highlights:
- Must arrange an assessment within 10 days of injury in order to access DTPR (see below)
- Direct billing will be arranged if injury qualifies for DTPR
- We do not sign agreements with insurers in order that we can ensure treatment is in your best interest
- No referral is necessary
- Treatment provider and location is legally your choice (not your insurers)
If you have been injured in a motor vehicle collision, whether it was your fault or not, you are entitled to accident benefits. You must do your best to access a primary care practitioner, such as a physical therapist, within 10 days of the collision. You do not need a physicians referral to access our care intially or in most instances to have your treatment covered by your automobile insurance benefits. If your insurer has suggested another facility, despite what you may have been told, it is important to know that the choice is yours. The claims process can be complicated and we are prepared to help you to navigate the various forms and procedures. Your injury is complicated enough.
Leading Edge will:
- Guide you through the process – you must complete form Ab-1 Notice of Loss and Proof of Claim Form, retain a copy for your records and send the original signed form(s) to the insurance company. If you are unable to send the form within the 10 day timeframe, submit it to your insurance company as soon as practical and explain the reason for the delay.
- Complete the remainder of the necessary paper work – form Ab-2
- Perform an initial assessment to determine your diagnosis and identify which funding exists for your injuries
- Set-up direct billing for those who fall within the minor injury parameters of the Diagnostic Treatment “Protocols” (DTPR)
If your injury qualifies for the Diagnostic and Treatment “Protocols” Regulation:
All clients who qualify, injuries classified as WAD I or II, can receive up to a maximum of 10 or 21 pre-authorized payments for treatment visits, depending on the type of injury. These treatments must be completed within 90 days of your collision.
What if I am still not better?
It is important to know that, should the number of treatment visits be insufficient to address the injury under the Diagnostic Treatment “Protocols”, clients can still claim treatment visits covered under other plans. For many clients coverage is available under extended health benefits (e.g., Blue Cross or similar employee benefit plans) or from the client’s automobile insurer under Section B of the Standard Automobile Policy (SPF No.1).
If your injury does not qualify for the “Protocols”:
You will receive treatment under Section B of your auto insurance. In this instance, you pay for your treatments, submit to any Extended Health Care Benefits (EHCB) 1st, and subsequently to your insurer any ammounts not covered by your EHCB. Injuries that DO NOT Qualify for “Protocols” include:
- WAD III – diagnosed by your Doctor or Physiotherapist (Neurological findings – numbness and neurological weakness)
- WAD IV – diagnosed by your Doctor or Physiotherapist (Fracture dislocation of the spine)
- Fractures of other body sites
- Dislocation of other body sites
Section B Limits:
The limit on your total medical coverage including physiotherapy under Section B is $50,000, however, your insurer may request a medical assessment once $600 of Section B benefits for physiotherapy has been reached.
If you have any questions regarding our service fees, processes or funding options, please do not hesitate to contact one of our locations.
