December 2, 2011
Inside this issue:
- New Anti-Fraud Task Force
- Recent Auto Insurance Amendments
- Expedited Mediation Processes
- FSCO’s DRS eCalendar to be Mandatory
- Changes to DRS Forms
- CARR Conference
- Auto Insurance Filing News
New Anti-Fraud Task Force
In the 2011 Ontario Budget, the government announced the creation of a new Auto Insurance Anti-Fraud Task Force to examine the scope of auto insurance fraud in Ontario and make recommendations to address it.
The Task Force will provide a series of reports to the government beginning with immediate action recommendations at the end of the year, and final recommendations by fall 2012.
The Task Force is made up of a steering committee and three working groups. The steering committee members include Fred Gorbet, Chair, George Cooke representing the insurance industry, Margaret Beare representing academia, Bob Percy representing the justice sector, and James Daw representing consumers.
The working groups include regulators, law enforcement, insurers, and insurance intermediaries. The working groups will focus on developing collaborative approaches and finding specific solutions in three key areas:
- consumer engagement and education,
- protection, detection, investigation and enforcement
- regulatory practices
Stakeholders are being asked to make presentations on issues where they have particular expertise or experience. The Task Force has heard from insurance companies, insurance brokers and agents, health professionals, law enforcement, investigators, legal and other groups.
FSCO is playing an important role in all aspects of the Anti-Fraud Task Force. Tom Golfetto, Executive Director of FSCO’s Auto Insurance Division, is the Chair of the Regulatory Practices working group. Willie Handler, Senior Manager of Auto Insurance Policy, represents FSCO on the Prevention, Detection, Investigation and Enforcement working group and the Regulatory Practices working group. FSCO’s Sivan Raz participates in the Regulatory Practices working group, and Martin Ship and Rowena McDougall from FSCO’s Corporate Policy & Public Affairs Branch participate in the Consumer Engagement and Education working group.
Recent Auto Insurance Amendments
In October, FSCO released Bulletin A-06/11 on the revised Minor Injury Guideline (MIG). The revised MIG provides direction for billing practices when a claimant changes health practitioners within the MIG, and direction on the integration of extended health care benefits with the MIG.
Bulletin A-07/11 issued November 8, approved the release of the Revised Health Claims for Auto Insurance (HCAI) Guideline. As an aid to the Ontario government’s crackdown on auto insurance fraud, the new Guideline provides direction on billing procedures in:
- Invoicing frequency
- Incomplete invoices
- Duplicate invoices and invoices for non-approved goods and services
The bulletin also announced a future amendment to the OCF-21 form, effective July 1, 2012, whereby the Plan Number of the OCF-18 or OCF-23, to which the OCF-21 refers, will become a mandatory field.
Expedited Mediation Processes
FSCO continues to encourage parties to assume greater responsibility in the management and resolution of their disputes by offering them dispute resolution processes that are meaningful, efficient and appropriate to their needs and the nature of the issues in dispute.
To this end, FSCO recently introduced two new expedited processes in mediation:
- Consent failures (the option to fail mediation on consent, without a mediation meeting)
- Mandatory settlement Blitz Days
Since September of this year, parties to mediation have been invited to consider the option of failing mediation upon mutual consent. Here’s how FSCO is putting the option into operation:
Beginning with the oldest files awaiting assignment to a mediator, FSCO is sending letters to the claimants and insurers, advising of the option to fail the mediation upon mutual consent. A Consent to Fail Mediation Form is included in the letter, which both parties can sign and return to FSCO by a stated deadline.
The Consent to Fail Mediation Form requires the parties to list the issues that remain unresolved and to jointly request that the mediation be failed. The form also requires the parties to confirm that they have made best efforts to resolve the dispute without success and that there is no reasonable prospect of a resolution if a meeting were to be held.
Once received, FSCO assigns the form, and any supporting documents produced by the parties, to a mediator who will review the file. If the mediator is satisfied that best efforts have been made by the parties to resolve the disputed issues, that there is no reasonable prospect of resolution if a mediation meeting were to take place, and that in the opinion of the mediator, mediation will fail, a Report of Mediation failing the issues will be issued and the file will be closed.
Mandatory Settlement Blitz Days
Aimed at closing multiple files in a single day, FSCO’s Settlement Blitz Days engage the parties in settlement discussions to arrive at a resolution of the dispute, with the assistance of a FSCO mediator.
FSCO will require claimant and insurer representatives with multiple common files that have not yet been assigned to a mediator to attend one or more settlement Blitz Days.
