Master Your Understanding of MVA/MVC Insurance Regulation in Alberta

Recently ignitephysio podcast hosts Andrew Koppejan & Maxi Miciak sat down with some key insiders (physiotherapists & insurance adjusters) across two podcast interviews (see here and here) to chat about MVA regulations in Alberta and common challenges they face when managing MVA patients.
In this article, we will cover the current Diagnostic & Treatment Protocols (DTPR), the history of these protocols, and their benefits for improving patient care. As well, we will review an important lifeline that therapists have to help them with more challenging patient cases that are not progressing as expected. This lifeline is the Injury Management Consultant (IMC) system that is available to therapists when treating patients who are under the DTPR protocols.
As physiotherapists we treat patients who have been in car accidents all the time, and not all practitioners are aware that the system in Alberta is unique and offers a number of advantages for improved patient care and improved efficiencies for therapists.
If you\’re new to practice in Alberta or new to practice as a physiotherapist, you probably have a lot of questions regarding the process involved in providing care to MVA patients. This series of articles was created to help you increase understanding and confidence in treating your patients.

Important Background Documents

It is important as a practicing clinician to review the relevant documentation when treating MVA patients. These are foundational documents to review:
Diagnostic & Treatment Protocols Regulations
Alberta Minor Injury Regulation
As well, clinical guidelines were developed by Dr. Larry Ohlhauser (Senior Medical Advisor to the Superintendent of Insurance) and his guide is a must-read for primary healthcare providers. You can access it here.

What is the DTPR?

The DTPR, which stands for Diagnostic & Treatment Protocols Regulation, is the legislation relating to the diagnosis and treatment of minor injuries from car accidents in Alberta. It was brought into law in 2004 and was most recently updated in 2014. There is a related insurance document called the Minor Injury Regulation, which outlines determination of injury, recoverable damages, and the use of a certified examiner for minor injuries. Both pieces of legislation changed the way that motor vehicle accidents were handled in the province.

The Purpose & Benefits of the DTPR

The DTPR was introduced to \”ensure that people who are injured in collisions receive fast and effective treatment to support their recovery.\” (1, Ohlhauser).
It aimed to ensure that 1) patients didn\’t have to wait for approval from their insurance provider before receiving treatment, 2) patients would be receiving care based on the best available evidence and 3) an effective process was in place to treat people with minor injuries while giving a mechanism to review those cases that were not progressing as expected (1, Olhauser).

#1: Consistent Reporting

One of the benefits of the DTPR is improved communication between insurers and primary healthcare providers.
Simon Cooke, physiotherapist and member of the initial DTPR working group, highlights how important the improved communication is, “Consistent reporting did lots of things for all those involved. Everyone was speaking common languages. There wasn\’t a lot of deciphering that had to be done within reporting. Goal setting was a big part of this process moving forward, [meaning] that the patient or the injured person would be involved in the goal setting, the goals would be function-based and they would be measurable. That was a big driver for change there too.”

#2: Treatment Cost Containment

Prior to the DTPR, there were no parameters around the treatment costs associated with minor injury recovery from car accidents.
As Julie Chartrand, medical claims advisor with Peace Hills Insurance, highlights, \”pre-DTPR, thousands of dollars were being spent on treatment plans that basically had no end. There were therapies that were being provided that weren\’t necessarily evidence-based, more passive treatment than active treatment.\”
The development of this program helped to focus on identifying and delivering evidence-based, active treatment for patients and ensuring a common language was used between therapists and insurers.

#3: Limits on Injury Payouts for Minor Injuries

Prior to 2004, there was no limit to what patients could claim for pain and suffering payouts. With the introduction of the Minor Injury Regulation, the amount was limited to a total of up to approximately $5,000. Medical expenses are separate from this amount and Section B stipulates that medical expenses are limited to $50,000 within two years of the accident. This helped to reduce the costly involvement of lawyers in minor injury claims.
As Julie highlights, “The minor injury cap has obviously changed over the years with interest, but that is for settling claims for people who have been injured as a result of someone else. Under the Section B or the DTPR, there still isn\’t a cap but there are thresholds and limits when it comes to different types of therapy. Physiotherapy, occupational therapy, psychology have thresholds that can be met, chiropractic massage and acupuncture all have limits and those are specific limits.”

