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Accident Benefits Archives

New FSCO Decision Limits Timelines for Examination Under Oath for Specified Benefits

NOTE: This arbitration decision was overturned on appeal.  A petition for Judicial Review was filed, but later abandoned. The Financial Services Commission of Ontario (FSCO) has released an arbitration decision that limits an insurer's ability to request an Examination Under Oath in certain cases. In the decision Neil Williams and State Farm Mutual Automobile Insurance Company [FSCO A14-001463], Arbitrator Maggy Murray considered whether or not an insurer was prohibited from providing a notice of an Examination Under Oath more than 10 business days after receiving an application and completed disability benefit for a specified benefit. A specified benefit is an income replacement benefit, caregiver benefit, non-earner benefit, or housekeeping and home maintenance benefit. Section 36(4) of the Statutory Accident Benefits Schedule (SABS), reads as follows (emphasis added):

Genie Boom Crane is an "Automobile": FSCO Arbitrator

Note: This decision was overturned on appeal. A new arbitration decision from the Financial Services Commission of Ontario (FSCO) has determined that a "Genie Boom Crane" is an "automobile" under the Statutory Accident Benefits Schedule. The decision, Joseph Beattie and Unifund Assurance Company [FSCO A13-005289], describes the Genie as, "a four-wheeled mobile crane, propelled by its own motor", which is used to elevate a worker to perform a maintenance function. In this particular case, the Applicant, Mr. Beattie, was operating the crane on a private parking lot.  The ground level collapsed into the level below, injuring him.  Mr. Beattie applied for accident benefits through his own insurance company, Unifund Assurance.  Unifund took the position that the crane was not an "automobile" at the time and place when the structure collapsed and was, therefore, not an "accident". The arbitrator found that, since the crane was a "vehicle propelled or driven otherwise than by muscular power" and did not meet the specific exclusions under the section of the Highway Traffic Act, it was a vehicle.  Since it was used off-road, it did not require compulsory insurance, thereby not making it subject to the provisions of the Insurance Act. The entire decision can be read by clicking on the link below. Beattie and Unifund - Genie Boom - Accident

New OCF Forms to be used effective November 1, 2014

The Financial Services Commission of Ontario (FSCO) has released two bulletins with new forms to be used for accident benefits claims, effective November 1, 2014. The new forms include the Application for Accident Benefits (OCF-1), Treatment and Assessment Plan (OCF-18), Auto Insurance Standard Invoice (OCF-21) and the Treatment Confirmation Form (OCF-23). In a bulletin released by FSCO it was indicated that the reason for these changes is "to improve transparency and clarity regarding data analytics and pooling of information to detect fraud.  The OCF-23 has also been revised to accommodate Service Provider Licensing." These new forms can be downloaded at the links below:
OCF-1 - Effective Nov 1, 2014
OCF-18 - Effective November 1, 2014
OCF-21 - Effective November 1, 2014
OCF-23 - Effective November 1, 2014

Bus Passes or Tickets constitute an "Economic Loss": FSCO

The Financial Services Commission of Ontario (FSCO) has released an arbitration decision that confirms that the purchase of bus passes or tickets by a non-professional for the provision of housekeeping and home maintenance, as well as caregiving services and (arguably) attendant care, constitutes "economic loss" under the Statutory Accident Benefits Schedule (SABS). On September 1, 2010, the accident benefits legislation was changed so that non-professionals (i.e., those who have not provided the services in the course of the employment, occupation or profession in which he or she would ordinarily have been engaged, but for the accident) could only be reimbursed for the services they provided if they had incurred an economic loss.  The term "economic loss" was not defined within the regulations. In the decision Asokumaran and TD Home (FSCO A12-007443) Arbitrator Susan Alves noted that it was submitted that the insured's friend purchased bus tickets and/or passes to travel to the insured's home.  Both parties agreed to submit to a preliminary issue on whether or not these expenses would constitute an "economic loss".  The arbitrator did not address whether or not these expenses were incurred to provide the housekeeping and caregiver services and that issue will be decided at the main arbitration hearing. What is clear from this decision is the rejection of a de minimis requirement (that is, that there is a possible minimum amount required for an economic loss argument to be established).  The insurer in this case relied heavily on a previous arbitration decision, Simser and Aviva Canada, which was generally restrictive with respect to broader-use definitions of what constitutes an economic loss.  Arbitrator Alves noted the following:

Balance needed between interests of drivers, insurers

June 2, 2014

Balance needed between interests of drivers, insurers

While the future of a bill meant to address pressing concerns in the auto insurance system is unknown, the issues persist, and drivers are still in need of cost-saving solutions, says Toronto personal injury lawyer Peter Cho. The Liberal government's Bill 171, the Fighting Fraud and Reducing Automobile Insurance Rates Act, passed second reading in April, and proposed making several changes to the auto insurance dispute resolution system. The bill is now effectively dead as the legislature has dissolved for the June 12 election. Cho, associate with Smitiuch Injury Law, said he's glad to see Bill 171 go by the wayside, but as long as auto insurance rates remain an issue in Ontario, another version of the bill is likely to be presented in the near future. Read the complete article at: Advocatedaily.com Contact Peter Cho for further information.

FSCO Increases Attendant Care Hourly Rates

The Financial Services Commission of Ontario (FSCO) has just released the updated hourly rates for attendant care for all accidents after June 1, 2014.  This applies to accident benefits claims. Part 1 services (for routine personal care) will be $13.19 per hour.  Part 2 services (for basic supervisory functions) will be $11.00 per hour.  Part 3 services (complex health/care and hygiene functions) will be $19.35 per hour. A copy of the guideline can be obtained by clicking below. 2014 Attendant Care Hourly Rate Guidelines

FSCO Issues Revised Minor Injury Guideline and OCF-18

The Financial Services Commission of Ontario (FSCO) has released a revised Minor Injury Guideline (MIG) as well as a revised Treatment and Assessment Plan (OCF-18).  Both of these become effective February 1, 2014. These revisions reflect the changes to be made to the Statutory Accident Benefits Schedule (SABS) on February 1, 2014. To access the FSCO Bulletin, as well as the documents, click here.

Health Care Clinics to be Regulated by Ontario Government

The Government of Ontario has filed regulations governing health care clinics and assessment centres who provide services paid for by automobile insurers. The following was reported on Willie Handler's Blog this morning.  Mr. Handler formerly worked in auto insurance regulatory policy for the Ontario government.

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