- Where Can I purchase Auto Insurance?
- I’m a high-risk driver. Can I be refused insurance coverage?
- I have medical benefits through a plan at work. Why do I need to purchase statutory accident benefits on my auto insurance policy?
- What is an excluded driver endorsement?
- What is a Consumer AutoPlus Report?
- My insurance agent/broker quoted a premium that I agreed to and I bought the policy. Now I got a notice that the premium is more than they quoted. Can they do this?
- Why does an insurance company charge me a penalty if I want to cancel the policy in the middle of the policy term?
- How does my company determine whether I am at fault in an accident?
- The police officer who attended the accident scene told me I was not at-fault in the accident. Why did my insurance company tell me that I am at-fault?
- Can Fault in an Auto Accident Be Shared?
- How Does an At-Fault Accident Affect Me?
- What can you do if you disagree with your insurance company’s assessment of fault?
- How does my insurance company decide whether to repair my vehicle or declare it a total loss?
- What is a preferred body shop? Do I have to take my car there to get fixed?
- If I’ve been injured in an automobile accident, what can I expect?
- What Can You Do If You and Your Insurance Company Disagree about Your Entitlement to Accident Benefits, or the Amount of Benefits?
- If I don't have my own auto insurance and am not listed on someone else's policy, but have been injured in an auto accident, where can I seek assistance?
- Why were there changes to the HCAI Guideline?
The changes were introduced to facilitate the timely processing of invoices by insurers and to address abusive invoicing practices by some health care providers in the auto insurance system, including:
- submitting invoices (OCF-21s) for non-approved goods and services for which prior approval is required;
- submitting multiple invoices for the same goods and services; and
- invoicing multiple times under the same treatment and assessment plan (in some cases daily).
- How do these changes address abusive invoicing practices by some health care providers in the auto insurance system?
Frequency of Invoicing
Some health care providers are inundating insurance companies with multiple invoices from the same treatment and assessment plan within a short time period. This overloads claims departments and makes it difficult for them to reconcile invoices to treatment and assessment plans.
Limiting the frequency of invoicing will give insurance companies more time to confirm that the goods and services claimed have been delivered to the claimant.
Completion of Invoices
Under the revised Guideline, invoices must clearly indicate the following (if applicable) in the “Other Information” section:
• If the insurance company is required to pay for goods and services as a result of failing to respond to an OCF-18 within 10 business days; and
• If there are items not requiring an OCF-18 (e.g. drugs prescribed by a regulated health professional or goods with a cost of $250 or less).
Invoices must also include complete and accurate information regarding other available insurance and health care coverage available to the claimant in the “Other Insurance” section.
This additional information will reduce the time insurance companies spend confirming their liability for payment of a claim.
Duplicate Invoices and Submitting Invoices For Non-Approved Goods and Services
Health care providers that deliberately or repeatedly submit duplicate invoices for non-approved goods and services may have their access to HCAI suspended or revoked by HCAI Processing.
- Does the revised guideline mean that health care providers can only invoice insurance companies only once per month?
No. A health care provider may submit more than one invoice per month, but can’t invoice for goods or services rendered under any particular treatment and assessment plan more than once every 30 days. For a plan that covers a longer period of time, a health care provider may invoice an insurance company for that plan 30 days after the previous invoice was submitted in respect of that plan.
- Why did FSCO decide to limit the frequency of invoicing? Were health care professionals consulted on this?
Yes. Before issuing the revised Guideline, FSCO received input from representatives of health care professionals, the insurance industry and clinicians. FSCO also considered the different invoicing practices that exist in the sector.
- If an insurance company has not paid a submitted invoice, can a health care provider submit another invoice for the unpaid good or service?
No. The health care provider should contact the insurance company directly to inquire about the unpaid invoice.
- What about insurance companies that are not meeting their 30-day requirement to pay for approved goods and services from an OCF-18? How do the revisions address this?
The Statutory Accident Benefits Schedule requires insurers to pay interest at one per cent per month, compounded monthly, on late payments. This is an incentive for them to make payments on time.
If there is an issue with an insurance company being late with payment, you can file a complaint.
Q: I have medical benefits through a plan at work. Why do I need to purchase statutory accident benefits on my auto insurance policy?
A: In Ontario, automobile insurance is mandatory. The government has a responsibility to provide a product which addresses the needs of as many insurance consumers as possible and ensures that the interest of the public at large is protected. This is why all vehicles operated on the road must carry certain mandatory coverages. These coverages are liability, statutory accident benefits, uninsured automobile and direct compensation-property damage.
The statutory accident benefits provided to persons insured are detailed in the Statutory Accident Benefits Schedule (SABS) . Coverage includes, among other things, income replacement benefits, supplementary medical and rehabilitation benefits, death and funeral benefits and long-term care benefits. These benefits are available not only to the owner of the policy, but they could also be accessed by passengers in the vehicle, as well as pedestrians, who may not have coverage under their own automobile insurance policy.
Q: What is an excluded driver endorsement?
A: An excluded driver endorsement is an agreement that allows you to exclude specific drivers from being covered under your auto insurance policy. It is typically used by people who want to exclude a young driver in their household, or a driver with at-fault accidents or convictions, to avoid higher premiums.
An excluded driver endorsement is signed by you and the driver(s) you want to exclude from your policy. By signing the endorsement, you promise to prohibit the excluded driver(s) from driving the vehicle described in the agreement. The excluded driver, by signing this agreement, promises not to drive this vehicle and acknowledges that if he/she does, there is no liability insurance in effect. However, if the excluded driver is found to have operated the vehicle while excluded, along with there being no liability insurance in effect, the owner of the vehicle and others legally responsible for the acts of the driver may be held personally liable for damages and injuries in the event of an accident. In addition, the insurance company may terminate or non-renew the policy for material misrepresentation or breach of contract if the insurance company has filed an underwriting rule permitting it to do so.
You can request an excluded driver endorsement from your insurance company at any time, and your insurance company must allow it to be added to your policy. To add such an endorsement to your policy, fill out the Excluded Driver Ontario Policy Change Form and send it to your insurance company.
Note: While insurance companies cannot demand that an excluded driver endorsement be placed on your policy, they can advise that if you do not put such an endorsement on your policy, it may result in non-renewal/not being offered insurance.
Q: What is a Consumer AutoPlus Report?
There are a number of private services in the marketplace such as CGI’s Autoplus that provide claims information services to the insurance industry and maintain databases of claims information that is shared by all participating insurance companies. Not all insurance companies participate in providing information to these private companies. For more information about CGI Autoplus you can visit their website
Q: My insurance agent/broker quoted a premium that I agreed to and I bought the policy. Now I got a notice that the premium is more than they quoted. Can they do this?
A: An insurance company has sixty days from the effective date of the policy to review the application and confirm the information provided. It may adjust the quoted premium, which is an estimated premium, based on that review or underwriting process. The insurer must notify the insured of the revised premium in writing.
Q: Why does an insurance company charge me a penalty if I want to cancel the policy in the middle of the policy term?
The Statutory Conditions in the Ontario Automobile Policy (OAP 1)
state that an insurer may use a short rate cancellation table when an insured requests a cancellation of the policy, and most companies follow that practice. This cancellation table takes into account administrative or handling costs involved with issuing the policy and cancelling it before the expiry of the term.