MCI Medical Clinics Inc.


MCI Medical Assessments Home Page Why Choose MCI Medical Assessments? Our Services Make a Referral Contact Us Clinic Locations (PDF Map)	Paper Reviews Subsection 42(3) of the SABS provides that Insurer Examinations undertaken for five specified purposes are to be done only as “paper reviews,” unless the person(s) conducting the examination determines that the insured person should be in attendance and personally examined (see s. 42(7)). MCI Medical Assessments currently offers the following “Paper Review” type of Insurer Examinations: An examination to assist the Insurer in determining whether the insured person has an impairment to which a Pre-approved Framework Guideline applies. To make a referral for an examination to assist with a determination as to whether an insured person has an impairment to which a Pre-approved Framework Guideline applies, click HERE. An examination to assist the Insurer in determining whether to pay for goods or services contemplated by a treatment plan if the goods and services are substantially similar to goods or services the insurer previously refused to pay for. To make a referral for an examination to assist with a determination as to whether to pay for goods and services contemplated by a Treatment Plan which have previously been denied, click HERE. An examination to assist the Insurer in determining whether to pay for an assessment or examination which has been proposed under section 24. To make a referral for an examination to assist with a determination as to whether to pay for a proposed section 24 assessment or examination, click HERE. The other specified Insurer Examinations that must take place as “Paper Reviews” unless the person(s) conducting the examination determines otherwise, are: an examination for the purposes of section 37.2 to assist the insurer in determining whether to pay for ancillary goods and services claimed by the insured person Presently, the only ancillary goods and services that may be claimed by an insured person is an Activities of Normal Life Intervention; the so-called “ANLI.” In our view, ANLI’s are generally beneficial for the insured person, and should ordinarily be approved by the Insurer. Furthermore, since ANLI’s are to be provided for no more than 4 hours of regulated health professional time (not including travel time) we believe that it is not economically advisable to challenge an application for an ANLI. If the Pre-approved Framework Guidelines are modified to provide for a greater range of ancillary goods and services, we will consider offering examinations for the purposes of section 37.2. and, an examination for the purposes of section 40 that relates only to the issue of whether the insured person has a brain impairment that results in a score of 9 or less on the Glasgow Coma Scale. As a determination as to whether an insured person has a brain impairment that results in GCS of 9 or less involves a determination as to when it is reasonable to take that GCS score, we feel that issue is best left to a neurosurgical specialist to answer.

Paper Reviews

Subsection 42(3) of the SABS provides that Insurer Examinations undertaken for five specified purposes are to be done only as “paper reviews,” unless the person(s) conducting the examination determines that the insured person should be in attendance and personally examined (see s. 42(7)).

MCI Medical Assessments currently offers the following “Paper Review” type of Insurer Examinations:

An examination to assist the Insurer in determining whether the insured person has an impairment to which a Pre-approved Framework Guideline applies.
To make a referral for an examination to assist with a determination as to whether an insured person has an impairment to which a Pre-approved Framework Guideline applies, click HERE.
An examination to assist the Insurer in determining whether to pay for goods or services contemplated by a treatment plan if the goods and services are substantially similar to goods or services the insurer previously refused to pay for.
To make a referral for an examination to assist with a determination as to whether to pay for goods and services contemplated by a Treatment Plan which have previously been denied, click HERE.
An examination to assist the Insurer in determining whether to pay for an assessment or examination which has been proposed under section 24.
To make a referral for an examination to assist with a determination as to whether to pay for a proposed section 24 assessment or examination, click HERE.

The other specified Insurer Examinations that must take place as “Paper Reviews” unless the person(s) conducting the examination determines otherwise, are:

an examination for the purposes of section 37.2 to assist the insurer in determining whether to pay for ancillary goods and services claimed by the insured person

Presently, the only ancillary goods and services that may be claimed by an insured person is an Activities of Normal Life Intervention; the so-called “ANLI.” In our view, ANLI’s are generally beneficial for the insured person, and should ordinarily be approved by the Insurer.

Furthermore, since ANLI’s are to be provided for no more than 4 hours of regulated health professional time (not including travel time) we believe that it is not economically advisable to challenge an application for an ANLI. If the Pre-approved Framework Guidelines are modified to provide for a greater range of ancillary goods and services, we will consider offering examinations for the purposes of section 37.2.
and,
an examination for the purposes of section 40 that relates only to the issue of whether the insured person has a brain impairment that results in a score of 9 or less on the Glasgow Coma Scale.
As a determination as to whether an insured person has a brain impairment that results in GCS of 9 or less involves a determination as to when it is reasonable to take that GCS score, we feel that issue is best left to a neurosurgical specialist to answer.