Sample Auto Accident Treatment Plan Form

Claims Form Needs Automated Interface with Database System

May 1, 2009 Daniel Workman

Even a well-organized, clearly designed and automated insurance claim form can be further improved.

Treatment Plan OCF-18 refers to a standardized six-page form for insured persons injured in automobile accidents. The Ontario government has approved this document as part of an initiative to streamline the administration of auto insurance claims.

After the injured person first visits a clinic for a consultation, a health practitioner usually creates the treatment plan and submits the OCF-18 form to claimant's insurer. A health practitioner can be a dentist, doctor, nurse, optometrist or a paramedical professional like a chiropractor or psychologist.

OCF-18 Treatment Plan Form

The form has 14 subsections. The injured person fills out the first two parts titled applicant information and insurance company information, respectively.

The health practitioner then fills out all other subsections except:

• Part 14 which the injured applicant or a substitute decision maker signs; and
• Part 13 which records the insurance company’s decision to fully approve, partially approve or disapprove the applicant’s proposed treatment plan.

A claims adjuster must sign and date the Part 13 decision.

Saveable Portable Document Format

Currently OCF-18 is available on the Financial Services Commission of Ontario website as an Adobe PDF form. Unlike many PDF forms, OCF-18 saves information that users enter into the form’s fields provided the user has Adobe Acrobat version 7.0 or higher, which is available for free. The current six-page PDF stores a significant amount of auto accident details, and is a vast improvement over older forms that often have to be re-keyed or rewritten by hand. The form also is self-documented with essential instructions included within each subsections. A clearly written user manual with links to web update bulletins is also provided.

Below are business requirements to make this sample automobile accident treatment plan even more effective. The following analysis is based on discussions with systems solution architect Joe Mante, MSc of Mantrac Information Systems. Joe Mante has designed an automated system for OCF-21 Auto Insurance Standard Invoice.

Service Fee Calculations Key to OCF-18

Part 12 - Proposed Goods and Treatment Services presents a table of goods and services that one or more health practitioners propose for the claimant’s treatment plan. The subsection has 16 rows to list treatment products and services, each with nine columns of descriptive data including quantities and costs.

Currently, these details are keyed into data fields. Codes and corresponding descriptions for these treatment items should be automated into correlated drop-down lists. To reduce errors and save time, the calculations for total count and total cost of all items must be automated as well. Other calculations that can be programmed are subtotals, and the math that adds the General Sales Tax (GST) and Provincial Sales Tax (PST).

Other OCF-18 Form Improvements

None of the PDF form’s fields have validation capabilities. For example, one could enter 13 characters when the true business requirement for a Canadian postal code is a six-character alphanumeric field without an error message or even a warning. The current PDF form has no security features that prevent unauthorized users from entering data into data fields that only a regulated health professional should complete. Security features and built-in audit trails are essential to automated system processes.

Many fields in the form require a lot of manual key entry. The insurance company name and injury code fields are excellent candidates for drop-down lists. Information that is saved in the OCF-18 form will have to be re-keyed in related forms for the same claimant. Examples include OCF-13 Disability Certificate, OCF-21 Auto Insurance Standard Invoice and OCF-22 Application for Approval of an Assessment. The form can have more than one health care provider. This runs the risk that duplicate forms will be submitted to auto insurance companies.

Time-saving hyperlinks to the user manual and update bulletins website could be added to the top of the form.

Database Essential to Form Automation

The key here is to understand that the data drives the form as it is captured and stored from applicant, health practitioner and insurance company. The form is a well-designed vehicle that transports the data to all entities related to the pretreatment plan workflow.

But in all cases, data is the driver.

The injured claimant, health practitioner, auto insurance company and independent auditors can interface more effectively if that data is secured in central repository. Pertinent forms are generated, signed by appropriate parties and stored separately from the data.

The copyright of the article Sample Auto Accident Treatment Plan Form in Insurance is owned by Daniel Workman. Permission to republish Sample Auto Accident Treatment Plan Form in print or online must be granted by the author in writing.

Part 12 - Proposed Goods and Treatment Services

OCF-18 Sample Auto Accident Treatment Plan Form