In the recent decision of Chaparina and State Farm,
(FSCO A14-007595, February 19, 2016), Arbitrator Sapin dismissed
the Applicant's claim for the cost of a number of OCF-18s
(Treatment and Assessment Plans) because the OCF-18s were not
signed either by her or by a regulated health professional, as
required by section 38(3) of the Statutory Accident Benefits
Subsection 38(3) of the Schedule requires that a
Treatment and Assessment Plan must be signed by the Insured person
unless the Insurer waives the requirement. In addition, the plan
must be completed and signed by a regulated health
Subsection 38(2) further states that an Insurer is not liable to
pay for medical or rehabilitation expenses incurred before the
Insured person submits a Treatment and Assessment Plan that
satisfies the requirements of ss. 38(3).
In this case, it was noted that none of the three OCF-18s in
dispute were signed by either Mrs. Chaparina or the chiropractor
who completed the OCF-18s. (Ms. Chaparina's evidence was
that she did not know anything about the OCF-18s, had not seen
them, did not go for the proposed treatment, and did not incur the
expenses described in the plans; however, she still claimed the
cost of same in the Hearing.)
Arbitrator Sapin noted that it did not matter that State Farm
had not previously advised Ms. Chaparina when the OCF-18's were
submitted that one of the reasons it was refusing to pay for them
was because they were not signed. Arbitrator Sapin noted that
while that "would have been helpful", it was not
necessary. Arbitrator Sapin concluded that the language of
section 38 is clear and straightforward:
"an Insurer is under no
obligation to pay for treatment outlined in a Treatment and
Assessment Plan that has not been signed by either the Insured
person or the health professional who prepared and submitted it on
As such, the Applicant's claim for the cost of the OCF-18s
Overall, the decision in Chaparina and State Farm
highlights the importance of ensuring that OCF-18s submitted are
signed by the Applicant and her health care provider. This
decision should be cited when reminding Applicants and treatment
providers of their obligations under the Schedule.
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