New Participating Insurer in Health Claims for Auto Insurance

Bulletin

No. A-02/17

Property & Casualty

- Auto

To all insurance companies licensed to
transact auto insurance in Ontario and all health service providers

NOTE: The bulletins that are posted on this website are provided for historical reference purposes. The information in these bulletins is accurate on the date the information is published, but is subject to change and may be replaced by more recent bulletins.

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With this Bulletin, the Financial Services Commission of Ontario (FSCO) is releasing a new Health Claims for Auto Insurance (HCAI) August 2017 Guideline – Superintendent’s Guideline No. 01/17 (new Guideline). This new Guideline replaces the previous Health Claims for Auto Insurance May 2015 Guideline – Superintendent’s Guideline No. 01/15 that was issued in May 2015.

Health Claims for Auto Insurance (HCAI)

Effective August 1, 2017, the Motor Vehicle Accident Claims Fund (MVACF) is a Participating Insurer for the purposes of the new Guideline. Therefore, all sections of the new Guideline apply to MVACF claims as of August 1, 2017. All documents specified in the new Guideline must be submitted through HCAI on or after August 1, 2017 regardless of the date of the accident to which they relate.

Insurers under a Winding-up Order

Subsection 268.0.1(2) of the Insurance Act states that for any insurer where a winding-up order has been made under the Winding-up and Restructuring Act (Canada), if there are outstanding statutory accident benefits that are payable, the benefits are to be paid out of the MVACF. In order to allow MVACF to continue to pay these benefits, the exclusion of insurers under a winding-up order has been removed from the new Guideline.

Process for MVACF Claims

When completing the Treatment and Assessment Plan (OCF-18), Auto Insurance Standard Invoice (OCF-21) or Treatment Confirmation Form (OCF-23) for MVACF claimants, Participating Facilities must make the following substitutions:

In the Claim Number field insert the Case Number;
In the Policy Number field insert the Incident Number;
In the Name of Policy Holder same as Applicant box check ‘yes’.

When submitting an OCF-21 for an OCF-18 that was approved prior to August 1, 2017, or for an OCF-23 that was submitted prior to August 1, 2017, the word “exempt” should be used in the Plan Number field.

Providers should ensure that they successfully complete and submit their forms before 5 p.m. Eastern Daylight Time (EDT) on July 31, 2017, if they are to be processed under the HCAI May 2015 Guideline.

Authority

The new Guideline is issued pursuant to section 268.3 (1) of the Insurance Act for the purposes of the Statutory Accident Benefits Schedule (SABS).

Copies of the HCAI Guideline

The new Guideline is available on FSCO’s website at www.fsco.gov.on.ca Size: ## kb and will be published in the July 8, 2017 edition of The Ontario Gazette.

Additional HCAI Information

Additional information about HCAI can be found online at www.hcaiinfo.ca . If a question is not addressed by this website, please contact HCAI Processing by email: