Interpretation Costs and Assessments and Examinations Under the Statutory Accident Benefits Schedule - Effective September 1, 2010

 

Bulletin

No. A-23/10
– 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 the Cost of Assessments and Examinations Guideline – Superintendent's Guideline No. 08/10 (Guideline), which applies to all accidents occurring on or after November 1, 1996.


The cost of services that are sometimes provided by interpreters in connection with assessments or examinations of insured persons who have a language barrier are not intended to be covered under the Statutory Accident Benefits Schedule - Effective September 1, 2010 (SABS). This does not prevent an insurer from paying or arranging for these services as an adjusting expense.


Health care providers and other persons acting on their behalf should not be arranging for interpreters unless they have prior approval by the insured person and the insurer for payment.


FSCO expects insurers to use their own internal policies and procedures that comply with best practices and legislative requirements, when determining whether interpreters are required. 


The Insurance Bureau of Canada released Standards of Sound Marketplace Practice on March 6, 2006. Standard 4, Fair Claims Settlement and Claims Handling, describes best practices that insurers should follow when adjusting a claim. In particular, Standard 4 directs that insurers should have internal policies and procedures that are well understood, fully in place and utilized to ensure "that claims are handled as expeditiously as possible and in accordance with any legal requirements, with fairness and transparency to the claimant". In addition, insurers’ standards and guidelines for dealing with claimants and policyholders should ensure "that similar claim situations are treated consistently, and that in all cases insurance contracts are interpreted in ways that are deemed to be in the spirit of fairness".


Authority


The Guideline is issued pursuant to section 268.3 of the Insurance Act for the purposes of the SABS and becomes effective when published in The Ontario Gazette. As required by section 268.3 (2) of the Insurance Act, the Guideline shall be considered in any determination involving the interpretation of the SABS.


 

Copies


The Guideline is attached for your information and can also be downloaded from the FSCO website at www.fsco.gov.on.ca. In addition, the Guideline will be published in The Ontario Gazette.



Philip Howell
Chief Executive Officer and
Superintendent of Financial Services


November 23, 2010



Attachment:


Follow FSCO on social media  

hotline-en.jpg 

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