In most personal injury cases there are three sources of fees.
OHIP – governed by the agreement for the provision of services with OHIP
Insurance – governed either by provincially regulated fee structures or as established in agreement with insurance providers
Patients – fees for services requested by patients not covered above
The key consideration is that the provision of non-OHIP funded services to patients must be fairly compensated.
In most cases, patient request for services will be protected by a way of an undertaking made by their lawyer. The provision of these services, while subject to guidelines established by the OMA (see omathirdpartyguide.pdf) and discipline by the College of Physicians and Surgeons, are primarily contractual.
When asked for records, provide a report or appear in Court, do not be afraid to confirm your fee requirements in advance.
From a net income perspective, hourly rates for fair fees can be relatively easily calculated. The OMA website gives two examples. However, fee rates can simply be set by agreement. Keep in mind that the patient will be seeking reimbursement from a third party. Ultimately the Court has authority to approve or disapprove of any agreement for fees.
See the document “Establishing An Hourly Rate” published by the Hamilton Academy of Medicine.
What this means is that while the patient is ultimately fully responsible for the fees for services provided, the patient will only be able to recover those fees from the third party if they are fair and withstand the scrutiny of the Court.
The Court establishes criteria for fair fees based primarily on three factors. Time and effort expended, results achieved – or was the time expended justified, and what, on the whole, is the industry standard.
Photocopies and staff time for record retrieval are governed by the same rules.
For non-OHIP or non-insured services, the lawyer will happily protect the account of the physician on behalf of the client. That means the Physician can look to the lawyer for payment. However, the patient is always paying the fee.
For reports and preparation keep track of time.
Fees will only be paid for necessary services provide. For example, the court will generally not pay for a review of notes and records if the only request made was for copies of notes and records.
Per Diem fees are entirely appropriate, particularly for Court appearances. Block fees should be avoided for preparation of records, reports, consultations or preparation for Court.
Some physicians see their involvement in the litigation process as an impediment to their practice. Taking a day away from patient care to sit in court, or to sit in court and not even be called to testify can be justifiably perceived as wasteful. However, so might a vacation. In the end, insurance and litigation is simply part of providing patients with appropriate care. While not compensated through OHIP, the compensation is appropriate and remunerative. The key to reimbursement is to have a clear understanding of what services are being provided and at what rate.
Documents & Guides:
- “Establishing An Hourly Rate” published by the Hamilton Academy of Medicine.
- “Guide to Fees for Uninsured Services – 2011” Hamilton Academy of Medicine
- “General & Family Practice – Common Family Practice Codes as of October 1, 2010” published by OMA.