Auto Insurance Sector

Most people don’t have the money to pay for the losses (property damage, injury, death) they might cause while driving, so governments require drivers to carry a certain amount of insurance to cover any losses they might cause others to suffer and to cover their own medical expenses and loss of income resulting from driving –related injuries.

Ontario’s no-fault auto insurance system is legislated by provincial statute, the Insurance Act, 1990. Insured benefits, including medical and rehabilitation benefits, available to persons injured in a motor vehicle accident, and how to access these are detailed in Ontario Regulation 34/10 Statutory Accident Benefits Schedule (SABS). Occupational therapists play important roles in this sector, both assessing and treating injured claimants and providing insurer examinations for insurers to access second opinions about claimant status and needs.

Policies and Legislation

Insurance Act – Part VI
Statutory Accident Benefits Schedule – Effective September 1, 2010 - Ontario Regulation 34/10
Statutory Accident Benefits Schedule – Accidents Before January 1, 1994
Statutory Accident Benefits Schedule – Accidents After December 31, 1993 & Before November 1, 1996
Statutory Accident Benefits Schedule – Accidents on or after Nov, 1, 1996
Unfair or Deceptive Acts or Practices – Ont. Reg. 7/00 Superintendent’s Guidelines
No. 01/12 – Cost of Goods Guideline
No. 03/11 – Health Claim for Auto Insurance December 2011 Guideline
No. 02/11 – Minor Injury Guideline
No. 08/10 – Cost of Assessments and Examinations Guideline
No. 05/10 – Transportation Expense Guideline
No. 03/10 – Attendant Care Hourly Rate Guideline
Auto Insurance Claims Forms (OCF Forms)

Practice Resources

Understanding Auto Insurance – a FSCO resource
Accident Benefit Coverage in Ontario – An Overview Health Claims for Auto Insurance (HCAI)
OCF Claim Forms
Common Codes for OT Use in Auto Insurance Sector
Assessment of Attendant Care Needs Form 1
Guidelines for Assessment Timeframes for use in the Auto Sector
OT Fees in the Auto Insurance Sector
Promoting OT in the Auto Insurance Sector (pdf)
Supporting Return to Work After MVA
Protecting Yourself – Preventing Identity Theft
Health Service Provider Toolkit for FSCO Examinations/Audits
FSCO Resource: Enabling Recovery from Common Traffic Injuries: A Focus on the Injured Person
OSOT Responds to Proposed Model of Clinic Regulation
Coalition Responds to Preliminary Recommendations of Review of Financial Services Regulator Mandates

Current Issues

OSOT is actively addressing the following issues to position and promote occupational therapy in Ontario’s auto insurance system and to ensure access to rehabilitation and benefits that meet the needs of persons injured in motor vehicle accidents.

Monitoring Impacts of Sept. 2010 Regulatory Changes on Access Benefits and OT Practice
Monitoring Implementation and Issues Relating to HCAI
Definition of Catastrophic Impairment
Auto Insurance Sector Fraud

Teams and Networks

OSOT Auto Insurance Sector Team
Ontario OT Interest Group List

Related Links

Financial Services Commission of Ontario (FSCO)
Health Claims for Auto Insurance Information Resource Site
Insurance Bureau of Canada (IBC)
Ontario Brain Injury Association
Spinal Cord Injury Ontario


Source: http://docphy.com/business-industry/personal-finance/insurance/auto-insurance-sector.html