#4: A System for Treating and Billing of Minor Injuries

Prior to the DTPR, there was no specific system or process in place for addressing minor injury claims. The introduction of forms such as the AB-2, AB-3, AB-4, etc. were all a part of the DTPR legislation which aimed to streamline reporting and communication between healthcare providers and insurers.
The DTPR also gave physiotherapists an increased role as a primary healthcare provider to diagnose patients following car accidents. As Simon highlights, “It reduced visits from injured Albertans to primary care physicians because Albertans were encouraged to see physiotherapists and chiropractors first. It enabled physiotherapists and chiropractors to give diagnoses, which up until that point was not an option.”

#5: A Mechanism Was Provided for Addressing Challenging Cases

The DTPR also incorporated a novel approach to help clinicians address challenging patient cases. The introduction of the Injury Management Consultant (IMC) role, which could include physiotherapists, MDs, and chiropractors, to provide a second opinion to an existing MVA case.

The IMC: A Resource For Managing Challenging Patient Cases

The protocols outline the recommended treatments for strains, sprains, and whiplash associated disorder (WAD) related injuries. But, there are times when you may be unclear about the nature of the injury or are finding that the injury is not resolving appropriately. When you are facing one of those situations, you can refer your patient for a second opinion to an Injury Management Consultant (IMC).
“The ability of a healthcare provider to be able to ask for a second opinion very early on in the process, either to confirm a diagnosis or ask for help in how to manage a patient that\’s not getting better at the rate he\’d expect, that\’s embedded within the protocol,” explains Simon. “That is not necessarily something that\’s easily done with people that are outside the protocol or just your average everyday injured person that you\’re seeing.”
It\’s important to understand that an IMC is a resource to you as a treating clinician and they are not there to take over care. They can provide advice and a report on the patient\’s diagnosis and treatment and also recommend additional assessment or a multi-disciplinary assessment of the patient.
We have put together an article here that goes through the IMC process and we cover the following:

• When you can access an IMC consult
• Understanding the referral process
• Who can authorize an IMC
• How to work with adjusters regarding the IMC
• How to find an IMC

Timing of Injury Treatment and Claims Process

There is a beneficial flowchart available showing the guidelines outlined for primary healthcare providers. Here is a snapshot of the flowchart and the full chart can be accessed in the clinical guidelines document on page 6 (as identified by the page numbering at the bottom of each page) here.

Here is a summary of key dates: 

• Up to 10 days: Notice of claim filed by the patient; assessment by a primary healthcare provider (PT, chiro or MD)
• Up to 3 weeks: Identify any alerting factors and request an IMC
• Up to 12 weeks: PT is able to authorize an IMC assessment if still being actively treated under protocols; DTPR applies with up to 10 or 21 visits depending on the injury
• After 12 weeks or Completion of Authorized Treatments (10 or 21 depending on the injury): DTPR protocol ends and Section B Benefits from the Alberta Standard Automobile Policy apply

What is Included / Excluded in the DTPR

The protocols address three types of injuries: whiplash-associated disorders (WAD) and peripheral and other spinal sprains and strains, fractures, internal injury, neurological injury (central or peripheral), etc. were excluded from these protocols.

Conclusion

Whether you are a new grad or a seasoned clinician in Alberta, understanding the DTPR and the associated regulations for treating MVA patients is a must. It’s important to know the regulations and have them easily accessible. It is important to understand the IMC system which you can access when you need a confirmation of a diagnosis or recommendations regarding treatment planning for a challenging patient.
Next up we look into the IMC in more detail here as well as other common caseload management challenges that arise when treating MVA patients here.