FSCO Announces Further Changes to the SABS Effective December 1, 2014 and January 1, 2015  

The Financial Services Commission of Ontario (FSCO) recently announced further changes to the Statutory Accident Benefits Schedule (SABS).   The changes will affect service provider regulations, administrative penalties, transportation expenses and interest rates.  Service providers, in particular, should familiarize themselves with the changes.  The following is a brief summary of the key changes.

Effective December 1, 2014:

  • Both licensed and unlicensed service providers will be able to provide goods and services to auto insurance claimants. But, only licensed service providers will be able to receive payment directly from auto insurers. Unlicensed service providers must complete an OCF-21 (Auto Insurance Standard Invoice) in the HCAI (Health Claims for Auto Insurance) system and provide the completed form to the claimant and the claimant must submit the form to the auto insurer and the insurer is expected to pay the claimant directly.  The unlicensed service provider will need to be compensated by the claimant.
  • A new unfair and deceptive act or practice (UDAP) is added for a service provider who advertises that they are licensed, when at the time, the service provider was not licensed. It would also be a UDAP where a person makes any false, misleading or deceptive statements about their business and billing practices.
  • Licensed providers are now able to seek direct payment for a listed expense under the SABS from anyone other than an insurer.
  • Administrative Monetary Penalties (AMPs) may be levied in fixed amounts (for low-level, high-volume contraventions, e.g. non-compliance related to FSCO reporting requirements with final amounts ranging from $250 to $1,000) and variable amounts (for other requirements in the regulations, e.g. significant contraventions of the regulations that can involve or potentially lead to improper billing practices with a maximum of $25,000).
  • A reminder that “authorized transportation expenses”, as defined in the SABS, are intended to apply to expenses incurred by the insured person and an aide for travel to and from treatment sessions, and not mileage expenses for service providers traveling to and from an insured’s location when providing services.

Effective January 1, 2015:

  • Once a mediation proceeding is commenced, the interest rate of 1%, compounded monthly will then change to the prejudgment interest rate described in the Courts of Justice Act for past pecuniary loss (currently 1.3%), to be calculated from the date on which the mediation proceeding is commenced and ending on the date a settlement is reached or a decision is heard.