Regulation - LGIC
Ontario Regulation 34/10 Statutory Accident Benefits Schedule – Effective September 1, 2010
Regulation Number(s):
Ontario Regulation 34/10
Instrument Type:
Regulation - LGIC
Bill or Act:
Insurance Act
Summary of Decision:
The following changes from the current Schedule come into effect on September 1, 2010 • Capping medical/rehabilitation and assessment/examination expenses for minor injuries to $3,500. • Replacing the existing Pre-Approved Framework Guideline for Grade I and II Whiplash Associated Disorders with a new Minor Injury Guideline for accidents occurring on or after September 1, 2010. • Providing standard medical and rehabilitation coverage for non-catastrophic claims of $50,000, with optional coverage of $100,000 or $1,100,000. • Offering standard attendant care coverage for non-catastrophic claims of $36,000, with optional coverage of $72,000 or $1,072,000. • Supplying optional caregiver, housekeeping and home maintenance benefits for non-catastrophic claimants. • Capping each assessment to $2,000 – this applies for all assessments, whether they are requested by the claimant or insurer. • Providing payment for in-home assessments only to claimants who have sustained more than a minor injury. • Eliminating rebuttal examinations. • Offering $2,500 for accounting reports to support income replacement benefits claims. • Merging treatment plans and applications for approval of assessments or examinations into one process. • Providing adjusters with discretion in the use of insurer examinations. • Creating a definition for "incurred expense". • Simplifying and consolidating the rules that govern claims processing. • Eliminating a number of approved forms.
Further Information:
Insurance Act
Proposal Number:
10-MOF007
Posting Date:
March 22, 2010
Summary of Proposal:
The following changes from the current Schedule come into effect on September 1, 2010
• Capping medical/rehabilitation and assessment/examination expenses for minor injuries to $3,500.
• Replacing the existing Pre-Approved Framework Guideline for Grade I and II Whiplash Associated Disorders with a new Minor Injury Guideline for accidents occurring on or after September 1, 2010.
• Providing standard medical and rehabilitation coverage for non-catastrophic claims of $50,000, with optional coverage of $100,000 or $1,100,000.
• Offering standard attendant care coverage for non-catastrophic claims of $36,000, with optional coverage of $72,000 or $1,072,000.
• Supplying optional caregiver, housekeeping and home maintenance benefits for non-catastrophic claimants.
• Capping each assessment to $2,000 – this applies for all assessments, whether they are requested by the claimant or insurer.
• Providing payment for in-home assessments only to claimants who have sustained more than a minor injury.
• Eliminating rebuttal examinations.
• Offering $2,500 for accounting reports to support income replacement benefits claims.
• Merging treatment plans and applications for approval of assessments or examinations into one process.
• Providing adjusters with discretion in the use of insurer examinations.
• Creating a definition for "incurred expense".
• Simplifying and consolidating the rules that govern claims processing.
• Eliminating a number of approved forms.
• Capping medical/rehabilitation and assessment/examination expenses for minor injuries to $3,500.
• Replacing the existing Pre-Approved Framework Guideline for Grade I and II Whiplash Associated Disorders with a new Minor Injury Guideline for accidents occurring on or after September 1, 2010.
• Providing standard medical and rehabilitation coverage for non-catastrophic claims of $50,000, with optional coverage of $100,000 or $1,100,000.
• Offering standard attendant care coverage for non-catastrophic claims of $36,000, with optional coverage of $72,000 or $1,072,000.
• Supplying optional caregiver, housekeeping and home maintenance benefits for non-catastrophic claimants.
• Capping each assessment to $2,000 – this applies for all assessments, whether they are requested by the claimant or insurer.
• Providing payment for in-home assessments only to claimants who have sustained more than a minor injury.
• Eliminating rebuttal examinations.
• Offering $2,500 for accounting reports to support income replacement benefits claims.
• Merging treatment plans and applications for approval of assessments or examinations into one process.
• Providing adjusters with discretion in the use of insurer examinations.
• Creating a definition for "incurred expense".
• Simplifying and consolidating the rules that govern claims processing.
• Eliminating a number of approved forms.
Contact Address:
Cathryn MacFarlane
Senior Manager
Industrial and Financial Policy Branch
Ministry of Finance
95 Grosvenor Street, Frost North, 5th floor
Toronto ON M7A 1Z1
Senior Manager
Industrial and Financial Policy Branch
Ministry of Finance
95 Grosvenor Street, Frost North, 5th floor
Toronto ON M7A 1Z1
Effective Date:
September 1, 2010
Decision:
Approved