The Financial Services Regulatory Authority of Ontario (FSRA) issued new guidance, effective June 3, which requires insurer and health providers to provide reasonable accommodations to Statutory Accident Benefit (auto insurance) claimants during COVID-19 service disruptions.
The guidance encourages insurers to be flexible in the way they collect information – to allow claimants to provide information by phone or email, instead of in a hard copy form with a signature, for example – to relax requirements for medical assessments and examinations that would normally be required, and to allow informed access to virtual care where reasonable and necessary. Where virtual care is provided in lieu of in-person care, the guidance goes on to state that it is important for health service providers to explain the virtual treatment, what it will involve, its limitations compared to in-person treatment, and how the fees for virtual treatments will impact the claimant’s entitlement to future treatment.
The interpretation document addresses the subsections of Ontario’s Insurance Act which speak to unfair or deceptive acts or practices. Under the subsections in question, “an unfair or deceptive act or practice includes any conduct resulting in unreasonable delay in, or resistance to, the fair adjustment and settlement of claims,” and “the failure or refusal of an insurer, without reasonable cause, to pay a claim for goods or services or for the cost of an assessment within the time prescribed for payment in the schedule.”
In FSRA’s guidance, the regulator’s interpretation requires reasonable accommodation of claimant’s needs during the COVID-19 emergency, where necessary, given the current exceptional circumstances. “Reasonable accommodations that are necessary in the context of a claim as a result of the emergency should be considered for all consumers as claimants,” the guidance states. “The nature and extent of the accommodations required will vary on a case-by-case basis.”