How FSCO is Regulating Service Providers
The Financial Services Commission of Ontario (FSCO) is responsible for the licensing and regulation of the business and billing practices of service providers. As of December 1, 2014, service providers must be licensed in order to receive direct payment from auto insurers for goods and services (listed expenses) provided on or after December 1, 2014, in connection with the SABS.
Typically, service providers are health and rehabilitation clinics, as well as providers of assessments and examinations.
Service provider licences are issued at the business or legal entity level. This means that only one licence is needed for all of the facilities, branches or locations operated by the same service provider who provide specified goods or services (listed expenses) to statutory accident benefit claimants.
For the purposes of applying for a licence, FSCO classifies service provider businesses as one of the following forms:
- Sole Proprietorship
- Partnership (General and Limited)
Service Providers That Need to be Licensed
Currently, service providers can bill automobile insurers directly for listed expenses through the HCAI system.
Listed expenses as specified in the Superintendent's Health Claims for Auto Insurance Guideline Size: ## kb are assessments, examinations, reports, forms, plans, goods and services that must be billed through HCAI on an Auto Insurance Standard Invoice (OCF-21).
Beginning December 1, 2014:
- A service provider will need a service provider licence to receive direct payment from automobile insurers for these listed expenses.
- Automobile insurers will not be allowed to pay a service provider for listed expenses in connection with goods or services provided on or after December 1, 2014, if the business or legal entity does not hold a service provider licence.
Note: Unlicensed service providers will still be required to submit all OCF forms through the HCAI system, but will not be able to receive direct payment from auto insurers. Unlicensed service providers must seek payment from their claimants, who in turn, will seek reimbursement from their insurer. Get more information on unlicenced services providers.
Service Providers Exempt from Licensing
Service providers that only complete a disability certificate under sections 21, 36 or 37 of the Statutory Accident Benefits Schedule (SABS) and do not submit the invoice for the disability certificate through HCAI do not need to be licensed by FSCO, and may be paid directly by automobile insurers without a service provider licence.
Without a service provider licence, service providers must seek direct payment from claimants for goods and services provided in connection with statutory accident benefits. Claimants will then need to seek reimbursement directly from their automobile insurer.
FSCO's Regulatory Powers and Applicable Laws
FSCO's regulation is designed to ensure that service providers have appropriate business practices in place to bill automobile insurers for specific listed expenses provided to statutory accident benefit claimants.
FSCO's responsibilities include:
- Reviewing licence applications submitted by service providers, and providing licences to service providers that meet eligibility requirements.
- Investigating complaints and conducting audits to ensure that service providers are complying with the law, and taking enforcement action when required.
- Informing service providers of any changes to FSCO's regulation and regulatory requirements, and responding to inquiries from service providers.
- Publishing a public registry on FSCO's website with information on current and former service provider licensees.
- Recovering the costs of regulation from the sector by charging fees, and monitoring the fees on an annual basis to ensure they suit the level of regulation needed.
The following regulations made under the Insurance Act set out FSCO's regulatory authorities and requirements for service providers.