The purpose of this Bulletin is to provide clarification on two matters: the usage of accident benefit claims forms related to the Health Claims for Auto Insurance system and; the role of the Financial Services Commission of Ontario in the oversight of Statutory Accident Benefit Schedule representatives.
Accident Benefit Claims Forms and HCAI
The Financial Services Commission of Ontario (FSCO) has received inquiries that indicate there is some confusion about the correct version of OCF forms 18, 21, 22 and 23 that should be used on and after August 1, 2008.
In December 2007, FSCO released Bulletin No. A-08/07 – Health Claims for Auto Insurance Guideline and Changes to Certain Accident Benefit Claim Forms – along with the HCAI Guideline and revised OCF forms 18, 21, 22 and 23. These revised forms are essentially the same as previous versions. The main difference is that certain fields are highlighted and must be completed in order for the data entry centre (DEC) to process the submission.
Health care providers were informed that they could use the revised forms as of January 7, 2008, or continue to use their existing stock of forms until July 31, 2008. After this date, the revised versions of these forms would be required for all paper submissions to the DEC.
With the temporary suspension of the HCAI Guideline on March 12, 2008, health care providers have returned to submitting documents in paper format directly to the insurance company.
As the revised forms were developed to facilitate DEC submissions and are essentially unchanged from their previous versions, the current and previous version of each form continues to be approved for use and must therefore continue to be accepted by insurers, until further notice or reinstatement of the HCAI Guideline.
The OCF forms below are posted on FSCO’s website at www.fsco.gov.on.ca:
- Effective as of January 7, 2008
- Effective as of May 1, 2007
OCF-21: Auto Insurance Standard Invoice
- Effective as of January 7, 2008
- Effective as of April 2, 2007
OCF-22: Application for Approval of an Assessment or Examination
- Effective as of January 7, 2008
- Effective as of May 1, 2007
OCF-23: Pre-approved Framework Treatment Confirmation Form
- Effective as of January 7, 2008
- Effective as of March 1, 2006
Health care providers who use existing stock or earlier versions of these forms are reminded to properly complete all fields that are highlighted in the revised forms.
FSCO Oversight of SABS Representatives
On May 1, 2008, under the provisions of the Access to Justice Act, 2006, the Law Society of Upper Canada (Law Society) assumed responsibility for the regulation of paralegals, including SABS representatives.
Following the release of Bulletin No. A-04/08, FSCO received inquiries about the scope of the Law Society’s oversight and whether complaints about Insurance Act contraventions should continue to be addressed to FSCO.
Although the Law Society now regulates paralegals and SABS representatives, complaints regarding contraventions of the Insurance Act and regulations, including unfair or deceptive acts or practices, should still be directed to FSCO’s attention.
Bob Christie
Chief Executive Officer and
Superintendent of Financial Services
September 10, 2008