March 3, 2010 by Canadian Underwriter
Regulations for Ontario’s auto insurance reforms are now public, and will take effective on Sept. 1, 2010, the province’s insurance regulator has announced.
The reforms include a new Statutory Accident Benefits Schedule (SABS) that will cap medical/rehabilitation and assessment/examination expenses for minor injuries at $3,500.
The new SABS also features a new Minor Injury Guideline for accidents.
A minor injury is defined under the new SABS as “a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae.” (Sequelae are symptoms arising as a result of any of the listed injuries.)
Reforms to the SABs will provide standard medical and rehabilitation coverage for non-catastrophic claims of $50,000, with optional coverage of $100,000 or $1.1 million.
The reforms will offer standard attendant care coverage for non-catastrophic claims of $36,000, with optional coverage of either $72,000 or $1.072 million.
For non-catastrophic claimants, insurers will supply optional caregiver, housekeeping and home maintenance benefits. Payment for in-home assessments will be available only to those claimants who have sustained more than a minor injury.
Assessments will be capped at $2,000. This applies to all assessments, be they requested by the claimant or the insurer. Rebuttal examinations will be eliminated, as will be a number of existing approval forms.
Several procedures will be simplified. For example, treatment plans and applications for approval of assessments or examinations will be merged into one process. And the rules governing claims processing will be simplified and consolidated.
Adjusters will have discretion in the use of insurer examinations.
The new SABS also contains a definition for “incurred expense”.
The new SABs (Ontario Regulation 34/10) is available on e-laws at: