On March 27, 2012, the Ontario provincial budget was released. This report includes changes to the definition of catastrophic impairment and enforcement to reduce auto insurance fraud.
The Insurance Bureau of Canada is of course applauding the fraud measures proposed in the budget and the administrative penalties recommended.
On September 1, 2010 the government made major changes to Ontario’s auto insurance system. The government feels that premiums are stabilizing for drivers across Ontario. Building on the success of these reforms, the government wishes to take action to tackle fraudulent and abusive practices, base insurance benefits on scientific and medical principles, and ensure its regulator continues to identify and respond to new and emerging issues.
Auto Insurance Anti-Fraud Task Force
The government is committed to combating insurance fraud and continues to support the Auto Insurance Anti-Fraud Task Force who issued an interim report in December 2011 and the government has already:
- enhanced auto insurance fraud training for police officers;
- started a pilot project using the Health Claims for Auto Insurance database, which will allow health care providers to flag clinics that are misusing their credentials and cut down on identity theft;
- amended regulations to ensure that treatments are provided as invoiced;
- issued a Superintendent’s Guideline to ensure that insurers are not being involved for medical devices at a significantly higher than market rate;
- encouraged the industry to communicate the issue of fraud across a number of media platforms, and measure the current state of consumer engagement and awareness on the issue; and
- required CEOs of automobile insurers in Ontario to annually attest that their accident benefit cost controls are effective and that legitimate claimants claimants are treated fairly.
The Task Force recommended that the government should provide that the Superintendent of Financial Services with the power to impose administrative monetary penalties for contraventions of legislation and regulations. The government is proposing amendments that will provide the authority in order to enhance regulatory effectiveness.
Scientific and Evidence-Based Approaches:
What does the government mean by basing insurance benefits on scientific and evidence based approaches? This is a reference to accident benefits of course. The report mentions that scientific and medical knowledge with respect to identifying and treating “a variety of injuries” has improved “remarkably” over the past decade and states that “The government will ensure, where possible that insurance regulations reflect the most relevant science on identifying and treating injuries from automobile accidents”. This apparent clarity will help minimize disputes over benefits and ensure people get the treatment they need and ensure treatments are based on medical evidence.
The report goes on to say that newer scientific and evidence-based approaches can be applied to serious and minor MVA injuries.
There are recommendations that a new Minor Injury Guideline be developed.
The government received the Superintendent of Financial Services Report with respect to Catastrophic Impairment (based on the work of an expert panel) and will move forward to propose regulatory amendments in this area.
The report is to be made public in the coming weeks. The question is, will the report mirror what the expert panel said? Will Superintendent Phil Howell’s report differ? Two big concerns that the Plaintiffs’ bar has is whether or not the combining of physical and psychological impairments will be allowed to determine catastrophic determination and the use of the Glasgow Coma Scale. To learn more about the proposed changes, refer to our earlier post about the changing definition of catastrophic impairment found here.
Modern Insurance Regulation:
FSCO, the Financial Services Commission of Ontario is to modernize to meet current challenges. The government proposes to enhance FSCO and its regulation of the insurance sector by proposing to:
- engage in a review of the automobile insurance dispute resolution system;
- strengthen the Superintendent’s authority regarding Unfair or Deceptive Acts or Practices;
- clarify the Superintendent’ s authority regarding rate and risk classification approvals;
- support a Superintendent’s review of the profit provision benchmark in auto insurance rate change approvals;
- work with insurers to explore the implications of voluntary usage-based auto insurance policies;
- harmonize the timing of statutory automobile insurance reviews; and
- improve solvency supervision of Ontario insurers.
The new Budget also noted the Ontario government’s intention to review and update the Insurance Act:
- the government is proposing amendments to the life insurance and accident and sickness insurance parts of the Insurance Act to enhance consumer protection, reduce regulatory burden and harmonize with other Canadian jurisdictions; and
- the government is enhancing the effectiveness of its insurance regulation by proposing amendments to give the Superintendent of Financial Services the authority to impose administrative monetary penalties in the insurance sector.
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