Updated Professional Services Guideline

Bulletin

No. A-08/14

Property & Casualty

– Auto

To the attention of all insurance companies licensed to transact automobile insurance in Ontario

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With this Bulletin, the Financial Services Commission of Ontario (FSCO) is releasing an updated Professional Services Guideline (Guideline).

The updated Guideline increases the maximum hourly rates for medical and rehabilitation services by 0.9 per cent. This increase is based on the 2013 Consumer Price Index (CPI) and applies to services rendered on or after September 6, 2014.

Insurers are reminded that they are liable to pay for reasonable and necessary medical and rehabilitation expenses described in sections 15 to 17 of the Statutory Accident Benefits Schedule – Effective September 1, 2010 (SABS). The hourly rates and maximum amounts established in the Guideline are to be used to determine the amounts payable for medical and rehabilitation services. Insurers are not liable to pay for expenses that are not listed. For example, expenses for missed or cancelled appointments, rescheduling missed or cancelled appointments, and other non-listed expenses are not payable under the SABS (whether or not they are payable by an insured person).

Insurers and health care providers are also reminded that the amounts payable by insurers for approved assessments or examinations requested by an insured person are subject to the SABS $2,000 limit for any one assessment or examination and also to the hourly rates set out in the Guideline.

Authority

This Guideline is issued by the Superintendent of Financial Services under subsection 268.3 of the Insurance Act and is incorporated by reference in the SABS.

Copies

The updated Guideline is attached for your information and can also be downloaded from the FSCO website at www.fsco.gov.on.ca. In addition, the updated Guideline is expected to be published in the September 6, 2014 edition of The Ontario Gazette.

Philip Howell

Chief Executive Officer and

Superintendent of Financial Services

September 5, 2014