No. A-2/98
Property & Casualty
- Auto

Clarification of Compliance Mechanism Regarding Statutory Accident Benefits Schedule Claims

The Ontario Insurance Commission (OIC) is providing, as a follow-up to OIC Bulletin No. A-11/97, dated November 24, 1997, clarifying information on the compliance mechanism for monitoring and improving insurers’ claims management practices for Statutory Accident Benefits Schedule (SABS) claims.

During the past month, the OIC received a number of comments on the reporting of non-compliance ratios for market conduct audits on a file basis, and tolerance levels.

Following further consultations with an industry accident benefits committee as well as some insurers, the OIC has determined that the audits, as required under the compliance mechanism, are now to be calculated on a transaction basis, instead of on a file basis. The tolerance levels remain between 7% and 10%.

Insurers should, therefore, substitute the attached pages 4 and 5 of the Protocol for Market Conduct Audits: Statutory Accident Benefits Schedule Claims (the Protocol) that accompanied OIC Bulletin No. A-11/97. The following changes should be noted on those pages: (a) On line 20, page 5, "transaction" has replaced the word "file" under the heading "Tolerance Standards"; and (b) on line 23, page 5, we have added the definition of "transaction" for your information.

In response to inquiries that the OIC has received from insurers regarding the compliance mechanism, we are attaching a list of questions-and-answers that will be of assistance in implementing the market conduct audit protocol and the claimant satisfaction survey.

Dina Palozzi
Commissioner
February 9, 1998

Attachments:

1. (2) Replacement pages for the Protocol for Market Conduct Audits: Statutory Accident Benefits Schedule (PDF)
2. Questions and Answers on Compliance Mechanism for Private Passenger SABS Claims