Canada: New Ontario Licensing Requirements For Health Services Providers Who Bill Automobile Insurers

Legislative provisions requiring health services providers who invoice automobile insurers directly to obtain service provider's licenses from the Financial Services Commission of Ontario will be effective November 1, 2014. After that date, if a service provider is not licensed, it will have to bill claimants directly, rather than billing the insurance company, subject to any exemptions provided by regulation.

The new requirement will not prevent an insurer reimbursing an insured person for a listed expense, whether or not the reimbursement relates to a payment made to a licensed service provider. Listed expenses in connection with statutory accident benefits include amounts payable for assessments, examinations, reports, forms or plans authorized or required by the Statutory Accident Benefits Schedule and related expenses, and amounts payable for prescribed goods or services that relate to prescribed medical, rehabilitation, attendant care and other statutory accident benefits, subject to regulations excluding certain types of amounts from the definition of "listed expenses".

Legislative changes establishing the application process and other related requirements, as described below, will be effective May 1, 2014.

APPLICATION FOR LICENCE

A person or entity wishing to be licensed as a service provider must file an application with the Superintendent of Financial Institutions of Ontario (the "Superintendent") and satisfy the prescribed requirements. Regulations may create different classes of service provider's licences and may establish different requirements, conditions and restrictions for each class. In addition, the Superintendent may impose conditions on a service provider's licence.

Public registers will be developed listing the holders of service providers' licences. Service providers will be required to designate an individual as the principal representative, and the service provider must comply with such standards as may be prescribed with respect to business systems and practices and matters of integrity in managing its operations, as well as any other conditions that may be imposed by the Superintendent or the Financial Services Tribunal, including conditions with respect to submission of periodic reports to the Superintendent.

SUSPENSION OR REVOCATION OF LICENCE

The Superintendent may revoke or suspend a service provider's licence if the licensee ceases to satisfy the requirements for issuance of the licence; the licensee breaches the Insurance Act, the Regulations or a condition of the licence; the Superintendent believes the licensee is no longer suitable to be licensed; the licensee has failed to pay an administrative monetary penalty; the licensee has failed to pay an assessment under the Financial Services Commission Act or for other prescribed circumstances. The service provider must obtain the Superintendent's approval to surrender its licence.

RIGHT TO HEARING

The applicant or the licensee has a right to request a hearing from the Financial Services Tribunal if the Superintendent proposes to refuse to grant a licence, impose conditions on the licence, amend, revoke, suspend or refuse to allow the surrender of a service provider's licence. If the hearing is requested within 15 days of the date of the Superintendent's proposal, the Financial Services Tribunal is required to hold a hearing. The decision of the Financial Services Tribunal is subject to appeal to the Divisional Court.

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