This process applies to Medical Nurse Case Management.
Before reviewing the Accident Benefits Process, visit web please make sure to review Best Practices for Discharge and Beyond.
STEP 1: REQUEST FROM LAWYER / CLIENT
A) Complete the Excel Care Referral Form
Download Excel Care Referral Form
B) Compose a letter for Excel Care outlining your request, with a copy going to the client
C) Permission to Disclose Health Information (OCF-5) Form: completed and signed by the client
D) Excel Care Consent Form: to be signed by the client allowing us to communicate with their, Doctor(s), Insurance, and any extended health carriers
E) Medical Brief: In order to get a full background we request a medical brief or any medical documentation that we can access to build a timeline of events
STEP 2: FINANCIAL APPROVAL
A) An introduction phone call will be made to the client to review request and to explain our services
B) A Treatment and Assessment Plan (OCF-18) will be prepared and reviewed with the client in person
C) Excel Care will contact the client to review the OCF-18. Once reviewed, we also ask for verbal permission and signatures of the OCF-18 form for submission. Excel Care will have the client sign and initial the OCF-18. A consent form will also be signed to allow Excel Care to share information with the Family Physician or Most Responsible Physician. Excel Care will then obtain their signature (Physician) agreeing to the projected treatment and assessment plan
D) Excel Care submits the OCF-18 to the Insurer
OUTCOME OF OCF-18 SUBMISSION
APPROVAL
- Excel Care proceeds with the Nursing Assessment: An assessment will be conducted to determine the level of care and/or the client’s rehabilitation needs. The Ontario College of Nurses Decision Tree will guide this Nursing Assessment
- Excel Care to prepare and submit Nursing Assessment report and recommendations to the Client, Insurer, and Legal Representative
- Excel Care builds and implements the Rehabilitation Team
DENIAL
Excel Care will contact the client’s Legal Representative and Client to communicate possible solutions, and to receive direction as to how to proceed.