Liberals offer up new DAC replacement scheme in Ontario

According to documents from the Financial Services Commission of Ontario (FSCO) obtained by Canadian Underwriter, a new system to replace Ontario’s “designated assessment centers” (DACs) has been established.
The new “post-DAC” system would allow claimants to receive assessments within the statutory accident benefit schedule (SABS) from their health care provider, and allow insurers to request their own assessment if the initial assessment is in question. However, the DAC stage is eliminated and a disputed SABS claim will go directly to FSCO’s dispute resolution process or to the courts following mediation.
The goal is to eliminate DACs, which were found to be a costly and duplicative service by the new Ontario Liberal government. The first stab at reform, the “expert assessor network” was not well received by stakeholders, including insurers, sending the government back to the drawing table.
The new system, which will require amendments to the SABS regulations, will create a new category of examinations in addition to existing “section 24” assessments. The “pre-claim examination” can be requested by the insurer and within five days following that examination a report would be sent to insurer, insured and the insured’s health practitioner.
Other changes include the removal of attendant care benefits from the SABS, with approval for such benefits to rest with the superintendent of FSCO; insurers being allowed to negotiate assessment fees directly with individual health care providers; the potential to avoid multiple assessments by combining them into one comprehensive examination; set timelines for the completion of assessments and notification to parties; the elimination of the DAC committee with no replacement.
New regulations to amend the Insurance Act also set out a clear list of what will be considered “unfair or deceptive practices”, including an insurer requesting examinations which are not reasonably required, or a service provider accepting or paying referral fees.
It is expected the full proposal will be released on the FSCO website later this week.