These questions are frequently answered....
A “service provider” is a business that provides specified goods or services (“listed expenses”) to statutory accident benefit claimants for which it submits an invoice through Health Claims for Auto Insurance (HCAI) for payment by automobile insurers. Typically, these businesses are health and rehabilitation clinics, as well as providers of examinations and assessments.
FSCO has regulated the business and billing practices of service providers (businesses that invoice auto insurers for Statutory Accident Benefits). FSCO’s service provider licence authorizes service providers to receive direct payments from auto insurers for specific listed expenses.
(Without FSCO’s service provider licence, service providers must seek direct payment from claimants (MVA victim) for goods and services provided in connection with statutory accident benefits. Claimants will then need to seek reimbursement directly from their automobile insurer.)
These are benefits that are provided by law to victims of motor vehicle accidents in Ontario, regardless of who is at-fault for an accident. You could be the driver of a car, the passenger, a pedestrian or cyclist who was struck by a motor vehicle. These benefits are called Statutory Accident Benefits, SABS, ABs or no-fault benefits. They are part of your automobile insurance policy that you have purchased.
In Ontario there are three injury categories regarding insurance motor vehicle accident benefits.
Minor Injury: $3500
Non Catastrophic: $65,000 (medical/rehabilitation and attendant care combined)
Catastrophic: 1 million (medical/rehabilitation and attendant care combined)
In addition to the basic coverage in your policy, you may also purchase additional coverage for your benefits.
No. Your accident benefits are not automatic. You have to apply for your benefits through forms that you request from your insurer. Notify your insurance company/Broker no later than 7 days (or as soon as it is practical for you to do so after the accident) if you want to apply for benefits because there are strict time limits and deadlines that must be met in order to avoid delays or disqualification from obtaining compensation. These forms must be returned to your insurer within a 30-day time limit. No benefit is payable until the insurance company has received the completed forms.
Fill this application out even if you have benefits available to you through other plans since there will be a limited amount of funding available to you through those other policies. Your automobile accident benefits may make up the difference. It is recommended that a Personal Injury Lawyer review these forms to help with the process.
In Ontario, your own insurance company is responsible for the cost of accident benefits including med/rehab services regardless if you are found to be at fault or not. If you have any extended health insurance, you must submit your claim to them first and the unpaid or uncovered portion will be picked up by your own auto insurance company. If you don’t have any insurance and are involved in a motor vehicle accident and if you live with your partner, parents or someone who has auto insurance then their insurance may be liable to pay for your cost of medical/rehab expenses and if you live alone then you may be covered by the insurance of the car you were in at the time of the accident or the other car that hit you.
If you have absolutely no insurance coverage, you can seek as a last resort, financial compensation from the province’s Motor Vehicle Accident Claims Fund (MVACF), but it only covers damage to vehicles up to $10,000 and the cap on personal injury claims is $200,000 – Motor Vehicle Accident Claims Act, RSO 1990, c M.41; s. 23(1)
Any accident with more than $1,000 in damages and/or involving injury must be reported to the police, while accidents with minor damage and no injury can be registered at collision reporting centres.
|Your Situation / Circumstance||Where to Send the Application|
|You were driving a company vehicle.||The insurance company that insures the company vehicle.|
|You were a passenger in someone else’s vehicle when injured||The insurance company that insures the vehicle you were a passenger in.|
|You were a passenger in an uninsured vehicle and there was more than one vehicle involved in the accident.||The insurance company of an insured vehicle involved in the accident.|
|You were a pedestrian or cyclist.||The insurance company of the vehicle that hit you.|
|None of the above.||The Motor Vehicle Accident Claims Fund (MVACF); see below for more details.
No, your premiums do not go up because you make an accident benefits claim. Ontario has a no-fault motor vehicle insurance system. This means that regardless if you are at fault for the accident or not you access accident benefits from your own insurance company. Accessing your benefits does not affect your premiums.
Your premiums may go up if your insurance company determines that you were more than 25% at fault for the accident. Premiums will increase if you are more than 25% at fault and your insurance policy does not provide you with accident forgiveness. This has no bearing on your accident benefits as they are two separate systems.
Yes, you can go to any Ontario health care facility (clinic/practice) and health care provider. Health care providers assisting Ontarians after an MVA are registered on the HCAI data base. Those providers wishing to direct-bill the insurance company also have a FSCO service provider’s license.
*Service providers without a FSCO license will be billing you directly.
