Government of Ontario publishes draft regulations regarding the elimination of DACs and seeks stakeholder input in July 2005
Highlights:
An arbitrator may award expenses against an insured for failure to attend an IME or provide information required by the Regulation
Disability certificates may be required for claims for lost educational expenses
Redefines what expenses incurred by an insured’s health practitioners and others may be recoverable and under what conditions:
Makes the submission of a disability certificate mandatory for any application for
IRB,
NEB, Caregiver benefit or housekeeping benefit
Permits insurers to delay payment of those benefits pending a s. 42 [IME] or pending receipt of information requested under s.33.
Permits insurers to delay payment of those benefits if after receiving information under s. 33 it requests an IME under s. 42.
Replaces the DAC system with independent medical examinations under s. 42.
Insurers may not deny benefits until an examination under s. 42 is held, the insured refuses to attend a s. 42 IME or another provision in the Regulation entitles the insurer to deny benefits [for eg: failure to have insurance]
Changes the method of termination of benefits
Permits payment of medical and rehabilitation benefits incurred after submission of a treatment plan but before approval by an insurer
Makes Social workers subject to the same limitations as health professionals
Sets out new rules for the approval of an assessment of examination by a health professional or social worker including permitting an IME to be conducted before the insured’s assessment
If an insurer denies all or part of a request for Attendant Care, it must request an IME
Insurers may require submission of new Form 1s if it wishes to assess changes in attendant care amounts and require an IME
Revising the rules for determination of Catastrophic Impairment and payment of interim expenses
Creates two categories of insurer assessment: one for assessment and one for denial of benefits [a denial IME or DIME]
Clarifies the status of Substitute Decision Makers.
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