucket, but in all reality the adjuster might not get it for a day or two after that by the time they figure out whose [file] it is. By that time, the adjuster’s now got one day [to complete the file].”

But, Smith noted, the insurer is accountable if a SABS timeline is missed.

“The insurer has the flexibility to set up their organization in HCAI in a way that ensures forms are received by adjusters (independent or otherwise) in a timely manner,” he said. “It is possible, for example, for insurers to set up outside adjusters to receive forms directly, but that decision is up to the individual insurer.”

Despite these particular concerns on the part of independent adjusters, they are quick to point out the system is a very useful tool, not only to manage workflow, but to also keep track of what is being paid out on claims.

“It is a very user-friendly system, so adjusters will definitely adapt to the system very easily,” Norn noted. “Take the technical issues away, it’s a fantastic system … and I think the insurance industry as a whole will benefit from it — from the statistical data that can be gathered.”