CANADA – Ontario proposes anti-fraud amendments
RANDY CARROLL, CEO OF THE INSURANCE BROKERS ASSOCIATION OF ONTARIO
Ontario’s Ministry of Finance has proposed regulatory amendments stemming from the work of the province’s auto insurance anti-fraud task force.
It is looking for comments from stakeholders by 23rd February on changes to the Statutory Accident Benefits Schedule (1st September 2010) and to regulations concerning disputes between insurers and unfair or deceptive acts or practices.
The proposed amendments are based on several of the recommendations included in the task force’s final report last fall.
One stipulates that the government should reduce uncertainty and delay for those who have legitimate auto insurance claims by moving aggressively to amend the SABS to make it clear that insurers are required to provide claimants with a full explanation when refusing to pay for treatment, assessment or other benefits.
Another says that the government should amend rules so that claimants play a more active role in helping to detect and prevent fraud. It would mean claimants would be required to confirm attendance at treatment facilities and receipt of goods and services billed to insurers. It is also
proposed that insurers should be required to itemise the list of invoices they have received when they provide a benefit statement to a claimant every two months.
The insurers should also have the ability to examine a claimant under oath, where necessary to determine which insurer should be responsible for coverage, without prejudice to the right for an examination under oath that now exists.
The finance ministry also cited a task force recommendation calling for the government to add to the list of activities described as unfair or deceptive acts or practices subject to sanctions under the SABS (charging insurers more for goods or services than the ordinary retail price and requesting a claimant to sign a blank form).
Another one said that the government should clarify the exemption for lawyers and paralegals in the unfair or deceptive acts or practices regulation so that it applies to lawyers and paralegals only when they are acting in a legal capacity.
Randy Carroll, CEO of the Insurance Brokers Association of Ontario said he and his members are encouraged that the government has announced these initial first steps. However, there is still much more to do in order to tackle the fraud problem in Ontario auto insurance.
He added, “The more fraud that is removed out of the system the better chance we have to see reductions in overall premiums and that is why it is essential to keep the ball rolling.”
