Amendments to Anti-Fraud Regulations - Effective June 1, 2013

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Recently the Ontario Government released an update regarding regulatory changes that will be implemented to help fight fraud in the insurance industry.

On January 21, 2013 these changes were approved and will come into effect on June 1, 2013. This change is referred to as, Regulation 14/13, and it was created to amend the Statutory Accident Benefits Schedule (SABS) 34/10. Below is an outline of the Specific amendments;

  1. A requirement for insurers to provide all reasons when denying medical and rehabilitation claims
  2. Giving FSCO authority to stipulate additional information that insurers must provide in bi-monthly benefit statements to claimants
  3. Giving insurers authority to require claimant confirmation of receipt of goods and services that have been billed
  4. Providing FSCO with authority to stipulate by Guideline the maximum payable by insurers for goods as well as services

The amendments were only made to a particular section, section 38(8), which outlines the requirements for insurers to give reasons for denying medical and rehabilitation claims. Also, FSCO plans to implement a new standard form in anticipation of the regulations coming into effect. This will require insurers to use the new form for all bi-monthly benefit statements to claimants. Regulation 15/10 amends the Unfair or Deceptive Acts or Practices (UDAP) Regulation - 7/00. Amendments to UDAP regulation include;

  • An offence to request, require or permit a claimant to sign an incomplete claim form
  • Clarifying the exemption for lawyers and paralegals to ensure the regulation applies to lawyers and paralegals when not acting in a legal capacity

Regulation 16/13 amends the Disputes Between Insurers (DBI) Regulation - 283/95. This change allows the insurer to have a claimant examined under oath after they received the initial application for benefits. Through this they will determine the priority issues involved in each particular case. The new DBI requirement is giving the insurer a second opportunity to determine the claimants accident benefits, which is unfair to the victims.

Again, these changes all point to aiding insurers, NOT THE VICTIMS. Perhaps FSCO believes this is necessary to help prevent fraud, however, they are further scrutinizing claimants/victims by creating more road blocks and hoops for them to jump through in order to receive the benefits they are owed. It is essential to ensure we are treating these victims with respect rather than focusing on saving insurance companies money.



Gluckstein Personal Injury Lawyers:


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