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ontario regulation 547/05

made under the

Insurance Act

Made: October 26, 2005
Filed: October 28, 2005
Printed in The Ontario Gazette: November 12, 2005


Amending O. Reg. 7/00

(Unfair or Deceptive Acts or Practices)

1. (1) Paragraphs 1, 2, 3, 4 and 5 of subsection 3 (2) of Ontario Regulation 7/00 are revoked and the following substituted:

1. Charging an amount in consideration for the provision of goods or services to or for the benefit of a person who claims statutory accident benefits or who otherwise claims payment under a contract of insurance, if the goods or services are not provided.

2. Soliciting or demanding a referral fee, directly or indirectly, by or from a person who provides goods or services to or for the benefit of a person who claims statutory accident benefits or who otherwise claims payment under a contract of insurance.

3. Acceptance of a referral fee, directly or indirectly, by or from a person who provides goods or services to or for the benefit of a person who claims statutory accident benefits or who otherwise claims payment under a contract of insurance.

4. The payment of a referral fee, directly or indirectly, to or by a person who provides goods or services to or for the benefit of a person who claims statutory accident benefits or who otherwise claims payment under a contract of insurance.

5. Charging an amount in consideration for the provision of goods or services to or for the benefit of a person who claims statutory accident benefits or who otherwise claims payment under a contract of insurance, where the amount charged unreasonably exceeds the amount charged to other persons for similar goods or services.

(2) Section 3 of the Regulation is amended by adding the following subsections:

(3) For the purposes of paragraphs 1 to 5 of subsection (2), a person who provides goods or services includes,

(a) a person who provides towing services or who owns or operates a tow truck;

(b) a person engaged in the provision of vehicle repair services; and 

(c) a person engaged in the provision of automobile storage services.

(4) For the purposes of paragraphs 1 to 5 of subsection (2), a person who provides goods or services does not include a lawyer acting in the usual course of his or her practice of law. 

2. The Regulation is amended by adding the following section:

5. For the purposes of the definition of “unfair or deceptive acts or practices” in section 438 of the Act, each of the following actions, if done on or after March 1, 2006, is prescribed as an unfair or deceptive act or practice in relation to a claim for statutory accident benefits under the Statutory Accident Benefits Schedule — Accidents on or after November 1, 1996 (in this section referred to as the Schedule):

1. 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. 

2. The determination by an insurer that a person is not entitled to a statutory accident benefit or that a person does not have a catastrophic impairment if,

i. the insurer makes the determination before obtaining a report of an examination in respect of the person under section 42 of the Schedule, and

ii. the Schedule does not authorize the insurer to make the determination without having obtained the report.

3. The making of a statement by or on behalf of an insurer for the purposes of an adjustment or settlement of a claim if the insurer knows or ought to know that the statement misrepresents or unfairly presents the findings or conclusions of a person who conducted an examination under section 42 of the Schedule.

4. A requirement by an insurer that an insured person attend for an examination under section 42 of the Schedule conducted by a person whom the insurer knows or ought to know is not reasonably qualified by training or experience to conduct the examination. 

5. A requirement by an insurer that an insured person attend for an examination under section 42 of the Schedule that the insurer knows or ought to know is not reasonably required for the purposes authorized under the Schedule.


6. The failure of an insurer to obtain the written and signed consent of an insured person in the approved form before a pre-claim examination under section 32.1 of the Schedule

is conducted in respect of the insured person. 

3. This Regulation comes into force on the later of March 1, 2006 and the day it is filed.

 

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