This Bulletin highlights new regulations governing the licensing of service providers who invoice auto insurers directly, and regulatory amendments to the Statutory Accident Benefit Schedule – Effective September 1, 2010 (SABS).
The service provider licence regulations are expected to be published in the January 4, 2014 edition of The Ontario Gazette and will be come into force on proclamation of the corresponding legislative provisions.
The SABS amendments are expected to be published in the January 4, 2014 edition of The Ontario Gazette. The in-force date of the SABS changes is February 1, 2014.
I. Service Provider Licensing
Recent amendments to the Insurance Act and the Financial Services Commission of Ontario Act, 1997 give authority to the Financial Services Commission of Ontario (FSCO) to license service providers who invoice auto insurers and oversee their business practices.
The Insurance Act amendments provide that insurers are not permitted to make payments for listed expenses directly to a person or entity who does not hold a service provider's licence at the applicable time, subject to any exceptions prescribed by regulation. Insurers can continue to reimburse insured persons for listed expenses paid by insured persons.
The legislation sets out a framework for licensing service providers by FSCO. This includes the requirement for service providers to designate a principal representative to exercise prescribed powers and duties, and for FSCO to maintain a public register of licensees and former licensees.
This legislation also provides that holders of a service provider's licence are required to comply with such standards as may be prescribed by regulation with respect to their business systems and practices in connection with statutory accident benefits, and to comply with such standards as may be prescribed with respect to matters of integrity in the management of the licensee's operations.
Summary of Service Provider Licensing Regulations
- Service Providers – Licensing (O. Reg. 348/13)
- A regulation that sets out service provider licensing eligibility requirements, including grounds for unsuitability
- Service Providers – Principal Representatives - (O. Reg. 349/13)
- A regulation regarding eligibility criteria and duties of the principal representative
- Service Providers – Public Registry (O. Reg. 350/13)
- A regulation prescribing information that is contained in the public registry of service providers maintained by the Financial Services Commission of Ontario.
Future Service Provider Licensing Regulations
Future regulations will be necessary to operationalize the new licensing regime. The application process is planned to begin in the spring of 2014 and the regime is planned to become fully operational in the fall of 2014.
Summary of SABS Changes
The amendments to the SABS:
- provide that a pre-existing condition referred to in s.38 (3) (c) (i) (regarding the Minor Injury Guideline) must be documented by a health practitioner prior to the accident;
- limit attendant care benefits to actual economic loss incurred by friends or family members in the provision of attendant care; and
- clarify that an election for income replacement, non-earner or caregiver benefits is final regardless of any change in circumstances, except if a claimant is subsequently determined to have sustained a catastrophic impairment.
This regulation has been amended by O. Reg. 347/13.
The SABS amendments are effective February 1, 2014.
Guideline and Form Changes
FSCO will also be releasing consequential changes to the Minor Injury Guideline and the Treatment and Assessment Plan (OCF-18) in January 2014 to reflect these regulation amendments.
III. MORE INFORMATION
The new SABS amendments can be found at www.e-laws.gov.on.ca , as can the new regulations governing service providers.
Chief Executive Officer and
Superintendent of Financial Services
December 19, 2013