Ontario auto insurance regulation changes take effect

Several amendments to Ontario auto insurance regulation took effect June 1, including changes to the Unfair or Deceptive Practices regulation and to the Statutory Accident Benefits Schedule.

Ontario Regulation 7/00, which is part of the Unfair or Deceptive Practices Act, now makes it illegal to request, require or permit an insurance claimant to sign an incomplete claim form. That change, and others, were initially announced in January and published in the Feb. 9 issue of the Ontario Gazette.

The part of SABS (also known as Ontario Regulation 34/10), which requires carriers to send a notice within 10 days of receiving a treatment and assessment plan, has been changed.

Until now, when denying claims, carriers were required to include in their notices to claimants, “the medical and any other reasons why the insurer considers any goods, services, assessments and examinations, or the proposed costs of them, not to be reasonable or necessary.”

The word “any” has been changed to “all” effective June 1. Therefore carriers now, when denying claims, must tell claimants the medical reasons and “all of the other reasons why the insurer considers any goods, services, assessments and examinations, or the proposed costs of them, not to be reasonable and necessary”.

Another amendment to SABS that took effect June 1 gives insurance carriers the right to request confirmation in writing that goods or services were provided to the insured person, when either the claimant submits an invoice to the carrier for payment for goods or service, or when someone else submits an invoice on a claimant’s behalf.

The SABS also now gives carriers the right to ask for a statutory declaration as to the circumstances that gave rise to the invoice, including particulars as to when, where and by whom the goods or services were provided.

Another change now in effect affects both the SABS and Ontario Regulation 283/95, on disputes between insurers.

Section 33, paragraph 2(a) of SABS states that a claimant, when requested by an insurer, “shall submit to an examination under oath,” but is not required to “submit to more than one examination under oath in respect of matters relating to the same accident.”

As of June 1, that clause now “shall not be interpreted as prohibiting an additional examination of the applicant under oath, under Ontario Regulation 283/95 (Disputes Between Insurers) made under the Act, at the insurer’s request that is conducted for the purpose of determining who is liable under section 268 (of the Ontario Insurance Act) to pay statutory accident benefits in respect of the accident.”

The Unfair or Deceptive Practices Act now clarifies the exemption for lawyers and paralegals. As of June 1, that law applies to lawyers and paralegals “when not acting in a legal capacity.”