Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
With all the legislative changes in the very contentious auto insurance industry, it can be hard to stay current. Case law, reports, position papers, and of course the high-profile circulations of the Toronto Star. But sometimes what goes unnoticed is the work of the Colleges or Professional Associations that spend time and resources trying to provide guidance and support to those of us working in this everchanging area of practice.
In the world of Occupational Therapy, one recent document has been posted by the College of Occupational Therapists of Ontario that thoroughly speaks to the challenges, college expectations and tug-of-war that OT’s experience in this difficult sector. This circulation, entitled “Guideline for Working with Third Party Payers” is a must-read for OT’s in the insurance industry, and serves as a useful tool for anyone (clients, lawyers, insurers, other professionals) who retain, work with, or otherwise engage with an OT for assessment or treatment services. The guideline (https://www.coto.org/news/new-guidelines-for-working-with-third-party-payers) covers all important aspects of practice in the world of third party work, and includes the following summarized sections:
Providing Ethical and Competent Client Care reviews the Ethical responsibilities of the OT to be transparent, fair and impartial.
Defining Your Role and Setting Expectations with Stakeholders addresses how important it is for OT’s to follow the Standards for OT Assessment and to understand the limits to their own competencies when accepting referrals.
Consent and Personal Health Information discusses how to manage difficult consent situations, for example if another person indicates they got “consent” for the OT, or if a client later withdraws consent during an assessment or treatment. Importantly, it also talks to an OT’s requirement to get new consent when presented with a request to review or comment on new information that was not received when initial consent was obtained. The submission of reports in draft form to third parties is also covered.
Managing Records and Reports reminds OT’s of their responsibility with record keeping, privacy legislation, and of course the client’s right to access their records.
Managing Conflicts of Interest considers the challenges in this high-stakes industry that is fraught with important funding decisions, conflicting agendas, and relationships that can be formed with clients, insurers, lawyers and the like. This section deals with these competing interests, conflicting standards and opinions, personal conflicts between oneself and third parties, companies or even other professionals. Also covered in this section is referrals received from friends or family members, being requested to observe an independent medical exam, and treating clients that are related. OT’s are reminded that practicing within a conflict of interest (perceived, real or implied) is considered professional misconduct.
Managing Professional Boundaries are addressed and this section highlights different types of potential boundary crossings with clients and referral sources / payers. It speaks to monetary relationships and financial / gift incentives as a boundary crossing and one that can jeopardize client outcomes and breach professional boundaries.
Use of Title is discussed as a reminder to the different titles an OT may have in providing service, and how to be clear about their role at all times.
Independent Practice reviews the nature of being an “independent contractor or provider” and the resources available to set up, and run, an independent operation.
Lastly, the guideline covers the expectations for providing services to clients who Live Outside of Ontario and reminds OT’s that the client’s location, not theirs, is the jurisdictional boundary and practicing outside of Ontario is not permitted unless the OT has a license in that location as well.
Overall, this document is a useful tool and hard reminder to OT’s of their obligations and expectations as licensed professionals in Ontario. It may also prove helpful for other stakeholders to review, such that they too understand the rules and boundaries on OT’s so that they can be mindful of these in their working relationships with us.