If you’re a healthcare professional and one of your patients has been injured, your first priority is their healing and recovery. Insurance forms, requests for clinical notes and medical-legal reports can seem time-consuming and overwhelming.
Grosso Hooper Law is here to help. We have designed this page to answer your questions and direct you to crucial resources. No more hunting around for forms, codes and fees – it’s all here. If you have a question and you can’t find the answer on this page, please contact me – I can help you, and will also add the information here for future use.
Our legal team is dedicated to fighting for the rights of injured people. If you have a client who needs help with benefits or compensation, please refer them to Grosso Hooper Law. We work with healthcare professionals every day to help people rebuild their lives.
Yes. You must send the completed form to your patient’s insurance company within 21 days of the patient’s receipt of the form. If the Disability Certificate is delayed, your patient may not be entitled to certain benefits.
This depends on how familiar you are with your patient’s medical history. The form may take significantly longer to complete if you are not the patient’s regular treatment provider or you have only recently started providing treatment.
The patient’s auto insurer will pay your fee for filling out the Disability Certificate, which is a maximum of $63.72. Click here for other treatment and form-related fees.
Yes. The College of Physicians and Surgeons of Ontario (CPSO) regulations require you to respond to requests for reports ‘within 60 days, unless other arrangements are made.’ You should have permission from the patient to disclose their health information and have that information in front of you at the time of writing.
Most importantly, leave ample time to prepare your report. Good medical-legal reports help settle cases and improve your chances of not having to testify at trial.
The lawyer or other third party requesting the medical-legal report will pay your fee. CPSO guidelines allow healthcare professionals to request payment before releasing the report, but non-payment should not be used as an excuse to withhold the report.
The amount you charge for a medical-legal report is up to you, but should reflect the time it took to prepare the report. A good guideline is to charge the amount you would have billed for the same length of time seeing a patient. You may charge a premium if you have recognized expertise in your particular field.
Be aware that CPSO regulations state you should ‘not…charge excessive fees’. You are also not allowed to ask for payment up front if the patient needs the report to obtain ‘the necessities of life, including income and health care benefits.’
Yes. According to a 1992 decision of the Supreme Court of Canada, medical records must be made available to the patient or the patient’s legal representative upon request. Clinical notes must also be released in response to a subpoena, discovery request, court order or other legal process.
Again, the duty not to charge excessive fees and to produce notes in a timely manner applies.
Maybe, but the possibility of testifying should not prevent you from providing a report, as it is a legal requirement (see above). A well-written and detailed report, however, will lower your chances of having to testify.
If you are asked to go to court, you will be cross-examined about the content of your report, your medical opinion on the plaintiff’s injuries, the nature of your practice and the fees you charge, amongst other matters.
You should ask your patient to complete an OCF-5 Permission to Disclose Health Information Form
A lawyer may also send an authorization signed by the client.
This depends on the nature of the rebuttal and the complexity of the facts involved. However, rebuttals do need to be submitted by the following deadlines:
80 business days for rebuttals concerning Catastrophic Impairment designation, from the day the insurer provides notice to the insured.
40 business days for all other medical or rehabilitation goods and services, from the day the insurer provides notice to the insured.
No. There is no obligation to do anything other than submit the original Treatment Plan. However, if you think the treatment you requested was reasonable and necessary, a rebuttal is a good way of defending your position. It will also help your patient if the dispute over service provision goes to mediation or arbitration.
$450 if the rebuttal does not require any further assessment.
$775 if the rebuttal requires additional assessment by one or more professionals, none of whom are physicians.
$900 if the rebuttal requires additional assessment by one or more professionals, one (or more) of whom is a physician.