Effective February 1, 2011, every Ontario health care facility (business/clinic/practice) and associated health care provider that submits OCF-18s, -21s and -23s directly to insurers is required to use HCAI to transmit these OCFs. Any OCF-18, -21 or -23 that is mailed or otherwise delivered by health care facilities to insurers directly will be deemed “not received”. s. 64(7)
Yes and No. Under the law in Ontario, it is mandatory to exhaust all other insurance policies first. This applies to all private and work insurance policies for dental and health benefits as well as short term and long term disability benefit policies.
Yes – If you are accessing your motor vehicle accident benefits and you do not go to a FSCO licensed service provider, “you” (the MVA client) will be personally responsible for paying your practitioner (service provider) for the goods and services (therapies) up front and then you will have to seek reimbursement from your insurance company.
No – You do not pay for your therapies upfront if you go to a FSCO licensed service provider. Clinics and practitioners who help MVA clients are registered with HCAI, an electronic database that transmits auto insurance Ontario Claim Forms (OCF Forms) between health care businesses and insurers in Ontario. If the service provider also has a FSCO license, their services are billed directly to the insurance companies.
The monies available to you are dependent on your injury designation and the “medical rehabilitation” coverage you have chosen on your insurance policy.
For out-of-pocket expenses, you must submit proof of payment (an original receipt) to your insurer for services rendered in order to be reimbursed. This is done on an “Application for Expenses Claim Form (OCF-6).
1. Third-party liability: This type of insurance coverage is mandatory in Canada. It covers you, the driver if you're in an accident and are at fault. It will help pay for the medical bills of other drivers and any damage to their vehicles from collisions that happen because they were driving your car or truck.
2. Comprehensive: Sometimes called "bad luck" insurance or other than collision insurance because it covers unfortunate events that could happen to your car - things like:
- Theft or attempted theft
- Fire or explosions
- Vandalism or civil disobedience, such as a riot
- Falling objects (like tree branches)
- Flying objects (like rocks or gravel)
- Weather and natural disasters (floods or lightning from thunderstorms, hurricanes, tornadoes)
Comprehensive insurance is a must-have for any car owner. You can purchase this option without having collision coverage, but they're generally offered as part of an entire package because the two provide maximum protection!
3. Collision: If you're involved in a car accident, and your vehicle is damaged, this coverage will pay for the maintenance or repairs needed to get it running again. It can also pay to replace your vehicle if it has been certified by an insurance appraiser to be deemed a write-off.
If you lease or finance your vehicle, then chances are good that both comprehensive and collision insurance will be required.
In Canada in order to legally drive a vehicle you will need to purchase a basic car insurance policy. Accident benefits coverage, third-party liability, and uninsured motorist protection are required in every province. In Alberta, Ontario, Quebec and the Atlantic provinces direct compensation for property damage is required.
The cost of car insurance drastically varies per province and per city. There are many factors that are taken into consideration by the insurance company when they set your rates. Our research has demonstrated that the average cost of car insurance is between $1300 and $1800 per year.
Yes, but they must have a drivers license be legally allowed to drive in the province or territory. If they drive your car regularly you may want to consider adding them to your insurance policy as an occasional driver. Check with your insurance company for more details.
Third-party liability coverage is a legal requirement in Canada that every driver must have when operating their vehicle. This type of insurance pays for various costs you might incur if there's an accident deemed to be your fault. These costs include:
- The costs for repairing other vehicles damaged in an accident
- If anyone has been injured, this covers medical costs
- Death benefits or a disability income for anyone you have injured
- Legal fees and lawsuits that result from the accident
- The damages awarded to drivers and passengers in court
- The prices of repairing any property you've damaged in a collision
If you want to get your vehicle on the road in most provinces, then it's important that at least $200K worth of third-party liability coverage is available. The exception lies with Quebec where a minimum requirement only stands up as 50k Canadian dollars.
When you purchase liability insurance, the company will pay up to $10K for property damage. You can also get coverage that goes beyond that amount and includes amounts of damages ($1-$5M) depending on what level of coverage is desired - just be aware that any increase in coverage will reflect a change to your premiums!
To get your vehicle on the road in most provinces, at least $200K worth of third-party liability coverage must be available. The exception lies in Quebec, where there is a minimum of 50k.
When you purchase liability insurance, the company will pay up to $10K for property damage. You can also get coverage beyond that amount and includes damage amounts of ($1-$5M) depending on what level of coverage you want - be aware that any increase in range will reflect a change to your premiums!
Like collision, you'll have to pay upfront for your deductible. You can choose what price points the insurance company offers (usually $300, $500 or $1000).
If you're leasing or financing your car, it's essential to know the deductible on the contract that will be required. Make sure this is clear before signing anything!
If you're financing or leasing your vehicle, these companies will require proof of insurance. This is because their financial interests are at risk when something happens to the car, and they want to be protected by having the right coverage for any damages incurred!
An individual who plans on applying for one or more benefits must notify their insurer of such intentions no later than the 7th day after the accident or as soon as it is practical.
Within 10 business days after the insurer receives the OCF-1 Accident Benefits application package and completed disability certificate, the insurer will let you know about the specified benefit or give a reason why the insurer does not believe you are entitled to the specified benefit.
The insurance company's decision to refuse payment for your claim can be appealed and reviewed by a third party.
The most common reason for rejection of claims is lack of information or wrong information.
Your full name and contact details. The information about any other parties involved (including their vehicles and location of the incident) A crime reference number if applicable.
The IRB is an essential benefit for those who have been injured and need help replacing their lost income. It only applies if you were self-employed or working at least 26 out of 52 weeks before getting hurt.
- The first thing an insured individual needs to do for themself or their loved one(s) to be eligible for IRBs is to satisfy specific preconditions.
- Second, the insured individual must satisfy the “substantial inability” test to be eligible for IRBs during their first 104 weeks after the accident.
- Third, the insured individual must also satisfy the “complete inability” test to qualify for the IRB after 104 weeks following the accident.
The insurer will require proof that your accident directly caused your injuries. Documentation such as an OCF-3 Disability Certificate (OCF-3) and other medical evidence will be required before paying any IRB to an individual.
You can get all of your required supporting documentation by asking the right questions.
The supporting documentation will be crucial for ensuring that the amounts on the OCF 2 have been completed correctly and accurately. This is a critical point if the insured individual was unemployed at the date of the accident, and to determine eligibility, it may be necessary for them to have been employed 26 out of 52 weeks before the accident.
You are responsible for filling out Parts 1, 2, 3 and Part 4 for your Signature. An authorized health care provider such as a Chiropractor, Dentist, Nurse practitioner, Occupational therapist, Optometrist, Physician, Physiotherapist, Psychologist, or Speech-language pathologist must fill out Parts 5-10.
Under the Regulatory Bodies / Professional Associations section on our healthcare profiles you will find links that direct you to the appropriate Regulatory College and Professional Association websites of the health professional profile you are viewing. On these websites you will be able to find information on the latest Public Protection initiatives put on by the College.
Public protection means that you can rest assured that if you schedule an appointment with a Regulated Health Professional you will obtain safe and effective health care.
The Ontario government protects your right to receive safe, competent, ethical and compassionate health care services for your health needs through the regulation of health professionals.
More information is now provided about the province’s health care professionals, specifically when it comes to their conduct and practice issues.
There are specific functions in place to protect you to receive safe and effective health care in Ontario, these are:
- Government legislation and regulations that Regulatory Colleges must follow
- Standards of practice, policies and guidelines as well as codes of ethics that must be carried out
- Registration requirements from those applying to the profession
- Quality Assurance Programs
- Public registrars so that you can check to see if the health care professional is qualified to practice
- A Complaints Process whereby the College will investigate your complaint or concern
- A continuous increase in transparency of College processes and decision-making, so that more information is available to you
It is only regulated health care professionals that have to answer to a regulatory body for the quality of the care they provide. This means protection for your life and health.
Unregulated care providers do not have the same mandatory measures to make sure their professionals have the proper training, education or standards. Your complaint or concern can only be dealt with by their employer or through the court system.
Evaluating the quality of healthcare includes:
- Assessing the quality of care
- Identifying problems or weaknesses in the delivery of care
- Designing actions that will overcome these deficiencies
- A follow-up audit to confirm that the corrective steps have been effective.
Colleges in Ontario have quality assurance programs that are established by Government requirements. These programs work to:
- Develop, establish and maintain programs and standards of practice to assure the quality of practice of the profession
- Develop, establish and maintain standards of knowledge and skill
- Develop programs to promote continuing evaluation, competence and improvement among the College members.
The end result of quality assurance programs is always to improve patient care.
The goal of “quality assurance” is to maintain a high quality of healthcare for individuals in Ontario. It is a commitment to the public by those within the various health disciplines, that they will work towards the objective of obtaining a degree of excellence in the services that they provide to every patient.
Ontarians’ have a right to safe and ethical healthcare. Quality assurance aims to improve the quality of the service delivered by practitioners at every level.
It ensures sure that:
- A health service meets specific and outlined requirements by the Regulated College
- The public has confidence that the requirements, rules and regulations are being followed
This involves a clear understanding of what is meant by “quality.” It also includes a credible and reliable mechanism for evaluating the care that is given.
It basically means doing those things necessary to meet and exceed the needs and expectations of those being served and doing those things right, every time.
By constantly measuring the effectiveness of the health professionals/organizations that provide treatments/services.
Transparency means making sure that the processes and information related to a regulated profession/service in Ontario can be easily accessed by applicants, the public and those in the profession.
Most people don’t know the cost of their care until after they receive it. They are usually more concerned about getting the care that they need immediately, then think about the cost afterwards. They also don’t always realize that the the price and quality of a particular service can be different for each provider.
They don’t know until it is too late – that a higher price does not necessarily mean a higher quality of service.
The goal of transparency allows the healthcare consumer to have detailed information regarding the cost and quality of care before choosing where to receive healthcare and who will provide the care. It enables them to make smarter healthcare choices.
Providing more information to the public has benefits, it:
- Allows the public to have the ability to make more fully informed choices about their health plans, health care professionals and treatments.
- Enhances public confidence and/or safety.
- Increases accountability for Regulators.
The public needs to understand how and why the Regulator makes the decisions it does and be able to evaluate its performance.
Regulated colleges must not only protect the public but their work of protection must be actively seen by the public.
What is a Professional Association?
- Provides a voice to the general public, referring health professionals, the media, the insurance industry, the government and other organizations on a regular and consistent basis regarding their scope of practice and the benefits of their professional services.
- Up-to-date Information for its members: Readily available information and trends that will affect their members’ practice, ie; changes in billing practices.
- Actively markets their profession: Pushes the value of the profession and counters any negative press that may harm it through multimedia venues.
- Creates Opportunities: Builds on current research that allows doors to open for their profession. Builds alliances to enhance their credibility and position.
- Professional Development:
- Associations are constantly creating and providing professional development opportunities for their members. This may be done through other institutes, associations, conferences and workshops with industry leaders. – in order for their members to maintain their membership privileges.
- They support their members in the achievement of competent and ethical practices by providing and promoting ongoing professional development and training in ethical practices.
- They work to ensure fair compensation for their members and continuously elevate their professional image across Ontario.
Each Association has requirements that members must meet yearly to maintain their certification. Professional development credits, hours performing the services under their scope of practice etc..
In Ontario, Regulated Health Professions are governed under the Regulated Health Professions Act, 1991, SO. 1991, c.18 Scroll down to “section 23(1) Register”
This Act introduced major changes to the Regulated Health Professions Act, 1991. It’s an important piece of legislation that strengthens the protection of and response to patient sexual abuse by health professionals.
A voice for the Professional Association’s members, so the public can know who they are and what they do. They promote the profession.
- Associations are not supervised by a government authority.
- They are self-governing with a Board of Directors that is made up of members of the association.
- Most associations will promote the profession they represent.
- Membership in an association is voluntary.
- Members pay membership dues and volunteer for association tasks to carry out the needs of the association.
- Often, members of an association are also members of a Regulated College.
What is a Public Register?
A Public Register = Protection & Accountability for the Public
The main intention of a public register is to confirm to the public that a particular health professional is accepted as a regulated and licensed practitioner of good standing.
The Ontario government authorizes all Regulatory Colleges in Ontario to maintain a Public Register.
- Ontarians have the right to safe, ethical and competent care. One of the ways that a Regulatory College fulfills its mandate of public protection is by providing a Register to the public.
- The public’s choice of a health practitioner should go hand-in-hand with their ability to check a College Register for information on the practitioner’s good standing.
- Each Regulatory College keeps its own Public Register up-to-date with accurate and reliable information.
- The information on the Public Register contains specific information required by the “ACT” and each College’s bylaws. (The main purpose of the “ACT” is to protect the public by providing registration of health professionals, investigating into professional conduct and professional performance).
Only registered professionals may use the protected title of his/her College. A member using the protected title makes sure he/she provides safe, effective and quality care to his/her clients.
Only qualified professionals can become registered members of a specific Regulated College. This means they must:
- Meet the required education standards
- Pass the College’s Competency Exam
- Satisfy and obey all professional obligations which include the Standards of Practise and the Code of Ethics
- Continually prove that he/she is competent through ongoing reporting to the College
- It is a list of all the professional members that each Regulatory College manages and supervises.
