Additional Automobile Insurance Regulations, Proclamation of Bill 198 Provisions, Professional Services Guideline and Revised Rate and Risk Classification Filing Guidelines

 

Bulletin

No. A-16/03
- Auto
Property & Casualty
[To the attention of all insurance companies licensed
to transact automobile insurance in Ontario]
With this Bulletin, the Financial Services Commission of Ontario (FSCO) is highlighting, for your reference:

 

  • four additional regulation changes filed by the Ontario Government with the Registrar of Regulations on September 18, 2003,

  • the Professional Services Guideline to be published in the September 27, 2003 edition of The Ontario Gazette, setting out maximum fees for services provided by health professionals and other providers, and

  • revised rate and risk classification filing guidelines.

In addition, on September 16, 2003, the Ontario Government proclaimed October 1, 2003 as the date that section 120 of Bill 198, the Keeping the Promise for a Strong Economy Act (Budget Measures), 2002, will come into force. Section 120 will be effective in respect of accidents occurring on or after that date.

Section 120 of Bill 198 expands an injured person’s right to sue for excess health care expenses to the extent they are not-at-fault, if the person has sustained permanent serious impairment of an important physical, mental or psychological function. As well, for pain and suffering awards over $100,000 and Family Law Act awards over $50,000, it eliminates the deductible that would otherwise apply. Finally, it provides protection to some parties who are vicariously liable for actions of protected defendants.

Regulation Changes

 

    1. Definition of Catastrophic Impairment for Court Proceedings (Ontario Regulation 381/03 amending Ontario Regulation 461/96 - Court Proceedings for Automobile Accidents that Occur on or after November 1, 1996) Filed: September 18, 2003

With the proclamation of Section 120 of Bill 198, the threshold for suing for excess health care expenses is changed from "catastrophic impairment" to "permanent serious impairment of an important physical, mental or psychological function". As a result, section 5 of Ontario Regulation 461/96 - Court Proceedings for Automobile Accidents that Occur on or after November 1, 1996 is revoked. This amendment will be effective for all accidents that occur on or after October 1, 2003.

 

  1. Definition of Permanent Serious Impairment of an Important Physical, Mental or Psychological Function (Ontario Regulation 381/03 amending Ontario Regulation 461/96 - Court Proceedings for Automobile Accidents that Occur on or after November 1, 1996) Filed: September 18, 2003

As outlined in an August 29, 2003 Government news release, the verbal threshold of "permanent serious impairment of an important physical, mental or psychological function" has been defined in Regulation. Also, the Regulation sets out evidence that must be adduced to prove permanent serious impairment of an important physical, mental or psychological function. This amendment will be effective for all accidents that occur on or after October 1, 2003.

 

  1. New Limit on Income Replacement Benefits (Ontario Regulation 380/03 amending Ontario Regulation 403/96 - Statutory Accident Benefits Schedule - Accidents on or after November 1, 2003) ("SABS") Filed: September 18, 2003

The maximum payable under the SABS for basic income replacement benefits is reduced from $400 to $300 per week. Also, insurers are required to offer consumers optional income replacement benefit coverage of $400 per week in addition to the existing optional limits of $600, $800 and $1,000 per week. This amendment will be effective for all auto insurance policies issued or renewed on or after January 1, 2004.

 

  1. Delivery of Written Notices (Ontario Regulation 380/03 amending Ontario Regulation 403/96 - Statutory Accident Benefits Schedule - Accidents on or after November 1, 1996) ("SABS") Filed: September 18, 2003

Section 68 of the SABS, as amended effective October 1, 2003, prescribes that most notices shall be given in writing. The amendment to the notice provisions provides greater certainty respecting document delivery. When an attempt has been made to personally deliver a document at a person’s place of residence and it has not been possible to do so, the new subsection 68(4) allows the document to be left with a person who appears to be an adult member of the same household. This amendment will apply to all notices delivered on or after October 1, 2003.

 

 

Professional Services Guideline
 

On August 28, 2003, the Minister of Finance issued a Policy Statement titled Health Care Provider Fee Schedules under the Ontario Insurance Act and published in the September 6, 2003 edition of The Ontario Gazette. The Superintendent of Financial Services has now issued the Professional Services Guideline in response to the Government White Paper titled Automobile Insurance Affordability Plan for Ontario: Next Steps and the Policy Statement. This Guideline sets out the maximum fee for the services of any of the health professions or health care providers listed in the Guideline. These maximum fees are applicable to:

 

  • a medical benefit under clauses 14 (2) (a), (b) or (h) of the SABS;
  • a rehabilitation benefit under clauses 15 (5) (a) to (g) or clause (5) (l) of the SABS;
  • case management services under subsection 17 (1) of the SABS; and
  • conduct of an examination or assessment or provision of a certificate, report or treatment plan under subsection 24 (1) of the SABS.

