Healthcare treatments can help us feel our best again, whether that is physio, a massage or health support.
These therapies can be especially helpful after a car accident. It is important to know that accident benefits, which include healthcare treatments, are mandatory car insurance requirements in most Canadian provinces.
Check your benefits again
Just like you would review your bills and payments for retail and leisure expenses, it’s also important to do your due diligence when insurance covers your injury treatment after an accident.
In health-care settings, you might not always be aware of the details being submitted to your insurance company. Beware of ill-intentioned health-care providers that submit details that don’t match your situation in order to collect extra money from your accident benefits coverage.
To help keep you informed, your insurer will send you regular statements, which outline your treatments and expenses incurred to date. Carefully reviewing the statements and asking questions about your treatment plan to both your healthcare provider and insurer can help ensure everything is accurate and appropriate.
In addition to carefully scrutinizing your statement, here are a few additional valuable tips to help protect yourself while getting the care you need.
1. Check that the treatment provider is qualified to diagnose or provide the treatment required. If you’re not sure, your insurance company can help clarify.
2. Ask to review your medical reports with the health-care provider to ensure the information is accurate before they submit to your insurance company.
3. Talk to your health-care provider about other options if your current treatment plan for your injuries isn’t helping you get better. It can be a warning sign if they won’t take your concerns seriously or won’t explain your treatment plan or expenses when asked.
4. Once you’ve received treatment, your insurance company will periodically send you a letter that confirms what payments have been made. If anything does not add up, contact your insurance provider.
5. Ensure you fully understand all documents prior to signing and never sign a blank form.
6. Take caution if a clinic or a provider is recommended to you by a body shop, tow company, lawyer, etc. You have the right to choose which healthcare facility you attend for your treatment.
7. Utilize an Aviva-approved healthcare clinic. These are healthcare clinics that are rigorously reviewed on a regular basis to ensure proper care is provided. Leveraging this network can help to safeguard you are receiving the care and treatment you need.
8. Be cautious of clinics and providers who offer items, such as discounts and/or gifts. These are offered to attract patients and while might sound enticing in the moment, may suggest unsavory and suspicious practices. Remember, good providers will focus on your care, follow the rules, and bill honestly to ensure your benefits are used appropriately to get you back in good health!
9. Lastly, make sure you fully understand your treatment plan – competent, skilled providers should take the time to view your treatment plan with you and address any questions or concerns you have.
Accident Benefits Misuse in the news
The Financial Services Regulatory Authority of Ontario (FSRA), an agency of the provincial government, which works to protect the rights of consumers in Ontario by promoting high standards of business conduct, financial safety, fairness and transparency within the financial services it regulates.
In November 2023, FSRA imposed a compliance order and administrative penalty of $15,000 against a registered psychologist who made misleading statements to insurance providers to obtain payment for services not rendered. He also submitted a treatment plan to an insurance company that indicated a claimant was employed prior to an accident when the claimant was retired.1
In another case, FSRA took action against a health and wellness clinic for unethical practices such as submitting fictitious invoices while the clinic was closed during the COVID19 lockdown. In this case, FSRA revoked the service provider license and imposed an administrative penalty of $200,000 against the clinic and imposed administrative penalties against two of its health care practitioners.2
Recently, FSRA imposed an administrative penalty on a personal support worker for billing for services that were not provided. As a result, FSRA issued a compliance order and imposed a $7,500 penalty.3
These cases show how FSRA helps protect consumers by taking action against unethical and improper practices.
We’re here to assist you
If you see suspicious expenses on your billing statement or have questions related to your account, please contact us. Our team can confirm any concerns directly with you.
