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Sunday, November 11, 2018

 
 
 

 
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Anti-Fraud Task Force Issues its Final Report

The Ontario Automobile Insurance Anti-Fraud Task Force Steering Committee has released its Final Report to the Minister of Finance.

The Committee makes several recommendations, including:

  • The formation of an Anti-Fraud Awareness Implementation Group;
  • Require insurers to disclose publicly how they choose and assess the performance of businesses and professionals they recommend to consumers or refer them to see, such as independent medical examiners;
  • Require insurers to ensure their public information on how consumers may register a complaint is simple to understand and easy to locate;
  • The government should reduce uncertainty and delay for those who have legitimate auto insurance claims;
  • Implement a province-wide licensing scheme for the towing industry;
  • Collect information about towing expenses to facilitate analysis of relationships between tow operators, collision repair facilities and health care clinics;
  • Take steps to reduce unreasonable storage costs for vehicles damaged in a collision;
  • Permit insurers to collect a cancellation fee from claimants who fail to attend a medical examination at the agreed time, without reasonable notice or explanation;
  • Insurers should move aggressively to establish an organization that would pool and analyse claims data to identify potential cases of organized or premeditated fraud;
  • Require the licensing of health clinics that treat and assess auto insurance claimants and empower FSCO to regulate their business practices, as well as oversee and audit the business and billing practices;
  • Additional powers for FSCO to conduct fraud investigation and enforcement;
  • Require claimants to confirm attendance at treatment facilities and receipt of goods and services billed to insurers;
  • Require insurers to itemize the list of invoices they have received when they provide a benefit statement to a claimant every two months;
  • Allow insurers to suspend income replacement benefits when there is compelling evidence the claimant has submitted a fraudulent claim in conjunction with an effective, timely and robust dispute resolution system; and
  • Health regulatory colleges should¬†enhance their understanding of the consequences associated with fraud and ensure that complaints are investigated and lead to disciplinary action where appropriate, as well as develop professional standards, guidelines and best practices to improve the quality of independent medical assessments of auto insurance claimants conducted by their members.

The entire report can be read by clicking here.

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