Expert Assessor Network: Proposed Model to Replace The DAC System for Ontario Auto BI Claims: FSCO

March 19, 2004, Ontario — The Financial Service Commission of Ontario has released a consultation paper (16 pages) asking for feedback. Submissions are due by April 14.

“The Designated Assessment Centre System (DAC System) provides neutral assessments that assist in the resolution of disputes regarding entitlement to certain accident benefits without the need for mediation or arbitration. In practice, this unique model has become very expensive to use, while only demonstrating marginal success. The System has evolved to become highly adversarial, costly, time consuming, and complex, with limited acceptance by stakeholders.

In no other jurisdiction has the value of an independent health care assessment been more eroded by complexity and the adjudicative role assessors must play.

By using discrete assessments for each benefit entitlement issue, this disputefocused model creates distinctions in the overall management of impairments that would not otherwise occur and perpetuates over-assessment. The number of separate DAC assessments, combined with Statutory Accident Benefits Schedule (SABS) Section 24 and 42 assessments, often places a significant
assessment burden on an injured person. These factors have limited the potential capacity of the DAC System to appropriately respond to and help address the rehabilitation and disability needs of injured persons.

As part of the auto insurance reforms, the government will be replacing the DAC System with a network of medical expert assessors that will provide customerfocused assessments across the province. These new assessments will respond to questions posed by insurers or insured persons and their primary practitioner, focusing on a broad range of medical, rehabilitation and disability issues. The network will deliver prompt, standardized, cost-effective assessments with conclusions and recommendations based on scientific evidence and best practices.

To reinforce the efficacy of these new medical expert assessments and reduce the burden of assessment on injured persons, this new expert assessor network will replace the need for Section 24 and 42 assessments. Additional assessments may be accessed outside the network in certain circumstances, such as when the injured person has filed for arbitration.”

The Consultation Paper is available at the FSCO site as a pdf