O. Reg. 89/14: SERVICE PROVIDERS - LISTED EXPENSES

Link to law: http://www.ontario.ca/laws/regulation/r14089
Published: 2014-03-28

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ONTARIO REGULATION 89/14

made under the

INSURANCE ACT

Made: March 26, 2014
Filed: March 28, 2014
Published on e-Laws: March 31, 2014
Printed in The Ontario Gazette: April 12, 2014


SERVICE PROVIDERS — LISTED EXPENSES

Definitions

1. In this Regulation,

“Guideline” means a Guideline referred to in subsection 49 (3) of the Statutory Accident Benefits Schedule; (“directive”)

“Statutory Accident Benefits Schedule” means Ontario Regulation 34/10 (Statutory Accident Benefits Schedule — Effective September 1, 2010) made under the Act. (“annexe sur les indemnités d’accident légales”)

Listed expenses, s. 288.1 (1) of the Act

2. (1) For the purposes of paragraph 1 of subsection 288.1 (1) of the Act, the following are the prescribed assessments, examinations, reports, forms or plans referred to in that paragraph:

1. The assessments, examinations, reports, forms or plans that are specified in a Guideline in the circumstances specified in the Guideline.

2. A disability certificate referred to in paragraph 2 of section 66 of the Statutory Accident Benefits Schedule, if an invoice in respect of the certificate is submitted to a central processing agency referred to in subsection 49 (3) of the Statutory Accident Benefits Schedule instead of to an insurer.

(2) For the purposes of paragraph 2 of subsection 288.1 (1) of the Act, the prescribed goods and services are those goods and services that are specified in a Guideline.

Payment for listed expenses, s. 288.2 of the Act

3. (1) An insurer is prevented by subsection 288.2 (1) of the Act from making a payment for a listed expense to a person or entity unless the person or entity held a service provider’s licence on both of the following dates:

1. The date recorded on the invoice as the date of service in respect of the assessment, examination, report, form, plan, good or service to which the listed expense relates.

2. The date on which the invoice in respect of the listed expense was received by the central processing agency referred to in subsection 49 (3) of the Statutory Accident Benefits Schedule.

(2) Despite subsection (1), an insurer is not prevented from making a payment for a listed expense to a person or entity if all of the following circumstances exist:

1. The person or entity held a service provider’s licence on the date on which the invoice in respect of the listed expense was received by the central processing agency referred to in subsection 49 (3) of the Statutory Accident Benefits Schedule.

2. The person or entity requests payment of the listed expense because of an acquisition, amalgamation or transfer involving another person or entity and,

i. the other person or entity provided the assessment, examination, report, form, plan, good or service to which the listed expense relates, and

ii. the other person or entity has not requested or received payment of the listed expense.

3. The person or entity that provided the assessment, examination, report, form, plan, good or service held a service provider’s licence on the date recorded on the invoice as the date of service in respect of that assessment, examination, report, form, plan, good or service.

(3) The restriction imposed under subsection 288.2 (1) of the Act does not apply with respect to a listed expense if the date of service recorded on the invoice in respect of the assessment, examination, report, form, plan, good or service to which the listed expense relates is before the date on which section 288.2 of the Act comes into force.

Commencement

4. (1) Subject to subsections (2) and (3), this Regulation comes into force on the day it is filed.

(2) Section 2 comes into force on the later of the day section 14 of Schedule 8 to the Prosperous and Fair Ontario Act (Budget Measures), 2013 comes into force and the day this Regulation is filed.

(3) Section 3 comes into force on the later of the day section 15 of Schedule 8 to the Prosperous and Fair Ontario Act (Budget Measures), 2013 comes into force and the day this Regulation is filed.

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