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Ontario Government Announces Specifics of Regulatory Changes to Combat Auto Insurance Fraud

The Ontario Government has made public the regulatory changes that will be made to help combat automobile insurance fraud in the province.  All changes are scheduled to come into effect on June 1, 2013.

The following changes will be in effect for the Statutory Accident Benefits Schedule (SABS):

  • The insurer is bound to pay only to the maximum rates established under the Guidelines for all medical and rehabilitation benefits, except for transportation.
  • The insurer is allowed to have an additional Examination Under Oath of an claimant for the purpose of determining the priority of accident benefits insurers.
  • An insurer will be required to give all reasons, not just a medical reason, for denying a medical or rehabilitation benefit.
  • The insurer can demand:
    • Confirmation in writing that the goods or services were provided to the insured person, and/or
    • A statutory declaration as to the circumstances that gave rise to the invoice.
    • This information must be provided within 10 business days after receiving the request; and
    • An invoice is not overdue and no interest accrues on it during any period during with the insured person has not provided the information within the above timeframe.
  • While the insurer is still obligated to provide regular statements to the insured as to what has been paid out on a claim, they may be required to provide additional information if the Superintendent approves a benefit statement form.

The following changes will be in effect for the Unfair or Deceptive Acts or Practices statute:

  • It will be a deceptive act or practice for anyone other than a lawyer or paralegal to require, request or permit a person to sign a blank OCF form.

The legal reference for these changes are O.Reg 14/13, O.Reg 15/13, O.Reg 16/13.

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