Regulation - LGIC
Amendments to regulations under the Insurance Act based on Ontario Auto Insurance Anti-Fraud Task Force recommendations
Regulation Number(s):
Ontario Regulation 34/10 (Statutory Accident Benefits Schedule – Effective September 1, 2010)
Ontario Regulation 7/00 (Unfair or Deceptive Acts or Practices)
Ontario Regulation 283/95 (Disputes Between Insurers)
Ontario Regulation 7/00 (Unfair or Deceptive Acts or Practices)
Ontario Regulation 283/95 (Disputes Between Insurers)
Instrument Type:
Regulation - LGIC
Bill or Act:
Insurance Act
Summary of Decision:
Amendments to Ontario Regulation 34/10 (Statutory Accident Benefits Schedule - Effective September 1, 2010), Ontario Regulation 283/95 (Disputes between Insurers) and Ontario Regulation 7/00 (Unfair or Deceptive Acts or Practices) have been approved. The amendments are based on certain recommendations made by the Auto Insurance Anti-Fraud Task Force (see below).
Further Information:
Auto Insurance Anti-Fraud Task Force Final Report
Ontario Regulation 34/10 (Statutory Accident Benefits Schedule – Effective September 1, 2010)
Ontario Regulation 7/00 (Unfair or Deceptive Acts or Practices)
Ontario Regulation 283/95 (Disputes Between Insurers)
Ontario Regulation 14/13 amending Ontario Regulation 34/10
Ontario Regulation 15/30 amending Ontario Regulation 7/00
Ontario Regulation 16/13 amending Ontario Regulation 283/95
Auto Insurance Anti-Fraud Task Force Final Report
Proposal Number:
13-MOF006
Posting Date:
January 9, 2013
Summary of Proposal:
The Ontario Auto Insurance Anti-Fraud Task Force was created to determine the scope and nature of auto insurance fraud in Ontario and develop anti-fraud recommendations. The Task Force Steering Committee's Final Report contains many recommendations, some of which can be introduced by amending existing regulations.
Amendments to Ontario Regulation 34/10 (Statutory Accident Benefits Schedule - Effective September 1, 2010), Ontario Regulation 283/95 (Disputes Between Insurers) and Ontario Regulation 7/00 (Unfair or Deceptive Acts or Practices) are being considered. The amendments are based on the following recommendations from the Task Force Steering Committee's Final Report:
Recommendation 4(c): The government should reduce uncertainty and delay for those who have legitimate auto insurance claims by moving aggressively to amend the Statutory Accident Benefits Schedule to make it clear that insurers are required to provide claimants with a full explanation when refusing to pay for treatment, assessment or other benefits.
Recommendation 17: The government should amend rules so that claimants play a more active role in helping to detect and prevent fraud. Specifically it should:
- require claimants to confirm attendance at treatment facilities and receipt of goods and services billed to insurers; and
- require insurers to itemize the list of invoices they have received when they provide a benefit statement to a claimant every two months.
Recommendation 18: Insurers should have the ability to examine a claimant under oath, where this is necessary to determine which insurer should be responsible for coverage, without prejudice to the right for an examination under oath that now exists.
Recommendation 28: The government should add the following to the list of activities described as unfair or deceptive acts or practices subject to sanctions under the Statutory Accident Benefit Schedule:
- charging insurers much more for goods or services than the ordinary retail price; and
- requesting a claimant to sign a blank form.
Recommendation 36: The government should clarify the exemption for lawyers and paralegals in the unfair or deceptive acts or practices regulation so that it applies to lawyers and paralegals only when they are acting in a legal capacity.
Amendments to Ontario Regulation 34/10 (Statutory Accident Benefits Schedule - Effective September 1, 2010), Ontario Regulation 283/95 (Disputes Between Insurers) and Ontario Regulation 7/00 (Unfair or Deceptive Acts or Practices) are being considered. The amendments are based on the following recommendations from the Task Force Steering Committee's Final Report:
Recommendation 4(c): The government should reduce uncertainty and delay for those who have legitimate auto insurance claims by moving aggressively to amend the Statutory Accident Benefits Schedule to make it clear that insurers are required to provide claimants with a full explanation when refusing to pay for treatment, assessment or other benefits.
Recommendation 17: The government should amend rules so that claimants play a more active role in helping to detect and prevent fraud. Specifically it should:
- require claimants to confirm attendance at treatment facilities and receipt of goods and services billed to insurers; and
- require insurers to itemize the list of invoices they have received when they provide a benefit statement to a claimant every two months.
Recommendation 18: Insurers should have the ability to examine a claimant under oath, where this is necessary to determine which insurer should be responsible for coverage, without prejudice to the right for an examination under oath that now exists.
Recommendation 28: The government should add the following to the list of activities described as unfair or deceptive acts or practices subject to sanctions under the Statutory Accident Benefit Schedule:
- charging insurers much more for goods or services than the ordinary retail price; and
- requesting a claimant to sign a blank form.
Recommendation 36: The government should clarify the exemption for lawyers and paralegals in the unfair or deceptive acts or practices regulation so that it applies to lawyers and paralegals only when they are acting in a legal capacity.
Contact Address:
Cathryn MacFarlane
Senior Manager
Industrial and Financial Policy Branch
Ministry of Finance
Frost Building North, 4th Floor
95 Grosvenor Street
Toronto, ON M7A 1Z1
Senior Manager
Industrial and Financial Policy Branch
Ministry of Finance
Frost Building North, 4th Floor
95 Grosvenor Street
Toronto, ON M7A 1Z1
Effective Date:
June 1, 2013
Decision:
Approved