O. Reg. 348/13: SERVICE PROVIDERS - LICENSING

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Insurance Act

ONTARIO REGULATION 348/13

SERVICE PROVIDERS — LICENSING

Consolidation Period: From June 8, 2019 to the e-Laws currency date.

Last amendment: 136/19.

Legislative History: 88/14, 136/19.

This is the English version of a bilingual regulation.

Eligibility criteria

1. A service provider’s licence may be issued under subsection 288.5 (3) of the Act to an applicant if all of the following requirements relating to the applicant’s business systems and practices and the management of its operations are satisfied:

1. The applicant has a mailing address in Ontario that is not a post office box and that is suitable to permit service by registered mail.

2. The applicant has an email address.

3. The application includes the particulars of the individual to be designated as the service provider’s principal representative.  The individual must be eligible under subsection 288.4 (7) of the Act to be designated as a principal representative.

4. The individual to be designated as the service provider’s principal representative has provided an attestation on the applicant’s behalf relating to the applicant and the application and relating to the applicant’s compliance with the Act.

5. The application includes the particulars of each facility, branch or location in Ontario that the applicant operates or intends to operate in connection with the provision of goods or services to or for the benefit of persons who claim statutory accident benefits or the provision of goods or services for the purposes of determining whether a person is or continues to be entitled to statutory accident benefits.

6. If a Guideline referred to in subsection 49 (3) of Ontario Regulation 34/10 (Statutory Accident Benefits Schedule — Effective September 1, 2010) made under the Act specifies that invoices are to be delivered to a central processing agency, every facility, branch or location referred to in paragraph 5 is enrolled with the central processing agency. O. Reg. 348/13, s. 1; O. Reg. 88/14, s. 1.

Criteria re unsuitability

2. (1) In determining whether an applicant is not suitable to hold a service provider’s licence, the Chief Executive Officer is required by clause 288.5 (3) (a) of the Act to have regard to the following circumstances:

1. Whether, having regard to the past conduct of the applicant, there are reasonable grounds for the belief that any of the following activities conducted by or on behalf of the applicant will not be carried on in accordance with the law or with integrity and honesty:

i. the completion or submission to an insurer, or to another person or entity on behalf of an insurer, of reports, forms, plans, invoices or other documentation or information authorized or required under Ontario Regulation 34/10 (Statutory Accident Benefits Schedule — Effective September 1, 2010) made under the Act.

2. Whether, having regard to the past conduct of any of the following persons, there are reasonable grounds for the belief that the applicant’s business systems and practices and the management of its operations will not be carried on in accordance with the law or with integrity and honesty:

i. The applicant.

ii. If the applicant is a corporation, a director, officer or shareholder of the corporation.

iii. If the applicant is a partnership, a partner of the partnership.

iv. If the applicant is a sole proprietorship, the sole proprietor.

v. The person to be designated as the applicant’s principal representative.

vi. An employee, agent or contractor of the applicant.

3. Whether, having regard to the past conduct of an interested person or entity in respect of the applicant, there are reasonable grounds for the belief that the applicant’s business systems and practices and the management of its operations will not be carried on in accordance with the law or with integrity and honesty.

4. Whether any of the persons referred to in paragraph 2 or 3 is engaged in a business or undertaking that would jeopardize the applicant’s integrity and honesty in relation to the applicant’s business systems and practices and the management of its operations.

5. Whether any of the persons referred to in paragraph 2 or 3 has made a false statement or has provided false or deceptive information to the Chief Executive Officer,

i. with respect to the application for a licence, or

ii. in response to a request for information by the Chief Executive Officer or by a person designated by the Chief Executive Officer. O. Reg. 348/13, s. 2 (1); O. Reg. 88/14, s. 2; O. Reg. 136/19, s. 2.

(2) For the purposes of paragraph 3 of subsection (1), a person or entity is an interested person or entity in respect of an applicant if, in the opinion of the Chief Executive Officer, the person or entity,

(a) has or may have a beneficial interest, either directly or indirectly, in the applicant’s business;

(b) exercises or may exercise control, either directly or indirectly, over the applicant; or

(c) has provided or may have provided financing, either directly or indirectly, to the applicant’s business. O. Reg. 348/13, s. 2 (2); O. Reg. 136/19, s. 2.

Revocation or suspension

2.1 (1) The following circumstances are prescribed for the purposes of paragraph 4 of subsection 288.6 (1) of the Act as circumstances in which the Chief Executive Officer may, by order, revoke or suspend a service provider’s licence:

1. The licensee or the applicant for the service provider’s licence has made a material misstatement or omission in the application for the licence or in a report or other information required to be provided to the Chief Executive Officer.

2. If a Guideline referred to in subsection 49 (3) of Ontario Regulation 34/10 (Statutory Accident Benefits Schedule — Effective September 1, 2010) made under the Act specifies that invoices are to be delivered to a central processing agency, the licensee or any of its facilities, branches or locations is not enrolled with the agency or is not in compliance with the Guideline. O. Reg. 88/14, s. 3; O. Reg. 136/19, s. 2.

(2) The following circumstances are prescribed for the purposes of paragraph 2 of subsection 288.6 (3) of the Act as circumstances in which the Chief Executive Officer may, by order, revoke or suspend a service provider’s licence without taking the steps required by section 288.7 of the Act:

1. The licensee fails to pay a fee imposed under section 121.1 of the Act

2. The licensee fails to pay a fee, levy, sector assessment or other charge imposed under the Financial Services Regulatory Authority of Ontario Act, 2016.

3. The licensee fails to pay a fee imposed under section 27 of the Financial Services Commission of Ontario Act, 1997.

4. The licensee fails to pay an assessment in accordance with section 25 of the Financial Services Commission of Ontario Act, 1997. O. Reg. 88/14, s. 3; O. Reg. 136/19, s. 1, 2.

(3) The following criteria are prescribed for the purposes of subsection 288.6 (10) of the Act as criteria to which the Chief Executive Officer shall have regard when determining whether or not it is in the public interest to allow a licensee to surrender a service provider’s licence:

1. Whether there are any outstanding or anticipated proceedings or regulatory matters involving the licensee, the licence or the licensee’s principal representative.

2. Whether the licensee has any outstanding fees, charges or penalties payable under the Act.

3. Whether the licensee has failed to make reasonable arrangements for the retention of its records relating to listed expenses after it ceases to hold the licence, or has failed to inform the Chief Executive Officer about the location where the records are to be kept. O. Reg. 88/14, s. 3; O. Reg. 136/19, s. 2.

3. Omitted (provides for coming into force of provisions of this Regulation). O. Reg. 348/13, s. 3.

 

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