The Guideline also sets out maximum fees payable for completion of certain SABS claim forms. Also, the Pre-approved Framework Guideline for Whiplash Associated Disorder Grade I Injuries With or Without Complaint of Back Symptoms and Pre-approved Framework Guideline for Whiplash Associated Disorder Grade II Injuries With or Without Complaint of Back Symptoms (the "Pre-approved Framework Guidelines") have been re-issued to include revised fees.

 

No fee guidelines for Designated Assessment Centre (DAC) assessments are being issued at this time. As directed in the Government White Paper, a review of the DAC system is currently underway and will be completed in October 2003. The review will look at establishing standard fees for DAC assessments.

 

The Professional Services Guideline applies to expenses incurred on or after November 1, 2003.

 

The revised Pre-approved Framework Guidelines are effective for new Treatment Confirmation Forms submitted on or after November 1, 2003. 

Copies of Guidelines

 

 

 

The Guidelines referred to in this Bulletin will be published in the September 27, 2003 edition of The Ontario Gazette. The Guidelines can also be downloaded from the FSCO website at: www.fsco.gov.on.ca

Revocation of Existing Fee, Utilization and Treatment Guidelines

 

With the release of the Professional Services Guideline and the revised Pre-approved Framework Guidelines, the following Guidelines, previously released by either the Superintendent of Financial Services, the Ontario Commissioner of Insurance, the Financial Services Commission of Ontario, or the Ontario Insurance Commission, are revoked:

 

  • Professional Fee Guidelines - Occupational Therapists, February 3, 2001, Professional Fee Guideline No. 1/01
  • Occupational Therapy Utilization Guidelines for Uncomplicated Soft Tissue Injuries, February, 3, 2001, Superintendent Guideline No. 01/01
  • Professional Fee Guideline - Podiatrists, March 9, 1998, Commissioner Guideline No. 01/98
  • Professional Fees Guideline - Physiotherapists, November 24, 1997
  • Physiotherapy Utilization Guidelines for Soft Tissue Disorders of the Spine, November 24, 1997, Commissioner's Guideline No. 2/97
  • Professional Fee Guidelines - Speech-Language Pathologists, March 31, 2001, Professional Fee Guideline No. 2/01
  • Professional Fee Guidelines - Psychologists, March 31, 2001, Professional Fee Guideline No. 3/01.

Two other utilization guidelines were established as a result of agreements and although they do not deal with fees, they call for an automatic review three years after the guidelines are issued:

 

  • The Insurance Bureau of Canada and the Ontario Psychological Association are requested to review the Psychological Assessment and Treatment Guidelines (Superintendent Guideline No. 2/01, March 31, 2001) and report back to the Superintendent on any proposed changes by December 31, 2003.
  • The Insurance Bureau of Canada and the Ontario Podiatric Medical Association are requested to review the Podiatry Utilization Guidelines (Commissioner Guideline No. 1/98, March 9, 1998) and report back to the Superintendent on any proposed changes by December 31, 2003.

Rate and Risk Classification Filing Guidelines

 

FSCO is releasing a revised simplified filing guidelines package as a result of the recent auto insurance changes. In addition to reflecting the cost savings from these changes, insurers must submit a filing that will include a rate for the new optional income replacement benefit coverage of $400 per week. The revised Bill 198 Simplified Filing Guidelines for Proposed Revisions to Automobile Insurance Rates and Risk Classification Systems are attached.

 

Copies of Regulations

 

 

Ontario Regulation 381/03 amending Ontario Regulation 461/96 - Court Proceedings for Automobile Accidents that Occur on or after November 1, 1996 and Ontario Regulation 380/03 amending Ontario Regulation 403/96 - Statutory Accident Benefits Schedule - Accidents on or after November 1, 1996 are enclosed for your information and will be published in the October 4, 2003 edition of The Ontario Gazette. The regulations will also be available for download from the Ontario e-Laws website at: www.e-laws.gov.on.ca

Bryan P. Davies
Chief Executive Officer and
Superintendent of Financial Services
September 18, 2003

 

Attachments (PDF):

 

 
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