FSRA Issues Updated Costs of Assessments Guideline for Auto Insurance Sector

The Financial Services Regulatory Authority (FSRA) has re-issued the Financial Services Commission of Ontario (FSCO) Costs of Assessments Guidelines (November 2010) to reflect June 2019 regulatory changes to Ontario Regulation 34/10 Statutory Accident Benefits Schedule regarding the treatment of Harmonized Sales Tax (HST). This Guideline provides guidance on the maximum amount payable for assessment or examination as set out in Section 25(5)(a) of the SABS. The Guideline replaces FSCO Superintendent’s Guideline 08/10 from November 2010, and is effective immediately.

View the Costs of Assessments and Examinations Guideline.

The updated Guideline clarifies that the SABS prohibits an insurer from paying more than a total of $2,000 plus the amount of any applicable harmonized sales tax payable under Part IX of the Excise Tax Act (Canada), for accidents that occur on or after June 3, 2019 inclusive of all fees and expenses for any one assessment or examination.  

"Fees and expenses” related to assessments referred to in  Section 25(5)(a) of the SABS (the “Cap”) include all costs, fees, expenses, charges, surcharges, overhead, administration costs, and other costs, including HST, incurred by or on behalf of the health care provider who conducted the assessment or examination. For example, a health care provider’s transportation expenses and any fees for travel time are included in the Cap of $2,000 plus the amount of any applicable HST since these fees and expenses are incurred by or on behalf of the provider in order to conduct an assessment or examination. 

Implications for Occupational Therapists

Occupational therapists working in Ontario's auto insurance system should maintain currency of knowledge of the Statutory Accident Benefits Schedule and the Guidelines of the Financial Services Regulatory Authority as these direct insurance coverage and payment of goods and services for individuals injured in motor vehicle accidents. OTs should be familiar with, and consult regularly, the FSRA website accessed at www.fsrao.ca.