The process works like this: FSCO notifies the parties’ representatives of their common files and that the meetings will be booked by Dispute Resolution Services staff. FSCO assigns mediators to facilitate the sessions and record outcomes. At the end of the sessions, a Report of Mediator is issued reflecting the outcome.
Settlement Blitz Days are mandatory and both sides are required to attend the meetings. Failure by either party to attend the meeting could result in the issuance of a Report of Mediator failing the issues.
The first Blitz Day took place on November 4th and FSCO is currently booking Blitz Days once a week into January 2012. The results will be reviewed in the spring of 2012.
FSCO’s Dispute Resolution Services eCalendar to be Mandatory
FSCO is making the booking of mediations easier and more flexible with the Dispute Resolution Services DRS eCalendar.
The DRS eCalendar lets you book mediation meetings and manage your mediation files online. Rescheduling, extension consents, notifications of settlement and requests for file closure – they all become quick and easy online. And, the DRS eCalendar is available for use 24 hours a day, seven days a week.
Since it was launched in July 2011, the DRS eCalendar has been used to register 1,600 mediation files, with claimant representatives and insurers booking and managing their files online.
Since its launch, system representatives have used the DRS eCalendar on an optional basis. This will change on February 1, 2012, when it will become mandatory. There will be exceptions to mandatory use – for example, unrepresented applicants will be allowed to continue booking mediation meetings via telephone.
In the meantime, FSCO strongly encourages all representatives to begin using the DRS eCalendar for all mediation files. More information is available on FSCO’s website or by contacting Mediation Inquiries at 416-590-7210 or 1-800-517- 2332 ext. 7210.
Changes to Dispute Resolution Services Forms
On August 1, 2011, FSCO revised Dispute Resolution (DRS) Forms A and B to reflect recent amendments to the Statutory Accident Benefits Schedule. Key changes appear under the Mediation Proceedings section which now includes new questions. Since October 1, 2011, FSCO has been accepting only the August 1, 2011 versions of these forms.
All representatives are now required to provide their email addresses on Forms A, B, C, D, E, G, I, J, K, L, M and P, which have been amended for this purpose.
To get more information on the forms, go to FSCO’s website or call:
- for mediation forms - 416-590-7210 or 1-800-517- 2332 ext. 7210
- for arbitration forms - 416-590-7202 or 1-800-517- 2332 ext. 7202
- for appeal forms - 416-590-7222 or 1-800-517-2332 ext. 7222
In October, FSCO hosted the 5th annual conference of the Canadian Automobile Insurance Rate Regulators (CARR) association in Toronto.
CARR is an organization of rate regulators from nine provinces across Canada that provides a forum for members to share best practices and discuss key issues. Ontario is the only province where rate regulation is part of the Superintendent’s responsibilities; in other jurisdictions, rate boards are responsible.
Fifty delegates attended the conference, including 14 from Ontario. The conference featured current auto insurance market issues, as discussed by a panel of CEOs from Aviva, Intact and Dominion of Canada. Presentations included:
- IBC on auto insurance fraud
- RBC on initiatives underway to combat fraud
- Towers Watson on rating trends from the U.S., including usage based insurance
- Eagle Eye Analytics on the use of predictive analytics in rating
- the Facility Association
- IBC on the CLEAR rating system
Auto Insurance Filing News
Information Session on Rate Filing Process
FSCO will be holding a webinar on the rating filing process in early 2012. Geared towards industry professionals involved in the rate filing process, the webinar will cover the rate review process at FSCO and provide guidance on what to include in a rate filing. Details will be made available on FSCO’s website.
The August 2011 edition of Auto Insurance e-Newsletter announced the updated Filing Guidelines for Endorsement Filings and updated Filing Guidelines and Technical Notes for Underwriting Rule Filings.
FSCO is currently reviewing the Filing Guidelines and Technical Notes for Rate Filings and, following a consultation with the Rating and Underwriting Technical Advisory Committee, plans to release updated versions in late 2011.
Twice a year, FSCO releases rate filing benchmarks to facilitate the preparation of rating filings by insurers. Based on Statistical Plan and other data, the benchmarks cover loss trends, loss cost adjustment factors, expense provisions and corporate tax rates.
FSCO’s website makes it easier for the auto insurance industry
This past summer, FSCO redesigned its website to give insurance industry stakeholders one-click access to content specific to their sector.
It’s now easier to access industry resources and services, and get important sector updates. Take a look at www.fsco.gov.on.ca.
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Auto Insurance Division
Financial Services Commission of Ontario
5160 Yonge Street, Box 85
Toronto, Ontario M2N 6L9
Telephone: (416) 250-7250
Fax: (416) 590-7265
TTY (416) 590-7108, 1-800-387-0584