Anti-Fraud Regulations Became Effective on June 1, 2013

Earlier this year the Ontario Government released the regulatory changes that will be made to help combat auto insurance fraud.  The changes were approved on January 21, 2013 and became effective on June 1, 2013. 

Regulation 14/13 amends the Statutory Accident Benefits Schedule (SABS) - 34/10. 

The amendments to the SABS include:

• a requirement for insurers to provide all reasons when denying medical and rehabilitation claims; 
• providing FSCO with authority to stipulate additional information that insurers must provide in bi-monthly benefit statements to claimants; 
• giving insurers authority to require claimant confirmation of receipt of goods and services that have been billed; and 
• providing FSCO with authority to stipulate by Guideline the maximum payable by insurers for goods as well as services.

A revised Cost of Goods Guideline was issued by FSCO on May, 29, 2013.  The accompanying Bulletin (A-2/13) also releases a number of revised claim forms. Effective January 1, 2013, the maximum fines under Part XIX of the Act have increased from $100,000 to $250,000 for a first conviction for an offence, and from $250,000 to $500,000 for each subsequent conviction. 

The following forms have been revised to reflect these changes:

• OAP 1 – Ontario Automobile Policy, Owner’s Policy
• OAF 1 – Ontario Application for Automobile Insurance
• OCF-1 – Accident Benefits Application Package
• OAF 4 – Ontario Application for Automobile Insurance Garage Form
• OAP 4 – Ontario Garage Automobile Policy
• Garage Certificate of Insurance – (Ontario)
• Certificate of Automobile Insurance  – (Ontario)

Regulation 15/10 amends the Unfair or Deceptive Acts or Practices (UDAP) Regulation - 7/00.

The changes to the UDAP regulation include:

• an offence to request, require or permit a claimant to sign an incomplete claim form and 
• 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.

The amendment to the DBI regulation allows for the insurer that receives the initial application for benefits to request one examination of the claimant under oath to assist in the determination of priority issues.

This amendment provides insurers with a second opportunity to request a claimant undergo an examination under oath.  The new DBI requirement is to assist an insurer to determine which insurer is liable to pay the claimant accident benefits.  The SABS provisions continues to assist an insurer to determine whether the claimant entitled to accident benefits.