Accident Benefits Data & the HCAI system
Health Claims for Auto Insurance (HCAI) is an electronic system for transmitting Ontario Claim Forms (OCFs) between insurers and health care facilities in Ontario. An initiative of Ontario auto insurers, working closely with the Financial Services Commission of Ontario (FSCO), the Ontario Ministry of Finance, various medical rehabilitation provider associations and other stakeholders, HCAI aligns insurers and facilities on a common platform using common business rules and a common approach to education.
Motor Vehicle Accident
There is damage to the vehicle involved and a passenger is injured. The insurer is contacted, the accident benefits claim process begins and the injured passenger becomes an auto insurance claimant.
Health Care Treatment
The injured passenger (now an accident benefits claimant) visits a health care facility. A health care professional at the facility assesses the injuries received by the passenger as a result of the motor vehicle collision.
OCF Submitted to Insurer
The health care facility completes an OCF using the HCAI system, identifies the claimant's injuries, makes treatment services and/or goods recommendations, and then digitally submits the OCF to the insurer via HCAI.
Data is Exchanged
HCAI and FSCO exchange facility and service provider licence details so that, at the time the health care facility submits the OCF to the insurer, the HCAI system validates the facility's licence status.
Insurer Approves OCF
Upon receipt, the insurance adjuster reviews the health care facility's submitted OCF and provides an adjudication decision immediately available to the facility via HCAI.
Payment is Issued
Following adjudication, the insurer pays the health care facility with a valid service provider licence in good standing directly. Payment for treatment goods and/or services delivered by an unlicensed facility, or one whose licence is not in good standing, is issued directly to the claimant.
Anonymized accident benefit health claims data is supplied to Insurance Bureau of Canada (IBC) by HCAI. IBC interrogates the data to develop an enhanced understanding of the costs inherent in Ontario's auto insurance product.
Health Claims Database
car crash by Olivier Guin from the Noun Project; Health Team by Luis Prado from the Noun Project; computer user by Divya Kulshreshtha from the Noun Project; Secure Database by Leonardo Schneider from the Noun Project; warranty by Anton Noskov from the Noun Project; transaction by Creative Stall from the Noun Project; Database Transfer by Yamini Ahluwalia from the Noun Project