Revised Application for Determination of Catastrophic Impairment and Summary of Changes to the Auto Insurance System - Effective September 1, 2010

 

Bulletin

No. A-21/10
– Auto
Property & Casualty

To the attention of all insurance companies licensed to
transact auto insurance in Ontario and all health care providers


With this Bulletin, the Financial Services Commission of Ontario (FSCO) is releasing a revised Application for Determination of Catastrophic Impairment (OCF-19) and providing a summary of key changes to the auto insurance system that became effective on September 1, 2010.  For more details on any of these changes, references to previously issued Property & Casualty – Auto Bulletins are provided.


A copy of the revised OCF-19 is attached and is also available on FSCO's website at www.fsco.gov.on.ca.


Summary of Changes

Transitional Rules (Auto Bulletins A-04/10 and A-11/10)


Auto Bulletin A-04/10, which was released on April 26, 2010, describes the rules for transition from the Statutory Accident Benefits Schedule – Accidents on or after November 1, 1996 (Old SABS) to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (New SABS).  These rules govern accident benefit claims that arise from accidents that occur between November 1, 1996 and August 31, 2010, as well as from accidents that occur on or after September 1, 2010.


As stated in Auto Bulletin A-04/10, "the New SABS will apply to all new accidents for all purposes", where "new accidents" are defined as accidents that occur on or after September 1, 2010.


For example, the New SABS provides that the $3,500 cap on medical and rehabilitation benefits for minor injuries applies to all accidents that occur on or after September 1, 2010, even if a policy is already in effect before September 1, 2010, and irrespective of the medical and rehabilitation benefit limit amount that was purchased.


However, any policy that is already in effect before September 1, 2010 will have the New SABS optional caregiver, housekeeping and home maintenance benefits, optional medical and rehabilitation benefits ($100,000), and optional attendant care benefit ($72,000) coverages until the policy expires or is terminated, or is amended by agreement between the insured and the insurer.  This is also the case for any optional benefits that were previously purchased under the Old SABS.


Auto Bulletin A-11/10, which was released on June 14, 2010, describes issues that are associated with mid-term policy changes that occur between September 1, 2010 and the policyholder's regular renewal date, as well as handling requests for purchasing optional or reduced benefits.

Harmonized Sales Tax (HST)


The HST legislation governs whether the HST applies to goods or services for which payment is available under the New SABS.  If HST legislation provides that the HST is applicable to any of these goods or services, then the insurer must pay the HST in addition to the amounts that are payable under the New SABS.   For example, the $2,000 cap that is provided for in s. 25(5) (a) of the New SABS to cover the costs and expenses of assessments, examinations and preparation of reports is exclusive of any HST that may be payable under HST legislation.  Insurers are therefore expected to pay the HST, if it applies to such costs and expenses, without considering the $2,000 cap.  


This is consistent with the treatment of the HST for services that are delivered by health care providers and that are governed by the Professional Services Guideline – Superintendent's Guideline No. 06/10.


Previously Released Auto Bulletins


FSCO previously released the following Auto Bulletins which cover changes to Ontario's auto insurance system that became effective on September 1, 2010:

Legislative Changes 


  • Auto Bulletin A-17/10 highlights the elimination of tort deductibles for fatality claims (s. 267.5 (8.1.1) of the Insurance Act) and changes to the calculation of tort income loss from 80 per cent of net income to 70 per cent of gross income (s. 267.5 (1) of the Insurance Act).

New Regulations


Disputes Between Insurers


Unfair or Deceptive Acts or Practices


  • Auto Bulletin A-16/10 provides a summary of changes to Ontario Regulation 7/00: Unfair or Deceptive Acts or Practices.
  • The Attestation of Compliance is due by October 15, 2010.

Rate Filing Guidelines


  • Auto Bulletin A-02/10 outlines requirements for submitting auto insurance rate and risk classification filings that were due by April 15, 2010.

