O. Reg. 7/00: UNFAIR OR DECEPTIVE ACTS OR PRACTICES

Insurance Act
Loi sur les assurances

ONTARIO REGULATION 7/00

Amended to O. Reg. 278/03

UNFAIR OR DECEPTIVE ACTS OR PRACTICES

Historical version for the period November 1, 2003 to August 25, 2004.

This Regulation is made in English only.

1. For the purposes of the definition of “unfair or deceptive act or practice” in section 438 of the Act, each of the following actions is prescribed as an unfair or deceptive act or practice:

1. The commission of any act prohibited under the Act or the regulations.

2. Any unfair discrimination between individuals of the same class and of the same expectation of life, in the amount or payment or return of premiums, or rates charged for contracts of life insurance or annuity contracts, or in the dividends or other benefits payable on such contracts or in the terms and conditions of such contracts.

3. Any unfair discrimination in any rate or schedule of rates between risks in Ontario of essentially the same physical hazards in the same territorial classification.

4. Any illustration, circular, memorandum or statement that misrepresents, or by omission is so incomplete that it misrepresents, terms, benefits or advantages of any policy or contract of insurance issued or to be issued.

5. Any false or misleading statement as to the terms, benefits or advantages of any contract or policy of insurance issued or to be issued.

6. Any incomplete comparison of any policy or contract of insurance with that of any other insurer for the purpose of inducing or intending to induce an insured to lapse, forfeit or surrender a policy or contract.

7. Any payment, allowance or gift or any offer to pay, allow or give, directly or indirectly, any money or thing of value as an inducement to any prospective insured to insure.

8. Any charge by a person for a premium allowance or fee other than as stipulated in a contract of insurance upon which a sales commission is payable to the person.

9. Any conduct resulting in unreasonable delay in, or resistance to, the fair adjustment and settlement of claims.

10. Making the issuance or variation of a policy of automobile insurance conditional on the insured having or purchasing another insurance policy.

11. When rating a person or a vehicle as an insurance risk for the purpose of determining the premium payable for a policy of automobile insurance, misclassifying the person or vehicle under the risk classification system used by the insurer or that the insurer is required by law to use.

12. The use of a document in place of a form approved for use by the Superintendent, unless none of the deviations in the document from the approved form affects the substance or is calculated to mislead.

13. Any examination or purported examination under oath that does not comply with the requirements under the Act or the regulations. O. Reg. 7/00, s. 1; O. Reg. 278/03, s. 1.

2. For the purposes of the definition of “unfair or deceptive act or practice” in section 438 of the Act, an action described in this section by an insurer, by an officer, employee or agent of an insurer or by a broker is prescribed as an unfair or deceptive act or practice:

1. When such a person makes or attempts to make, directly or indirectly, an agreement with a person insured or applying for insurance in respect of life, person or property in Ontario as to the premium to be paid for a policy that is different from the premium set out in the policy.

2. When such a person pays, allows or gives, directly or indirectly, a rebate of all or part of the premium stipulated by a policy to a person insured or applying for insurance in respect of life, person or property in Ontario, or offers or agrees to do so.

3. When such a person pays, allows or gives, directly or indirectly, any consideration or thing of value that is intended to be in the nature of a rebate of the premium, stipulated by a policy to a person insured or applying for insurance in respect of life, person or property in Ontario, or offers or agrees to do so. O. Reg. 7/00, s. 2.

3. (1) For the purposes of the definition of “unfair or deceptive acts or practices” in section 438 of the Act, each act and omission listed in subsection (2) is prescribed as an unfair or deceptive act or practice if it is committed by or on behalf of a person with the expectation that a benefit will be received that is funded, directly or indirectly, out of the proceeds of insurance. O. Reg. 278/03, s. 2.

(2) The following are the acts and omissions listed for the purposes of subsection (1):

1. Charging an amount in consideration for the provision of goods or services to or for the benefit of a person who claims statutory accident benefits if the goods or services are not provided.

2. Soliciting or demanding a referral fee, directly or indirectly, by or from a person who provides goods or services to or for the benefit of a person who claims statutory accident benefits.

3. Acceptance of a referral fee, directly or indirectly, by or from a person who provides goods or services to or for the benefit of a person who claims statutory accident benefits.

4. The payment of a referral fee, directly or indirectly, to or by a person who provides goods or services to or for the benefit of a person who claims statutory accident benefits.

5. Charging an amount in consideration for the provision of goods or services to or for the benefit of a person who claims statutory accident benefits where the amount charged unreasonably exceeds the amount charged to other persons for similar goods or services.

6. The failure to disclose a conflict of interest to a person who claims statutory accident benefits or to an insurer, as required under the Statutory Accident Benefits Schedule. O. Reg. 278/03, s. 2.

4. (1) For the purposes of the definition of “unfair or deceptive acts or practices” in section 438 of the Act, each of the following acts or omissions of a person is prescribed as an unfair or deceptive act or practice if it occurs in connection with an activity described in subsection 398 (1) of the Act or in connection with the representation of someone in a proceeding under sections 279 to 284:

1. The solicitation or acceptance of or demand for a fee by the person under a contingency fee arrangement.

2. The solicitation or acceptance of or demand for a referral fee, directly or indirectly, by the person from another person who provides goods or services to or for the benefit of anyone who claims statutory accident benefits.

3. The payment of a referral fee by the person, directly or indirectly, to another person who provides goods or services to or for the benefit of anyone who claims statutory accident benefits.

4. An act or omission that is inconsistent with the Code of Conduct for Statutory Accident Benefit Representatives issued by the Superintendent and published in The Ontario Gazette, as it may be amended from time to time.

5. The failure by the person to disclose a conflict of interest relating to a claim for statutory accident benefits to anyone who claims the benefits or to the appropriate insurer. O. Reg. 278/03, s. 2.

(2) For the purposes of paragraph 5 of subsection (1), a person has a conflict of interest relating to a claim for statutory accident benefits if,

(a) the person could receive, directly or indirectly, a financial benefit that arises out of the claim, other than compensation for providing a service referred to in subsection 398 (1) of the Act or for representing another person; or

(b) anyone related to the person may receive, directly or indirectly, a financial benefit that arises out of the claim. O. Reg. 278/03, s. 2.

(3) Subsections (1) and (2) apply to every person other than a barrister and solicitor acting in the usual course of the practice of law, whether the person is prohibited from carrying on an activity described in subsection 398 (1) of the Act or is legally entitled to represent someone in a proceeding under sections 279 to 284 of the Act. O. Reg. 278/03, s. 2.

(4) For the purposes of clause (2) (b),

(a) a person is related to another person if,

(i) one person is the spouse or same-sex partner of the other person,

(ii) one person is connected with the other person by blood relationship or adoption, or

(iii) one person is connected by blood relationship to the spouse or same-sex partner of the other person;

(b) persons are connected by blood relationship if,

(i) one is the child or other descendant of the other person, or

(ii) one is the brother or sister of the other person; and

(c) persons are connected by adoption if one has been adopted, either legally or in fact, as the child of,

(i) the other person, or

(ii) a person who is connected by blood relationship to the other person but is not the brother or sister of the other person. O. Reg. 278/03, s. 2.

(5) For the purposes of subsection (2), a financial benefit arises out of a claim for statutory accident benefits where the benefit is related to the claim and would not have arisen if the claim had not been made. O. Reg. 278/03, s. 2.