- It includes profiles of every health practitioner, specific to that professional College, in Ontario, as well as every professional corporation, specific to that professional College.
- It is information about the health professional that is gathered when she/he first registers with a Regulatory College. This information may also be obtained when the member renews her/his licence, when the professional updates her/his information or when there is a result of a hearing.
- Information on a member or past member can change from time to time, it is therefore important to verify your health professional’s profile regularly.
You will find the following health professional information on a public register listing:
- Name of the Member, including any former names, if know by the College
- Previous name(s) – if known to the College
- Name of business address & business telephone number
- Name of every health profession corporation of which the member is a shareholder
- Licence/Registration number – Member’s current status of their licence & specialist status
- Education – Class of certificate of registration
- Terms, conditions and limitations that are in effect on each certificate of registration
- Professional Activities
- Notations (e.g. every caution, suspension, cancellation or revocation of a member’s certificate of registration)
- Every result of a disciplinary or incapacity proceeding
- A notation of every revocation or suspension of a certificate of registration
- Other information in accordance with the College’s bylaws
Each one of Health Locator's professional profiles has a View License – Public Register link that directs you to the appropriate Public Register so you can review the licensing information of the healthcare professional in question with ease. It’s never been easier to review licensing and regulatory information. Each Public Register is slightly different, so follow the prompts on the screen to access the healthcare professional’s information you wish to review.
What is a Regulatory College?
It is a set of rules established by the Government to protect the public from harm and to make sure that they get the highest possible standard of services. A regulation provides boundaries.
For many professions in Canada, these regulations (rules) are enforced by regulatory bodies or Colleges.
- They are not institutions for teaching.
- They are under the authority of the provincial government and are granted specific powers and responsibilities to make sure they are serving the public interest. They do this through regulations and standards that are necessary, to make sure the rules are being followed for safe, competent and ethical healthcare that is provided to every person that goes to their professional members.
In short, they exist to protect the public.
- Registration with the college is mandatory for a member to obtain a licence to practice.
- Set the requirements for becoming a member of the profession.
- Make sure that only qualified and licensed professionals use their title.
- Keep up-to-date a publicly available registry of its members.
- Determine their scope of practise (boundaries for conduct and procedures).
- Provide guidelines for their professional practice.
- Monitor members participation in their ongoing professional development.
- Make available a procedure for the public to address their complaints of a professional who may have acted in a unprofessional, incompetent or unethical way.
- Manage a disciplinary process for their professional practitioners who do not meet the established standards of professional practice.
Rules and regulations make sure you are treated in a fair manner and that you are protected from risk of harm. This is done through their “code of ethics” and “standards of practice”.
A regulated health professional is governed by a scope of practise which protects the public and they are overseen by their Regulatory College. The health regulators exist to support your right to competent, safe and ethical care from regulated health professionals. Why? Because every Ontarian has rights regarding his/her healthcare.
You can always find up-to-date information about your health professional on his/her listing here at Health Locator. (ie, if he/she is still an active member of his/her Regulatory College, what services he/she provides, what payment methods are accepted, etc.)
What I can expect from my health care professional?
- Your healthcare professional will clearly outline all fees or costs of treatments/services before commencing therapy.
- Your healthcare professional will communicate and explain clearly any proposed treatment plan or procedure.
- You will be considered an active partner in making decisions about your healthcare.
- You can accept or refuse any treatment or procedure.
- You can ask questions or express concerns.
- You will be given the best treatment for your condition.
- Your treatment will be given to you safely.
- You will be treated with respect and understanding.
- You will be given information about what to do if your health changes or gets worse.
- Your personal information will always be confidential.
- You can contact your healthcare professional’s Regulatory College to talk about a concern or to make a complaint.
Every College has a standard procedure for filing a complaint. This makes sure that all parties have access to the same complete information.
Usually on the homepage of the College, you will find a tab with the word “Public” on it or a tab entitled “Filing a Complaint”. Under these tabs you will see how to “File a Complaint”.
A complaint must be received by the Registrar in writing, recorded on audio tape or on video, or other medium. The complaint should include the name of the Health Practitioner, as well as the time, place, date(s) and details of the event(s).
There are 26 Regulatory Colleges in Ontario that regulate 29 distinct professions – Visit the Federation of Health Regulatory Colleges of Ontario (FHRCO) website for more details.