Personal Injury Protection Plan Initial Package

Similar documents
VWA expectations for the delivery of osteopathic services to injured workers

General Information: (Circle One) (Circle One) Primary Insured's Information Skip if you are primary

Automobile Injury Compensation Appeal Commission

POLICY NUMBER: POL 26

International Emergency and Expatriate Dental Program Instructions For Dentists

By the August 15, 2013 letter, Bike Winnipeg is once again applying to be a party (intervener) to this GRA proceeding.

Basic Extras Cover. Effective 1 April 2017 v.2

Chapter 18 Section 2. EXPIRED - Department Of Defense (DoD) Cancer Prevention And Treatment Clinical Trials Demonstration

International Emergency and Expatriate Dental Program

Pro Active Physical Therapy & Sports Medicine

Winnipeg Regional Health Authority / Oral Health Program

Exhibit 2 RFQ Engagement Letter

Thank you for choosing Swedish Pediatric Therapy Services. We look forward to serving you and your child.

FITNESS REIMBURSEMENT

Billing WorkSafeBC for

Carter Physiotherapy, PLLC Patient Contact Information

YOUR GUIDE TO PATIENT SUPPORT SERVICES

General Terms and Conditions

Healthy Michigan Dental Plan Handbook

Medical gap arrangements - practitioner application

Neuroscience Seminar

CHIROPRACTIC NEW PATIENT FORM REASON FOR VISIT

Autism Funding Programs

Health Net Health Plan of Oregon, Inc. Well Net Supplemental Benefit Schedule CAM /09

Rehabilitation Programs

What to Expect When You Visit. The First Visit. Follow Up Visits. Laboratory Tests

Silver Extras Set Benefits

MENTOR PROMISE AND MENTOR PROMISE ENHANCED PROTECTION PLAN

$250 (Deductible does not apply to Tier 1 and Tier 2) $500 (Deductible does not apply to Tier 1 and Tier 2)

Massage Client Intake Form

PSYCHOLOGIST-PATIENT SERVICES

General Terms and Conditions

INDEPENDENT EDUCATIONAL EVALUATIONS

PATIENT CARE PROGRAM

Physiotherapy Tender Questions and Answers

SEEDS OF HOPE FAMILY CHIROPRACTIC HEALTH HISTORY

MENTORPROMISE AND MENTORPROMISE ENHANCED PROTECTION PLAN

Automobile Injury Appeal Commission Province of Saskatchewan. L.V., Appellant. and. Saskatchewan Government Insurance, Respondent

Dental plan. Help reduce the cost of protecting your family s teeth. Whether NHS or Private, there s a Boots Plan for you!

Corporate Policies. Corporate Billing and Collection Policy Section:

CHIROPRACTIC NEW PATIENT FORM REASON FOR VISIT

Extras Cover Special Options

Type A - Preventive 100% 80% Type B - Basic Restorative 80% 60% Type C - Major Restorative 50% 40% Deductible 3 Individual $50 $50 Family $150 $150

The Third-Party Reimbursement Process for Orthotics

International Emergency Dental Program Claim Form and Instructions for Members

About this consent form

Planning for a time when you cannot make decisions for yourself

GST/HST Technical Information Bulletin

Frequently Asked Questions

Description of. International SOS Services. Medical and Security Assistance

Dental Insurance. Eligibility

Health and Wellness Alberta Health Care Insurance Plan Statistical Supplement 2006/2007

KING COUNTY SUPERIOR COURT, WASHINGTON STATE CAUSE NO SEA

Medical Conditions and Driver Licensing Requirements

PATIENT ENTRANCE FORM

Margery E. Yuill Cancer Centre Patient Guide for Cancer Care

Welcome to. Active Health Chiropractic

EUTF and HSTA VB Retirees Group Number 2601 Dental Plan Benefits

RATE AND BILLING OPTIONS - Please check one: Please select the type of coverage you would like. Enclose a check for the rate selected and mail it with

PATIENT INFORMATION. Address City State Zip. Home Phone Work Phone Cell Phone Is it okay to contact you at work? Yes No. SSN - - DOB Age

New Patient Intake Form

Informed Consent for MINDFULNESS BASED Cognitive Therapy

New patients approved for the Novo Nordisk PAP may only be eligible for insulin vials. For a full list of available products, please visit:

