When the Insurance Act was amended in 2003, the Legislature imposed a review of Part VI of the act by the Superintendent of Financial Services at least once every five years. Part VI includes approval of forms, motor vehicle liability policies, statutory conditions, direct compensation, limitations on accident insurance, court proceedings, and dispute resolution. This review was to include any Regulations made under Part VI as well. These include the Statutory Accident Benefits Schedule (SABS), uninsured automobile coverage, fault determination rules, disputes between insurers, and court proceedings.
The first review under the government requirements has now been completed and a report was issued at the end of March 2009. Between June 3 and July 14, 2008, stakeholders were invited to submit their comments on this portion of the act and 90 responded, among them the Canadian Society of Chiropractic Evaluators, the Ontario Chiropractic Association and the Ontario Physiotherapy Association (OPA). Overwhelmingly, stakeholders reported that the existing accident benefit system and level of the regulatory burden created by SABS is too complex. It was interesting to note, given that fact, that some stakeholders proposed additional procedures to deal with non-compliance and system abuse that would have added to that complexity.
The report includes 39 recommendations, with #1 proposing that any future changes take into account whether or not they would further complicate the regulations. Definitely a good start!
- #8 – Amend Regulation 283/95 making it more difficult for insurers to deflect claims, ensuring that claimants receive accident benefits while the issue of liability for a claim is resolved (see the article Ontario orders insurer to pay on expired policy in this issue).
- #12 – Cap the fee for completing forms, including any assessment required to complete it, to $200. Cap costs of all other assessments at $2,000.
- #18 – Cap the cost of insurer examinations at $2,000.
- #20 – Revoke section 42.1 of the SABS which allows claimants to obtain an assessment from their health care provider to address issues raised in an insurer examination. The FSCO believes a single care provider should direct patient care.
Reduce the cap for medical and rehabilitation benefits for non-catastrophic claims to $25,000. Introduce an optional medical and rehabilitation benefit of $100,000, along with the existing $1 million optional benefit.
- #26 – FSCO should continue to monitor fees and availability of services in the insurance sector, particularly for seriously injured claimants. Several consumer submissions suggested an increase in the maximum income replacement benefit to bring coverage back to 1996 levels.
- #31 – The government should consider reducing deductibles to $20,000 and $10,000, eliminating deductibles for fatal claims and revoking the definition of serious and permanent impairment that now exists in Regulation 461/96. Both insurer and claimant representatives say that the $1,500 maximum expense award is insufficient for accounting reports and currently not recoverable elsewhere in the accident benefit system.
We urge you to review the total report submitted to the Finance Minister by the Superintendent of Financial Services. We have no doubt that you will be awaiting the government’s response to this report with much interest and we look forward to reporting further. Here’s the link to the full report: