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Accident Benefits Archives

FSCO: No Raise for Treating Professionals in 2013

The Financial Services Commission of Ontario (FSCO) has released an updated Professional Services Guideline for 2013. According to the FSCO website, "The hourly rates are unchanged from the 2012 level. This is in line with the auto insurance rate reduction strategy outlined in the government's 2013 Spring Budget."  It has also added a category for kinesiologists, who are now regulated health professionals in Ontario. A copy of the 2013 Professional Services Guideline is available by clicking here.

FSCO: Mediation Backlog will be over by September 2013

The Financial Services Commission of Ontario (FSCO) is reporting that the backlog of mandatory mediations will be over by the end of August, 2013. When an accident benefits insurer denies a benefit, such as medical treatment, a mediation through FSCO is the mandatory first step in the dispute resolution process.  In previous years a mediation date would often take up to one year from the date the mediation application was submitted.  Judicial and arbitration decisions (ironically from arbitrators at FSCO) deemed that a mediation must be conducted within 60 days in accordance with the Dispute Resolution Practice Code or it can be deemed to have been failed. FSCO provided statistics and timelines with respect to the backlog.  These can be viewed by clicking here.

Ontario Trial Lawyers Association Law Clerks Section new Chair - Chris Jackson

Chris Jackson was elected Chair of the Law Clerks Section of the Ontario Trial Lawyers Association (OTLA) on May 31, 2013, at the association's Annual General Meeting in Toronto. His term is for the 2013 - 2014 year.   Chris is the Accident Benefits Manager at Smitiuch Injury Law.   He can be reached directly at 416-621-1551 or [email protected]

First MIG Decision Released by FSCO

The Financial Services Commission of Ontario (FSCO) has released the very first decision with respect to injuries that fall within the Minor Injury Guidelines (MIG). In Lenworth Scarlett and Belair Insurance Company Inc. [FSCO A12-001079], Arbitrator John Wilson has provided clarification regarding what injuries subject an insured person to a maximum of $3,500.00 in medical and rehabilitation benefits. While Mr. Scarlett suffered soft-tissue (whiplash) injuries in his motor vehicle accident, he was also diagnosed with Temporal Mandibular Joint Syndrome, as well as psychological issues.  Despite the provision of documentation that supported injuries beyond those subject to the MIG, Belair maintained its position that he was subject to the MIG limits for accident benefits.  As Arbitrator Wilson pointed out, "In essence, Mr. Scarlett's attempts to claim certain benefits from Belair were being rebuffed because Belair took the position that he was within the MIG and either the benefits were not payable or they were in excess of what was required to be paid under that approach.  This appeared to be a major stumbling block since, even when Mr. Scarlett provided further evidence of complicating features of his claim that in his mind took it outside of the MIG framework, he was met with the same response." Arbitrator Wilson outlined the critical elements of the MIG as follows:

Ontario Government Announces Specifics of Regulatory Changes to Combat Auto Insurance Fraud

The Ontario Government has made public the regulatory changes that will be made to help combat automobile insurance fraud in the province.  All changes are scheduled to come into effect on June 1, 2013. The following changes will be in effect for the Statutory Accident Benefits Schedule (SABS):

Ontario Court of Appeal Upholds "60 Day" Rule for FSCO Mediations

The Ontario Court of Appeal has upheld a decision from the Superior Court of Justice of Ontario that declared a mediation by the Financial Services Commission of Ontario (FSCO) failed if it has not been mediated within 60 days of the application being submitted. In Cornie v. Security National [2012 ONSC 905], which was heard with three other similar cases, Justice J.W. Sloan found the insurance companies' position that accident victims must simply wait to be "preposterous" and suggests that FSCO can continue to try to comply with the 60 day period or seek a change and/or ask for some legislative direction to extend the 60 day period in appropriate circumstances.  This decision was posted in our blog on February 9, 2012. This ruling means that, when an accident benefits insurer has denied a benefit, the insured can apply for mediation at FSCO and, 60 days after the mediation has been filed, the insured can then move on to either arbitration or a lawsuit against the insurer if the mediation has not been conducted within that timeframe. The Court of Appeal concluded their decision by stating the following:

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