Register now for your merseyflow discount

Dr. Anita Kieswetter BSc, ND Waterloo Naturopathic Clinic 22 McDougall Rd Waterloo, ON N2L 2W5 Tel: (519)

MetLife Dental Insurance Plan Summary. In-Network % of Negotiated Fee * % of R&C Fee 100% 100% 80% 80% 50% 50%

The BacktoBetter process

This section includes billing guidelines and treatment information for alternative care providers including:

COMPLETE THIS PAGE FOR CHILDREN 4-8 YEARS OF AGE ASTHMA EAR INFECTIONS SORE THROAT BED WETTING HEADACHES UPSET STOMACH

OUTPATIENT SERVICES PSYCHOLOGICAL SERVICES CONTRACT

ADVOCATE PARTICIPANT KIT 2018

*FEEL FREE TO ASK YOUR LASER THERAPIST THE TOTAL COST OF YOUR TREATMENT PRIOR TO INITIATION.

International Emergency and Expatriate Dental Program Claim Form and Instructions for Members

Dr. Mark VanOtterloo DAOM - Licensed Acupuncturist

Type A - Preventive 100% 100% Type B - Basic Restorative 50% 50% Type C - Major Restorative 0% 0% Deductible 3 Individual $50 $50 Family $150 $150

WELCOME TO SOULSTICE WELLNESS CENTRE

DATE: Dear Mr./Mrs./Ms., location.

Submission to the State Insurance Regulatory Authority on WorkCover (Psychology and Counselling Fees) order 2018

Choice, Service, Savings. To help you enroll, the following pages outline your company's dental plan and address any questions you may have.

CONTINUUM CHIROPRACTIC ADULT HEALTH HISTORY FORM

Physical Evidence Chiropractic 7035 Beracasa Way, Suite 103 Boca Raton Florida, Phone# (561) Fax# (561)

Communication Access Services. Vendor Policy Manual

Drug Prior Authorization Form Alertec (modafinil)

RATE AND BILLING OPTIONS - Please check one: Please select the type of coverage you would like. Enclose a check for the rate selected and mail it with

Personal Information. Reason for Seeking Care. What is your reason for seeking care at Strive Chiropractic?

Your guide to Bupa Premier Network SECI Operatives Scheme. Effective from 1 September 2008

Sincerely, Dr. Justin & Woodbury Spine Staff

HEALTH RECORD REASON FOR THIS VISIT ABOUT YOU ABOUT YOUR SPOUSE HEALTH HABITS EXPERIENCE WITH CHIROPRACTIC

BRENT BELVIN, M.D. NAME: SEX: M F (circle one) DATE OF BIRTH: ADDRESS: CITY: STATE: ZIP:

SOUTHSIDE COMMUNITY ACUPUNCTURE, LLC. Financial Policies

Chances are, a rheumatologist

Register now for your merseyflow discount

Welcome to Delta Dental.

In-Network % of Negotiated Fee * % of Negotiated Fee * 100% 80% 50%

ADVOCATE PARTICIPANT KIT 2017

[CORRECTED COPY] CHAPTER 115

107 If I have the proofs DTA wanted, should I still ask for a hearing?

Transcription:

Personal Injury Protection Plan Initial Package This letter acknowledges that a bodily injury claim under the Personal Injury Protection Plan (PIPP) with Manitoba Public Insurance has been opened as a result of a motor vehicle accident. You are entitled to be reimbursed for most medical, personal, travel and parking expenses that you may incur when seeking treatment for your accident related injuries. To receive prompt reimbursement, please follow these steps: 1. If you are claiming reimbursement for medicine and/or other claim related expenses, fill out Your Medical and Personal Expenses. (see the form for more instructions) 2. If you are claiming travel and parking, fill out Your Travel and Parking Expenses. (see the form for more instructions) 3. Then submit the completed forms -- with legible copies of your original paid receipts. Please note that receipts will not be returned. We suggest that you keep your original paid receipts for your own records. After 60 days we destroy paper receipts and retain only an electronic copy. PIPP covers expenses that result from your motor vehicle accident related injuries. Taxi fares may be considered, but only when they are deemed medically necessary. Before taking a taxi, contact one of our Benefit Administrators for pre-approval. If you plan to see a physiotherapist, athletic therapist or a chiropractor, simply book an appointment so they can determine your treatment requirements. We have established agreements with each of the applicable associations for medically required treatment of injuries sustained in a motor vehicle accident as follows: Chiropractic Physiotherapy Athletic Therapy Please contact our office, or your treatment provider, in regards to how many treatments you are entitled to for each modality of treatment that are mentioned above. The treatment provider may submit medical information for our review to consider further treatment if medically required. Injury Claims Management 234 Donald Street Box 6300 Winnipeg, MB R3C 4A4 Inside Winnipeg Telephone: (204) 985-7200 Outside Winnipeg Call Toll Free: 1-866-254-7639 Facsimile: (204) 954-5332 Toll Free Facsimile: 1-877-318-5727 www.mpi.mb.ca

