Catastrophic Impairment - Public Hospitals Guideline and Updated Cost of Goods Guideline

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Bulletin

No. A-09/16

Property & Casualty

 – Auto

 

To the attention of all insurance companies licensed to transact automobile insurance and service providers in Ontario

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​​​​​With this Bulletin, the Financial Services Commission of Ontario (FSCO) is releasing the new Catastrophic Impairment - Public Hospitals Guideline (Superintendent’s Guideline No. 01/16) Size: ## kb​ and an updated Cost of Goods Guideline (Superintendent’s Guideline No. 02/16)  Size: ## kb​.

Amendments have been made to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (O. Reg. 34/10) (SABS) in regards to the definition of catastrophic impairment. The revised definition provides an automatic designation of catastrophic impairment for children (under the age of 18) with traumatic brain injuries in specified circumstances.

Another amendment was made to the eligibility test for medical benefit and rehabilitation expenses for other goods and services. The test for the listed expenses under the medical and rehabilitation benefits remains the same.

Catastrophic Impairment - Public Hospitals Guideline

The guideline provides a list of the public hospitals for which in-patient admittance is one criterion for determining whether an insured person under the age of 18 at the time of the accident has a traumatic brain injury, pursuant to subparagraph 5 (i) of subsection 3.1 (1) of the SABS.

This guideline applies to all accidents occurring on or after June 1, 2016.

Cost of Goods Guideline

The updated guideline applies to all accidents, effective on or after June 1, 2016, and accounts for the new test to be applied to other goods claimed under the medical and rehabilitation benefits. The test for other goods and services under paragraphs 15 (1) (h) and 16 (3) (l) are subject to a new requirement that an insurer agree that the goods and services claimed are essential for the treatment or rehabilitation of the insured person, and for which a benefit is not otherwise provided in the SABS.

Authority

The new and updated guidelines are issued pursuant to subsections 268.3 (1) and (1.1) of the Insurance Act and are incorporated by reference in the SABS.

Copy of the Guidelines

The Catastrophic Impairment - Public Hospitals Guideline and Cost of Goods Guideline are available on FSCO’s website at www.fsco.gov.on.ca and will be published in the forthcoming edition of The Ontario Gazette.

Brian Mills
Chief Executive Officer and
Superintendent of Financial Services
May 6, 2016