Insurance Act
SERVICE PROVIDERS — LICENSING
Historical version for the period December 17, 2013 to March 27, 2014.
Note: THIS REGULATION IS NOT YET IN FORCE. It comes into force on the day section 18 of Schedule 8 to the Prosperous and Fair Ontario Act (Budget Measures), 2013 comes into force. (See: O. Reg. 348/13, s. 3)
No amendments.
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 the Statutory Accident Benefits Schedule — Effective September 1, 2010 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.
Criteria re unsuitability
2. (1) In determining whether an applicant is not suitable to hold a service provider’s licence, the Superintendent 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 the Statutory Accident Benefits Schedule — Effective September 1, 2010.
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 Superintendent,
i. with respect to the application for a licence, or
ii. in response to a request for information by the Superintendent or by a person designated by the Superintendent. O. Reg. 348/13, s. 2 (1).
(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 Superintendent, 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).
3. Omitted (provides for coming into force of provisions of this Regulation). O. Reg. 348/13, s. 3.
