Regulatory tweaks required to prevent ‘papering’ of Ontario auto insurers with treatment plan submissions

Regulatory tweaks required to prevent ‘papering’ of Ontario auto insurers with treatment plan submissions

The Statutory Accident Benefits Schedule in Ontario is in need of further refinement to prevent insurers from getting “papered over” with an overwhelming number of treatment plans and assessments — a major component of auto insurance fraud.

There are still miles in preventing accident benefits fraud, claims manager for State Farm Insurance Company, who was a speaker at the IBC’s 11th Annual Regulatory Affairs Symposium in Toronto on Oct. 27.

There’s nothing in the SABS that prohibits claimants from papering us with 50 treatment plans per claimant, and that’s a tremendous impediment.”

We did not pay, His audience included representatives of Ontario’s insurance regulator, the Financial Services Commission of Ontario (FSCO).

In papering over an insurer, Jones discussed two medical providers associated with 125 State Farm claim files. The files involved 250 claimants in total, two people per file. The two health care facilities in question submitted 50 treatment plans per claimant, for a total of 12,500 treatment plans from these facilities, Jones noted.

This is just an example of an abuse of process,he said. “The overwhelming submissions, 50 treatment plans per claimant, are … designed to inundate claim managers, to lessen their opportunity to investigate the claim. They have six days to do this, and 10 days to do that: we’re working under a very regulated environment here. That is an example of ‘papering’ an insurance company.

“Just think about that: 50 treatment plans. How could the first treatment plan possibly have had a chance to be effective?”

At a cost of $1,500 to resist each treatment plan, Jones calculated that it would cost an insurer $37,000 to resist such an inundation of claims submissions.


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