Overview Of Regulatory Changes

A number of new Regulations under the Insurance Act were made on July 2, 2003 and came into force on October 1, 2003. Subsequent to July 2, 2003, two more Regulations were introduced which also came into force on October 1, 2003.

These new Regulations include:

1. Major changes to the Statutory Accident Benefits Schedule (SABS)
2. Changes to the DAC Referral Process
3. An increase of the monetary deductible which reduces pain and suffering claims by $30,000 – an increase from the current $15,000 deductible
4. An Unfair or Deceptive Acts or Practice Regulation which could impose sanctions on Treatment Providers (in force November 1, 2003)
5. Restrictions on the right to settle an accident benefits claim within one year of the accident and on persons who may represent injured persons
6. Further restrictions on who may sue, with definition of what constitutes a “permanent serious impairment”

The new SABS will pose challenges as a result of a delayed assessment process that can lead to delayed treatment; additional DAC assessments; and more complex forms.

Important changes to the SABS include:

• Injured automobile drivers, passengers and pedestrians risk delayed treatment and benefits if they fail to give notice to the Accident Benefit Insurance Company within seven (7) days of the accident
• Injured persons have greater obligations not only to provide notice but to participate in examinations under oath by a representative hired by the insurance company
• There are limits on assessments without prior approval of the insurer
• There are fee restrictions for professionals who conduct assessments and provide treatment
• A pre-approved treatment framework (PAF) has been developed for modest injuries which are defined as WAD I or WAD II injuries
• A complete set of new forms for all accident benefit purposes has been introduced for any accidents on or after November 1, 1996
• Insurers can give verbal approval for assessments to prepare treatment plans
• Insurers are prevented from obtaining insurer examinations (I.E.s) for medical and rehabilitation benefits until a dispute resolution process is commenced (s.20(1) amends s.42(1))
• Changes to the definition of Catastrophic Impairment (most importantly for children).

Changes to the DAC process include:

• In accordance with the new DAC Referral Process, individuals will no longer be assessed by the closest qualified DAC. Instead, insurers can suggest a DAC and if the individual agrees, that DAC will conduct the assessment. If the individual does not agree, the Financial Services Commission will appoint a DAC.
• DACs can now become involved in determining the reasonableness of a request for an assessment.

Important changes to the right to sue (the Tort claim) include:

• An increase in the monetary deductible on pain and suffering claims from $15,000 to $30,000 where the claim is assessed at $100,000 or less.
• An increase in the monetary deductible on all claims of family members from $7,500 to $15,000 where cases assessed at $50,000 or less.
• For accidents on and after October 1, 2003 a Regulation took effect which further restricts the right to sue and defining the verbal threshold (permanent serious impairment of an important physical, mental, or psychological function).

In addition to the changes that will be in force on October 1, 2003, there is much discussion about further automobile insurance changes, especially in light of the results of the recent provincial election.

A “Fee Guideline” has been introduced by the Superintendent of Insurance which regulates the fees that can be charged by Health Care Providers. This fee schedule is effective November 1, 2003 and on average reduces fees by 30%. We understand that the Superintendent of Insurance is also in the middle of a DAC review process – looking at issues of cost saving, credibility and the future role of DACs.

This fall and winter will be an extremely challenging time for Health Care Professionals and injured drivers, passengers and pedestrians. We look forward to working with all affected parties in order to help those with serious injuries find their way through this increasingly complicated process.