Insurance Act
SERVICE PROVIDERS — LISTED EXPENSES
Historical version for the period March 28, 2014 to May 31, 2014.
No amendments.
This is the English version of a bilingual regulation.
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”) O. Reg. 89/14, s. 1.
Note: On June 1, 2014, the day section 14 of Schedule 8 to the Prosperous and Fair Ontario Act (Budget Measures), 2013 comes into force, section 2 comes into force. (See: O. Reg. 89/14, s. 4 (2))
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. O. Reg. 89/14, s. 2 (1).
(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. O. Reg. 89/14, s. 2 (2).
Note: On December 1, 2014, the day section 15 of Schedule 8 to the Prosperous and Fair Ontario Act (Budget Measures), 2013 comes into force, section 3 comes into force. (See: O. Reg. 89/14, s. 4 (3))
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. O. Reg. 89/14, s. 3 (1).
(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. O. Reg. 89/14, s. 3 (2).
(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. O. Reg. 89/14, s. 3 (3).
4. Omitted (provides for coming into force of provisions of this Regulation). O. Reg. 89/14, s. 4.
