FSCO Bulletin Clarifies that Mileage Costs of Health Care Providers in Auto Insurance is not Covered in SABS

The December 1, 2014 Bulletin of the Superintendent of the Financial Services of Ontario (FSCO) communicated a number of regulatory amendments affecting health care providers that resulted from the licensure of health care professionals within the auto insurance sector. View Bulletin details.

In this same Bulletin, FSCO drew attention to payment of mileage costs of health care providers in the auto system. The Bulletin left the impression that insurers were not required to pay for mileage costs of health care providers, despite the fact that this has been common practice for many years. OSOT and other professional associations took issue with this stance and through the Coalition of Professional Associations in Auto Insurance (of which OSOT is a member) challenged FSCO for clarification of the intent and rationale for this communiqué.

Background for FSCO Communication re Mileage costs
There have been a number of inquiries over the past 9 months at FSCO about the payment of mileage. The calls were from providers, insurers and regulators.

Coalition Positions and Concerns: 
  1. The over 25-year history of payment of mileage; this is a standard business practice in North America, and insurers all get paid mileage for using their own vehicles when conducting business
  2. Mileage is neither an overhead nor administrative expense, and should be not expressed as such 
  3. The insurer practice of denial of both travel time and mileage 
  4. How mileage is akin to paying other disbursements such as parking, airfare etc 
  5. Mileage does not in any way have the effect of increasing our hourly rate, as per the PSG; it simply covers our “operating vehicle” expenses 
  6. How FSCO now has a fiduciary responsibility to us, as their licensees, to consult with us whenever there is a situation which will negatively impact us (this did not occur prior to the release of the Mileage Bulletin) 
  7. How non-payment of mileage will impact the seriously injured patients and rural clients, and/or have the effect of increasing travel time (e.g. if we don’t use our personal vehicles, we could take a bus to our clients which would double the travel time, theoretically)
Outcome and Implications for Occupational Therapists
  1. Mileage for providers is NOT covered in the SABS and never was. Though insurers have paid this expense, the SABS has never provided for this. The Statutory Accident Benefits Schedule (O.Reg. 34/10, s. 15 (2)) reads:

Despite subsection (1), the insurer is not liable to pay medical benefits,
  
(a)    for goods or services that are experimental in nature; 
(b)    for expenses related to goods and services described in subsection (1) rendered to an insured person that exceed the maximum rate or amount of expenses established under the Guidelines, other than for expenses related to the services described in clause (1) (g); or
(c)    for transportation expenses other than authorized transportation expenses.

In fact, when treating providers charge mileage, it is being deducted from the claimant’s $50,000 which is a concern of the MOF. This is not the case for IE examiners asthe cost of IEs are not taken from the person’s benefits.

2.    Travel time IS a compensable amount and FSCO will provide an FAQ on their website to explain this to all stakeholders 

OSOT and the Coalition posited the following RECOMMENDATIONS to FSCO;
  1. Consult with OSOT (and other FSCO’s licensees) whenever proposed changes potentially could impact the profession’s practice 
  2. Consult with OSOT around the language expressing the full payment of travel time before it is entered into the FSCO FAQ’s 
  3. Circulate an additional bulletin that defines an overhead and administrative expense (e.g., items not related to the direct provision of patient care) 
  4. Adapt the Regulation such that mileage is a paid expense in the SABS for non-MIG clients. 
  5. Arrange a second meeting in early 2015 to address mileage.

OSOT will continue to seek clarification and attention to the reasonable compensation of health care providers.