You will find information about whiplash and how we protect your privacy enclosed with this letter for your review. If you have any questions, please contact the Benefit Administration Unit from 7:30 a.m. to 5:00 p.m. Monday to Friday. Benefit Administration In Winnipeg: (204) 985-7200 Toll Free: 1-866-254-7639 Enclosures

Good news about whiplash! Although it may take some time, most people recover fully. We cover care from the following providers: Medical Doctor Chiropractor Physiotherapist Athletic Therapist Note: You do not need a referral from your doctor to see a chiropractor, physiotherapist, or athletic therapist. Together with Chiropractors, Physiotherapists and Athletic Therapists, we ve developed guidelines for treating whiplash. At the start of any treatment, ask your health care provider how these guidelines apply to you. What to expect should you require treatment Your health care provider should outline the treatment that is best for you. Generally, improvement should come quickly. If you think you re not improving quickly enough, discuss this with your health care provider. How do I know if I m recovering as I should? Ask yourself these questions: Do I understand my condition? Am I feeling better now than I did when I started treatment? Have treatment goals and milestones been discussed with me? Has my treatment plan changed to reflect my progress? Have I stopped taking medicines which I started because of my injury? Have self management measures such as exercises been discussed with me? If you answered no to any of these questions, talk with your health care provider to better understand your condition and recovery. Remember, you and your healthcare provider are on the same team, working towards the same goal: your recovery. Your Case Manager s role is to make sure you understand and receive the benefits to which you are entitled.

Personal Injury Protection Plan Frequently Asked Questions: What is the Injury Claims Management contact information? Mailing Address Manitoba Public Insurance Injury Claims Management P.O. Box 6300 Winnipeg, MB R3C 4A4 Telephone/Facsimile Winnipeg Telephone: 204-985-7200 Toll Free Telephone: 1-866-254-7639 Winnipeg Facsimile: 204-954-5332 Toll Free Facsimile: 1-877-318-5727 I received an ambulance invoice, what do I do? Forward the invoice to Manitoba Public Insurance and indicate your injury claim number. Manitoba Public Insurance will pay the ambulance charges directly to the provider. I am off work, what do I do? Beginning on the eighth day following the incident, you may be entitled to Income Replacement. Please contact our office to discuss this benefit. Do I get a settlement for my pain and suffering? There are no lawsuits or cash settlements for pain and suffering in Manitoba. Under the Personal Injury Protection Plan (PIPP), there is no provision to seek compensation through the courts for injuries sustained in a motor vehicle accident in Manitoba. Instead, specific benefits and payments are available to individuals who qualify, regardless of fault. My doctor prescribed massage therapy, is it covered? Massage therapy is only covered when done by a physician, chiropractor, nurse practitioner, physiotherapist or athletic therapist. I have property damage, what do I do? Please contact your physical damage adjuster if there are damages or expenses for items such as: Car seats Bicycles Motorcycle helmets Rental vehicles Cell phones Non-prescription sunglasses

Personal Injury Protection Plan Frequently Asked Questions (continued): What medications are covered? PIPP covers medication expenses related to the injury resulting from the accident. However, certain medications are not covered or are only covered within a set timeframe. Naturopathy is a form of alternative medicine. PIPP does not cover any expenses for any products or services that are deemed naturopathic or homeopathic, such as: o Epsom salts o Vitamins o Traumeel gel Should your doctor prescribe opioid medications, there is an Opioid Policy that must be followed. Please contact our office if you are taking opioid medications such as: o Tylenol #3 o Fentanyl o Oxycodone o Tramadol Please ensure to submit a copy of the Pharmacare receipt for reimbursement of your prescription medications, and a copy of the store receipt for your eligible over-the-counter medications.