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Ontario regulator issues guidance on auto insurance claimants during pandemic

June 22nd, 2020  |  Auto Insurance

In order to accommodate consumers during the COVID-19 emergency, the Financial Services Regulatory Authority of Ontario (FSRA) issued guidelines recently on how auto insurance claimants for statutory accident benefits should be treated by insurers and health service providers.

To protect claimants while the global outbreak continues, the FSRA ­ an independent regulatory agency created to improve consumer and pension plan beneficiary protections ­ is requiring insurers and health service providers to offer “reasonable accommodations” to clients.

Physical distancing and other similar measures required or recommended by public health officials have had an impact on the ability of claimants of SABs to communicate with their insurer, fulfill requirements for an in-person medical assessment for the determination of initial or ongoing entitlement to SABs, and/or access goods and services related to their recovery.

As a result, the FSRA accommodations include:

  • Flexibility in the way insurers obtain the necessary claim information and/or consent from a claimant. For example, allowing a claimant the opportunity to provide information by telephone or email rather than a hard copy form with a signature.
  • Waiving or relaxing requirements used to determine a claimant’s entitlement to benefits, such as medical examinations, which cannot be completed due to the pandemic. Alternatively, FSRA says insurers should consider permitting these requirements to be met through alternative means, such as through virtual medical assessments.
  • Access to goods and services related to the treatment for claimants should be improved. Insurers are directed to allow for the payment of virtual care services, while keeping in mind the approach to virtual care endorsed by the health service provider’s regulatory college.

Each consumer’s circumstances may be different in terms of what type of reasonable accommodation may be required. Insurers are asked to use their judgement as to how to best fulfill their duty of good faith to the insured, and to provide fair treatment of consumers, by means of reasonable accommodation during the emergency.

FSRA has also encouraged SAB claimants to contact their own insurers and health service providers to find out what other accommodations are available to them.

This guidance took effect June 3, 2020 and will remain in effect until withdrawn by FSRA.

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