In Person Assessments
Instead of Paper Reviews
There will be situations where the Insurer will want to have a section 42 examination
conducted with the presence of the insured person when the SABS provides for
only a “Paper Review” unless the person(s) conducting the examination determines
otherwise. However, subsection 42(7) states that this determination must
be made, and that the insured person must be so notified within two business
days after the original notice (as described in subsection 42(4)) is given.
MCI Medical Assessments understands the problems raised by these statutory
requirements, and has put in place the means to allow an Insurer to meet its
objective of having an in person assessment conducted for the purposes of
assisting with a determination as to whether,
- an insured person has an impairment to which a Pre-approved Framework
Guideline applies,
or
- whether to pay for an assessment or examination which has been proposed under section 24.
while remaining compliant with the SABS and avoiding a violation of the regulation pertaining to “unfair and deceptive practices.”
(see s. 5, para. 5, O. Reg. 7/00). MCI will arrange for a telephone consultation between the insurer’s
representative and the person who is to conduct the examination for the purposes of discussing the advisability of changing the examination into an in person
examination of the insured person.
- To make a referral for an in person 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.
- To make a referral for an in person examination to assist with a determination as to whether to pay for a proposed section 24 assessment or examination, click HERE.
