General Guideline #4 - Ensuring Neutrality of the Designated Assessment Centre System

Statement of Intent

Designated Assessment Centres (DACs) must not only be neutral, they must also be perceived to be neutral. This Guideline is intended to promote the neutrality of the DAC system by fine-tuning some of the current practices.

NOTE THAT ALL DACS ARE EXPECTED TO FOLLOW THIS AND ALL OTHER DAC GUIDELINES. FAILURE TO DO SO WILL BE CONSIDERED NON-COMPLIANCE ON THE PART OF THE DAC.

A. Post-DAC Treatment and Examinations

The current conflict of interest guidelines prevent health practitioners who have provided treatment or conducted insurer examinations from performing DAC assessments on a particular claimant, unless both parties agree otherwise. This guideline deals with DAC assessors providing treatment, conducting medical-legal assessments or Insurer Examinations (on behalf of either party) following a DAC assessment.

In order to maintain objectivity and a neutral position once a DAC assessment is completed, the DAC assessor(s) are not permitted to provide treatment (except as provided in Section 54 of the Statutory Accident Benefits Schedule) or conduct a medical-legal assessment for either claimant or insurer. If the matter is not resolved after the DAC assessment, and the matter continues to arbitration or court, the DAC assessor may have to testify. This assessor must remain and appear to remain neutral. This objective cannot be met if the assessor has provided/performed post-DAC treatment, a medical-legal assessment or an Insurer Examination at the request of one of the parties. Please note this applies to all post-DAC medical-legal assessments whether the request is to conduct a paper review and/or an actual examination. The DAC is, however, permitted to conduct a further DAC assessment of the claimant.

B. Addenda to DAC Reports

The Minister's Committee has heard from DACs that they are receiving additional material from a party following the assessment, with a request for an additional report.

The parties are required to provide all necessary information to the DACs prior to the assessment. There may be instances where the DAC has been informed that test results or other materials are outstanding at the date of the assessment. Under these circumstances, the DAC must notify both parties that there is material pending and that a report cannot be issued until the information is received and reviewed.

Once a DAC report has been completed, DACs may subsequently provide an addendum to both parties, containing a clarification of recommendations or corrections to errors that appear in the report. Only in situations where the corrected errors impact the outcome of the report can the report be altered and an addendum issued to both parties.

If there is new information and the parties agree that the review of the new material may alter the DAC's opinion, then a new DAC assessment should be arranged, rather than one party requesting an "updated" report from the DAC.

Where the parties disagree with either the outcome of the DAC or that any new information will have an impact on the original DAC findings, either party may choose to apply for mediation with the Dispute Resolution Group of the Financial Services Commission of Ontario.

C. Communications with Parties

Verbal

Except during the DAC assessment itself (when the claimant is present for and involved in an examination), there should be no one-sided verbal communication between the DAC and either of the parties unless the DAC confirms the details of the discussion in writing and copied to the other party. This includes all telephone communications before the assessment to set up the appointment, verbal reminders to the parties to provide necessary documentation, etc. All other questions or concerns that are posed to a DAC, by either party, should be in writing.

Written

When a DAC responds to written correspondence, the response must be written and copied to both parties. If a party corresponds with the DAC, and the other side has not received a copy of the correspondence, the DAC must copy both the original letter, and their response, to the other party. This includes the covering letters from either the insurer or the claimant and their representatives. The DAC should not provide any type of report, verbal or written, to one side or the other, in advance of the final written report. The completed and signed OCF-11 (Referral and Summary Report) may be sent to both parties in advance of the final report, if necessary.

D. Reports

The DAC Guidelines require that a final, written report be produced at the end of an assessment. No partial reports are permitted. That is, if there are a number of parts to an assessment plan, and for some reason all scheduled parts have yet to be completed, no final written report can be produced. Under these circumstances, the DAC must notify both parties, in writing, the reasons why the assessment plan was not completed, and that no final report will be produced until the entire assessment plan is completed.

We encourage feedback regarding this Guideline. Please let us know your experiences, and provide your suggestions, so that we may continue to improve the DAC system. Comments can be directed to:

 

The Minister's Committee on the Designated Assessment Centre System
c/o The Accident Benefits Analysis Unit
Financial Services Commission of Ontario
5160 Yonge Street
Toronto ON M2N 6L9

GG-4
March, 1999

 
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