O. Reg. 14/13: STATUTORY ACCIDENT BENEFITS SCHEDULE - EFFECTIVE SEPTEMBER 1, 2010

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ontario regulation 14/13

made under the

insurance act

Made: January 21, 2013
Filed: January 22, 2013
Published on e-Laws: January 22, 2013
Printed in The Ontario Gazette: February 9, 2013

Amending O. Reg. 34/10

(statutory accident benefits schedule — effective september 1, 2010)

1. Clause 15 (2) (b) of Ontario Regulation 34/10 is revoked and the following substituted:

(b) for expenses related to goods and services described in subsection (1) rendered to an insured person that exceed the maximum rate or amount of expenses established under the Guidelines, other than for expenses related to the services described in clause (1) (g); or

2. Clause 16 (4) (a) of the Regulation is revoked and the following substituted:

(a) for expenses related to goods and services described in subsection (3) rendered to an insured person that exceed the maximum rate or amount of expenses established under the Guidelines, other than for expenses related to the services described in clause (3) (k);

3. The French version of subsection 25 (3) of the Regulation is revoked and the following substituted:

(3) L’assureur n’est pas tenu, aux termes du paragraphe (1), de payer l’excédent des frais liés à des services professionnels fournis à la personne assurée sur le tarif ou le montant maximal de frais calculé suivant les directives.

4. Section 33 of the Regulation is amended by adding the following subsection:

(9) Clause (2) (a) 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 Act to pay statutory accident benefits in respect of the accident.

5. Subsection 38 (8) of the Regulation is amended by striking out “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” at the end and substituting “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”.

6. The Regulation is amended by adding the following section:

Duty of insured person to provide information

46.3 (1) An insurer may request any of the following information from an insured person who submits an invoice to the insurer for payment for goods or services under this Regulation, or from an insured person on whose behalf such an invoice is submitted:

1. Confirmation in writing that the goods or services were provided to the insured person.

2. 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.

(2) The insured person shall give the insurer the information requested under subsection (1) within 10 business days after receiving the request.

(3) For the purpose of section 51, the amount payable by an insurer under an invoice is not overdue and no interest accrues on it during any period during which an insured person fails to comply with subsection (2).

7. Subsection 50 (3) of the Regulation is amended by striking out “and” at the end of clause (d), by adding “and” at the end of clause (e) and by adding the following clause:

(f) if the Superintendent approves a benefit statement form for the purposes of this section, such other information as may be required by the approved form.

Commencement

8. This Regulation comes into force on the later of June 1, 2013 and the day it is filed.

 

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