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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