Guideline on rights and responsibilities of insurer and insured on automobile insurance accident benefits



No. A-07/95
- Auto
Property & Casualty

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

Here is the Guideline for Statutory Accident Benefits Applications, the Claims Process and the Mediation Process.  This Guideline first appeared in the May 20, 1995 edition of The Ontario Gazette, and was issued by the Commissioner of Insurance who is authorized under the Insurance Act  to issue guidelines on the interpretation and operation of the Statutory Accident Benefits Schedule (SABS).

We are pleased to enclose a copy of the Guideline, for your information.  It outlines the rights and responsibilities of both the insurer and the insured person within the automobile insurance accident benefits system.  By providing full and timely information to the two parties who are dealing with an accident benefits claims application, the Guideline will help facilitate more efficient processing of these applications.

As the Guideline indicates, insurers should realize that unreasonable actions are treated as unfair practices and may lead to penalties under Section 282(10) of the Insurance Act.  Consequently, we urge you to provide copies of this Guideline to your staff in the claims/adjusting and other departments, for their use.

Claimants, who will receive a copy of this Guideline as part of the OIC Accident Benefits Application (ABA) Package, are being reminded that unreasonable actions will delay payments and can lead to denial of benefits without access to court or arbitration.

This is the second Guideline to be issued this year.  The first Guideline, entitled Guideline for Identifying Self-Employed Individuals, was issued on April 25, 1995 as part of OIC Bulletin A-4/95, and is now available in a new format that is consistent in graphic design with the attached.

The content remains unaltered.

If you would like to receive a copy of the first Guideline in its new design, issued this year, please fax your request to the Administrative Officer, OIC, at (416) 590-7070.

Please note that this Guideline will also be included in the revised Dispute Resolution Practice Code which is to be released in the near future.

D. Blair Tully

June 1, 1995

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