Accident Benefit Claim Forms


  • Attached to this Bulletin is the revised Application for Determination of Catastrophic Impairment (OCF-19) with minor amendments.  This updated version of OCF-19 replaces the previous version that was released with Auto Bulletin A-13/10.
  • Auto Bulletin A-05/10 announced the issuance of three revised Health Claims For Auto Insurance (HCAI) forms:
    • Treatment and Assessment Plan (OCF-18)
    • Auto Insurance Standard Invoice (OCF-21)
    • Treatment Confirmation Form (OCF-23)
  • Auto Bulletin A-13/10 announced the issuance of the following revised forms:
    • Assessment of Attendant Care Needs (Form 1)
    • Accident Benefits Application Package (OCF-1)
    • Disability Certificate (OCF-3)
    • Permission to Disclose Health Information (OCF-5)
    • Expenses Claim Form (OCF-6)
    • Election of Income Replacement, Non-Earner or Caregiver Benefit (OCF-10)
    • Application for Determination of Catastrophic Impairment (OCF-19).  (Please note that OCF-19 has been updated and replaced by a revised version that is attached to this Bulletin.)
    • Settlement Disclosure Notice
    • Explanation of Benefits (OCF-9)
    • Activities of Normal Life (OCF-12)
    • Declaration of Post-Accident Income and Benefits (OCF-13)
    • Notice of Examination (OCF-25)
    • Voluntary Consent for Pre-Claim Examination (OCF-26)
    • Application for Approval of an Assessment or Examination (OCF-22) (this form was merged with OCF-18)

Policy & Endorsement Forms


  • Auto Bulletin A-03/10 announced the issuance of a Revised Certificate of Automobile Insurance Form and data elements for the Certificate of Automobile Insurance.
  • Auto Bulletin A-08/10 announced the issuance of the following revised forms:
    • Ontario Automobile Policy – Owner's Policy (OAP 1)
    • Ontario Garage Automobile Policy (OAP 4)
    • Ontario Application for Automobile Insurance – Owner's Policy (OAF 1) 
    • Ontario Application for Automobile Insurance Garage Form (OAF 4)
    • Alteration Form (OPCF 25A)  
  • Auto Bulletin A-12/10 announced the issuance of the following revised forms:
    • Garage Certificate of Insurance
    • O.P.F. 2 – Ontario Driver's Policy
    • O.A.F. 2 – Ontario Application for Automobile Insurance – Driver's Form
    • OPCF 2 – Providing Coverage when Named Persons Drive Other Automobiles or Rent or Lease Other Automobiles
    • OPCF 3 – Drive Government Automobiles
    • OPCF 21A – Monthly Reporting Basis Fleet
    • OPCF 27 – Liability for Damage to Non-Owned Automobile(s), and Other Coverages When Insured Persons Drive, Rent or Lease Other Automobiles
    • O.E.F. 72 – Multiple Alteration Endorsement (for Ontario Garage Automobile Policy)
    • O.E.F. 85 – Final Premium Computation Endorsement (for Ontario Garage Automobile Policy)
  • Auto Bulletin A-12/10 also announced the issuance of the following new forms:
    • OPCF 48 – Added Coverage to Offset Tort Deductibles (for OAP 1)
    • O.E.F. 87 – Added Coverage to Offset Tort Deductibles (for Ontario Garage Automobile Policy)

Consumer Information


  • Auto Bulletin A-09/10 announced the issuance of three consumer publications that need to be distributed by all insurers to all Ontario policyholders:
    • Changes to Ontario Auto Insurance Give You More Choice (Early Awareness mailer)
    • Summary of Important Changes to Your Policy (Point of Sale document)
    • Providing More Choice to Consumers: What You Need to Know About Changes to Auto Insurance in Ontario (More Choice mailer)
  • Auto Bulletin A-15/10 provided clarification concerning the issuance of consumer publications for new business.

 

Superintendent's Guidelines


  • Auto Bulletin A-10/10 announced the issuance of the Minor Injury Guideline – Superintendent's Guideline No. 02/10.
  • Auto Bulletin A-13/10 announced the issuance of the Attendant Care Hourly Rate Guideline – Superintendent's Guideline No. 03/10.
  • Auto Bulletin A-19/10 announced the issuance of the Professional Services Guideline – Superintendent's Guideline No. 06/10 and Transportation Expense Guideline – Superintendent's Guideline No. 05/10.

Update to Dispute Resolution Practice Code and Revised Forms


  • Auto Bulletin A-18/10 highlighted revisions to the Fourth Edition of the Dispute Resolution Practice Code and issued four revised dispute resolution forms and two accompanying guides.

 


Philip Howell
Chief Executive Officer and
Superintendent of Financial Services


September 17, 2010



Attachment:


Follow FSCO on social media  

hotline-en.jpg 

Outage  Scheduled Online Service Disruption Notice
Please consult our outage schedule for more details.