With this Bulletin, the Financial Services Commission of Ontario (“FSCO”) is releasing the Cost of Goods Guideline (“the Guideline”) for the purposes of the Statutory Accident Benefits Schedule – Effective September 1, 2010 (“new SABS”) and the Statutory Accident Benefits Schedule – Accidents on or After November 1, 1996 (“old SABS”).
This Guideline has been developed as a result of a recommendation by the Auto Insurance Anti-fraud Task Force in its interim report regarding measures that should be undertaken as soon as possible. Consistent with Ontario’s crackdown on criminal and opportunistic automobile insurance fraud, the interim report suggested the creation of “a guideline to address the issue of insurers being invoiced for medical devices at prices considerably higher than their normal retail value”. The interim report reflected input received from insurance industry stakeholders, the police, health care professionals and legal professionals.
The Guideline will be effective for any Treatment and Assessment Plan (OCF-18) and Auto Insurance Standard Invoice (OCF-21) submitted in respect of a medical or rehabilitation benefit claim made under the new SABS or old SABS, after the date of publication in the Ontario Gazette.
The Guideline is issued pursuant to section 268.3 (1) of the Insurance Act for the purposes of the SABS. 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.
A copy of the Cost of Goods Guideline is attached and is also available on FSCO's website at www.fsco.gov.on.ca. The Guideline will also be published in a forthcoming edition of The Ontario Gazette.
Chief Executive Officer and
Superintendent of Financial Services
January 6, 2012