Statutory Accident Benefits for Car Accident Victims in a COVID-19 World
With the COVID-19 worldwide pandemic, insurance companies have had to adjust their methods in dealing with their insureds. This is certainly true in Ontario for those who have been injured in a car accident. In the new norm of COVID-19, insurance companies need to be more flexible than ever in how they communicate with their customers. They also need to allow virtual care or treatment when it is a reasonable alternative for their insureds. The Financial Services Regulatory Authority of Ontario (FSRA) is the government agency that regulates automobile insurance in the province. It was created to improve consumer and pension plan beneficiary protections in Ontario. The FSRA took over from the Ontario Financial Services Commission (FSCO) in June of 2019. FSRA has released guidance that is aimed at ensuring consumers are treated fairly during the COVID-19 emergency period. The guidance is intended to assist insurance companies in meeting their requirements under the Unfair or Deceptive Acts or Practices regulation.
Reasonable AccommodationThe regulation requires insurance companies to adjust and settle claims fairly and without unreasonable delay. The FSRA guidelines further require insurance company to reasonably accommodate claimants during the COVID-19 emergency. What is reasonable has to be looked at on a case-by-case basis, but can include:
- Being flexible in how the insurance company receives claims information or consent, such as getting information by telephone or email rather than requiring a signed hard copy of a document;
- Waiving or relaxing requirements for a medical assessments or examinations that cannot reasonably be done during the COVID-19 emergency or permitting virtual examinations or assessments instead; and
- Paying for virtual care where this is reasonable and necessary to meet the rehabilitation and/or medical needs of the claimant.
Virtual CareHealthcare providers are also expected to take additional steps during the COVID-19 emergency to ensure that patients are treated fairly when receiving Statutory Accident Benefits Schedule (SABS). The amounts charged are to be reasonable and should not exceed the amount charged to other persons for similar goods and services, which are generally provided in-person. Virtual care allows you to speak and interact with members of your healthcare/ rehabilitation team without attending in person at a medical office, therapist's office, or hospital. Virtual care can be done using a telephone, smartphone, tablet, or computer.
- Virtual care should be appropriate and effective based on the individual's case and when it is supported by the health service provider's regulatory college and approved by the insurer acting reasonably; and
- The health care provider needs to obtain the patient's informed consent and in order to do so, the health care person needs to clearly explain what the virtual treatment will be and its objectives, and how the fees will erode the amount available to the insured for future treatment.
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