Ontario Ministry of Health and Long-Term Care

The Ontario Health Insurance Plan (OHIP) pays for almost all Hospital Emergency Room visits, and subsequent care, whether people have a Health Card or not. In cases where insurance is involved, these costs incurred are supposed to be paid by the insurer – for example, in a car accident, a victim may be rushed to a hospital – no one wants to have to haggle with an insurer at a time like that, even assuming you could reach an authorized person.

Insurance companies are obligated to pay those costs back to OHIP – subrogation is the term used to describe the legal mechanism.

Historically, subrogation cases were paper-based, often involved legal work and trials, considerable medical research and documentation, much contact and correspondence detail, and long time durations. This made organization, process and progress monitoring, and collection difficult.

Created a documentation repository and a case management and workflow management system to manage the files. The system encompasses digital file intake, file routing (dealing with specialization, management requirements, etc.) scheduling, correspondence, timelines and problem escalation. The system increased the monies collected, reduced the case durations and allowed management to assess performance based on collections, time parameters, activity levels, and other performance criteria such as contact frequency. The system increased the groups' revenue, increased per-case average collections, reduced case durations and increased the number of cases completed per member.

This project won the government IT manager involved the Canada Computing IT Manager of the Year Award in 2005.