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Friday, November 17, 2017

 
 
 

 
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Posts Tagged ‘MIG’

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.

Health Care Professionals: Be sure to use new HCAI Forms starting on November 1, 2012

The Financial Services Commission of Ontario (FSCO) has released a new Assessment and Treatment Plan (OCF-18) form, a new Treatment Confirmation Form (OCF-23) and a new Auto Insurance Standard Invoice (OCF-21) for use effective November 1, 2012.  Older versions of these forms will not be allowed as of that date.

You can download these new forms directly from our website by clicking on the links below:

OCF18-2012

OCF21 – 2012

OCF23 – 2012

Anti-Fraud Task Force Steering Committee is Seeking Public Comment

The Ontario Auto Insurance Anti-Fraud Task Force Steering committee is seeking public input on a number of potential recommendations prior to their final report in the fall of 2012.

These recommendations include:

  • Regulation of health clinics
  • Regulation of the towing industry
  • Enhanced authority for FSCO to regulate the business practices of health care treatment and assessment facilities
  • Tightened controls on the delivery of Accident Benefits, including requiring the patient’s signature on invoices before they are submitted, a second Examination under Oath, and billing claimants $500 if the claimant fails to attend an insurer’s examination.  Also being considered is requiring insurers to provide itemized statements to claimants every 60 days
  • Amending the consent provisions of the auto insurance applications to provide greater certainty about the ability to share information for the purpose of detecting and preventing fraud.
  • Provide insurers with broader civil immunity to protect them from lawsuits for reporting suspicious behaviour to regulators and the police
  • A website devoted to informing those injured in motor vehicle accidents about accident benefits and how to detect and report suspicious or inappropriate behaviour
  • Mandatory disclosure by insurance companies to the public about how they select and supervise their preferred providers of services – including independent medical examinations
  • For FSCO to hire appropriate staff and resources to carry-out these recommendations

The entire update can be read by clicking here.

FSCO Awards MIG Protocol Contract

Dr. Pierre Côté has been awarded the consulting contract by the Financial Services Commission of Ontario (FSCO) to develop the Minor Injury Protocol.  Dr. Côté is Associate Professor, Dalla Lana School of Public Health, at the University of Toronto.

According to the FSCO website, “Scientists and other experts will contribute to the development of an evidence-based Minor Injury Treatment Protocol (MITP) that will form the basis of a new Minor Injury Guideline.  The protocol will be used by insurers and health care providers when treating minor injuries resulting from automobile accidents and ensure that there is an extensive continuum of care based on current and scientific and medical evidence.  The MITP will include clinical prediction rules to screen for patients who may be at higher risk for developing chronic pain and disability. In addition, it will focus on treatment outcomes and provide health care providers with numerous milestones that could be used to measure progress.”
No details with regard to timelines for the protocol were released.

Toronto Star: Auto Insurers Routinely Deny Treatment Plans

An article in today’s Toronto Star addresses the issue of an increase in denials of treatment plans by auto insurers for people who are injured in automobile accidents.

It is reported that the Ontario Government intends to hold public hearings on auto insurance.

You can read the entire article by clicking here.

FSCO Releases 2012 Draft Statement of Priorities

The Financial Services Commission of Ontario (FSCO) has released its draft Statement of Priorities for 2012.

Many of the priorities focus on changes to the auto insurance sector.  They include the following:

  • Continuing to assess the extent of auto insurance fraud and consider the recommendations of the task force when their report is released in the Fall of 2012;
  • Exploring ways to utilize the Health Claims for Auto Insurance (HCAI) system to detect and prevent fraud;
  • Implement auto insurance recommendations made in the Auditor General of Ontario’s 2011 Annual Report;
  • Undertake long-term auto insurance reform initiatives, including review of the Minor Injury Group (MIG) protocol and changes to the catastrophic impairment criteria;
  • Reduce the mediation backlog; and
  • Conduct market conduct audit reviews of compliance with the 2010 auto insurance reforms including Statutory Accident Benefits;

The entire draft Statement of Priorities can be read by clicking here.

Ontario Budget Brings Announcement of Auto Insurance Reforms

Further reforms to Ontario’s Auto Insurance Industry are planned as part of the 2012 Budget announcement made yesterday in Toronto.  Two of these measures include changes to the
definition of catastrophic impairment and further enforcement of auto insurance fraud.

In 2010, the government made major changes to the auto insurance system. As a result, premiums are stabilizing for drivers across Ontario. Building on the success of the 2010 reforms, the government is taking action to tackle fraudulent and abusive practices, base insurance benefits on scientific and medical principles, and ensure its regulator continues to identify and respond to new and emerging issues. The government’s ongoing work in the area of auto insurance, including fraud, should continue to reduce the pressure on premiums.

Some of the key changes to be implemented include:

  • Regulation of health clinics;
  • Other gaps in regulation;
  • Establishment of a dedicated fraud unit;
  • Consumer education and engagement strategy;
  • A single web portal for auto insurance claimants;
  • Development of new Minor Injury Guideline;
  • Make the report of the Superintendent of Financial Services on catastrophic impairment public and move forward to propose regulatory amendments in this area;
  • Engage in a review of the automobile insurance dispute resolution system;
  • Strengthen the [FSCO] Superintendent’s authority regarding rate and risk classification approvals;
  • Support a Superintendent’s review of the profit provision benchmark in auto insurance rate change approvals;
  • Work with insurers to explore the implications of voluntary usage-based auto insurance policies;
  • Harmonize the timing of statutory automobile insurance reviews;
  • Improve solvency supervision of Ontario insurers
  • Update Ontario’s Insurance Act by:
    • Proposing amendments to the life insurance accident and sickness insurance parts of the Insurance Act to enhance consumer protection, reduce regulatory burden, and harmonize
      with other Canadian jurisdictions; and
    • Enhancing the effectiveness of its insurance regulation by proposing amendments to give the Superintendent of Financial Services the authority to impose administrative monetary penalties in the insurance sector.

You can read the Government’s comments on the insurance industry by clicking here.

The Toronto Sun explores the human side of the “catastrophic” debate

A story written in the Toronto Sun looks at the current debate over the definition of catastrophic impairment and details the ongoing battles of Robert Kusnierz, whos recent Ontario Court of Appeal win supported the combining of physical and psychological impairments for determining a whole body impairment.

You can read the article in full by clicking here.

Ontario Court of Appeal: Desbiens Stands

The Ontario Court of Appeal has reversed the decision of Kusnierz v. Economcial Insurance.

In the Kusnierz v. Economical Insurance decision, Justice Lauwers had determined that it was not permissible to assign percentage ratings in respect of psychological impairments under 2 (1.1)(g) of the Statutory Accident Benefits Schedule (SABS) and combine them with percentage ratings in respect of Kusnierz’s physical impairments under Clause 2(1.1)(f) of the SABS for the purposes of determining whether an individual was catastrophically impaired.

Justice Lawers reviewed the earlier decision of Justice Spiegel in Desbiens v. Mordini but respectfully came to a different conclusion.  Justice Lauwers did not review any of the FSCO decisions on the issue.

This means that both physical and psychological impairment percentage ratings can be combined when determining a catastrophic impairment.

Toronto Star: Fight fraud, but not at the expense of legitimate claimants

The Toronto Star has published an article about the need to find balance between fighting fradulent accident benefits claims and providing necessary goods and services for legitimaely injured clients.

You can read this article by clicking here.

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