hordruma/ontario_laws_and_regs huggingface dataset:
PART VI AUTOMOBILE INSURANCE
Resolution of disputes
280 (1) This section applies with respect to the resolution of disputes in respect of an insured person’s entitlement to statutory accident benefits or in respect of the amount of statutory accident benefits to which an insured person is entitled. 2014, c. 9, Sched. 3, s. 14. Application to Tribunal (2) The insured person or the insurer may apply to the Licence Appeal Tribunal to resolve a dispute described in subsection (1). 2014, c. 9, Sched. 3, s. 14. Limit on court proceedings (3) No person may bring a proceeding in any court with respect to a dispute described in subsection (1), other than an appeal from a decision of the Licence Appeal Tribunal or an application for judicial review. 2014, c. 9, Sched. 3, s. 14. Resolution in accordance with Schedule (4) The dispute shall be resolved in accordance with the Statutory Accident Benefits Schedule. 2014, c. 9, Sched. 3, s. 14. Orders, powers and duties (5) The regulations may provide for and govern the orders and interim orders that the Licence Appeal Tribunal may make and may provide for and govern the powers and duties that the Licence Appeal Tribunal shall have for the purposes of conducting the proceeding. 2014, c. 9, Sched. 3, s. 14. Orders for costs, other amounts (6) Without limiting what else the regulations may provide for and govern, the regulations may provide for and govern the following: 1.  Orders, including interim orders, to pay costs, including orders requiring a person representing a party to pay costs personally. 2.  Orders, including interim orders, to pay amounts even if those amounts are not costs or amounts to which a party is entitled under the Statutory Accident Benefits Schedule. 2014, c. 9, Sched. 3, s. 14. Section Amendments with date in force (d/m/y) 1993, c. 10, s. 1 - 01/01/1994; 1996, c. 21, s. 35 (1, 2) - 01/11/1996 2014, c. 9, Sched. 3, s. 14 - 01/04/2016 280.1 Repealed: 2014, c. 9, Sched. 3, s. 14. Section Amendments with date in force (d/m/y) 1996, c. 21, s. 36 - 01/11/1996 2014, c. 9, Sched. 3, s. 14 - 01/04/2016
PART VI AUTOMOBILE INSURANCE
Protection of benefits after Tribunal resolution
281 (1) After the Licence Appeal Tribunal issues a decision, the insurer shall not reduce benefits to the insured person on the basis of an alleged change of circumstances, alleged new evidence or an alleged error except as provided under this section. 2014, c. 9, Sched. 3, s. 14. When benefits may be reduced (2) The insurer may reduce benefits if, (a)  the insured person agrees; (b)  the insurer is authorized to do so as a result of a successful appeal of the Licence Appeal Tribunal’s decision; or (c)  the insurer is authorized to do so by the Licence Appeal Tribunal. 2014, c. 9, Sched. 3, s. 14. Section Amendments with date in force (d/m/y) 1996, c. 21, s. 37 - 01/11/1996 2002, c. 24, Sched. B, s. 39 (5) - 01/01/2004 2014, c. 9, Sched. 3, s. 14 - 01/04/2016 281.1 Repealed: 2014, c. 9, Sched. 3, s. 14. Section Amendments with date in force (d/m/y) 2002, c. 24, Sched. B, s. 39 (6) - 01/01/2004 2014, c. 9, Sched. 3, s. 14 - 01/04/2016
PART VI AUTOMOBILE INSURANCE
Assessment of dispute resolution costs
282 (1) The Lieutenant Governor in Council may, in accordance with the regulations, assess all insurers that have issued motor vehicle liability policies in Ontario for expenses and expenditures of the Licence Appeal Tribunal relating to disputes described in subsection 280 (1). 2014, c. 9, Sched. 3, s. 14. Same (2) If an assessment is made under subsection (1), the share of a particular insurer shall be determined in the manner prescribed by regulation, which may take into account the degree of usage made of the Licence Appeal Tribunal that is specified in the regulations. 2014, c. 9, Sched. 3, s. 14. Same, fees received (3) In setting an assessment under subsection (1), the Lieutenant Governor in Council shall take into account the fees received from insurers and insured persons in respect of disputes described in subsection 280 (1). 2014, c. 9, Sched. 3, s. 14. Insurer’s duty to pay (4) An insurer shall pay the amount assessed against it. 2014, c. 9, Sched. 3, s. 14. Unpaid assessments (4.1) If an insurer that is assessed does not pay the assessment, the unpaid amount of the assessment is a debt due to the Crown and the Crown may recover the debt by action or by any other remedy or procedure available by law to the Crown for the collection of debts owed to the Crown, whether or not the Chief Executive Officer exercises the rights set out in subsections (5) and (6). 2016, c. 37, Sched. 10, s. 2; 2018, c. 8, Sched. 13, s. 22. Same (5) If an insurer fails to pay an assessment made under subsection (1), the Chief Executive Officer may suspend or cancel the insurer’s licence. 2014, c. 9, Sched. 3, s. 14; 2018, c. 8, Sched. 13, s. 22. Same (6) The Chief Executive Officer may revive the licence of an insurer whose licence was suspended or cancelled under subsection (5) if the insurer pays all amounts owing by the insurer under this section. 2014, c. 9, Sched. 3, s. 14; 2018, c. 8, Sched. 13, s. 22. Section Amendments with date in force (d/m/y) 1993, c. 10, ss. 1, 33 - 01/01/1994; 1996, c. 21, s. 38 (1-6) - 01/11/1996 2002, c. 18, Sched. H, s. 4 (24) - 26/11/2002; 2002, c. 22, s. 127 - 01/10/2003 2014, c. 9, Sched. 3, s. 14 - 01/04/2016 2016, c. 37, Sched. 10, s. 2 - 08/12/2016 2018, c. 8, Sched. 13, s. 22 - 08/06/2019
PART VI AUTOMOBILE INSURANCE
Listed expenses in connection with statutory accident benefits
288.1 (1) For the purposes of this Part, the following are listed expenses in connection with statutory accident benefits: 1.  Amounts payable for such assessments, examinations, reports, forms or plans authorized or required by the Statutory Accident Benefits Schedule as may be prescribed for the purposes of this section and expenses relating to those assessments, examinations, reports, forms and plans. 2.  Amounts payable for prescribed goods or services that relate to such medical benefits, rehabilitation benefits, attendant care benefits and other statutory accident benefits as may be prescribed for the purposes of this section. 2013, c. 2, Sched. 8, s. 14; 2014, c. 7, Sched. 14, s. 4. Exceptions (2) Despite subsection (1), the regulations may specify that certain types of amounts payable are not listed expenses in such circumstances as may be prescribed. 2013, c. 2, Sched. 8, s. 14. Section Amendments with date in force (d/m/y) 2013, c. 2, Sched. 8, s. 14 - 01/06/2014 2014, c. 7, Sched. 14, s. 4 - 24/07/2014 Restrictions re payments for listed expenses
PART VI AUTOMOBILE INSURANCE
Payment by insurer
288.2 (1) An insurer is not permitted to make payments for listed expenses directly to a person or entity who does not hold a service provider’s licence at the applicable time, as determined in accordance with the regulations. 2013, c. 2, Sched. 8, s. 15. Exception (2) The restriction imposed by subsection (1) does not apply with respect to payments to such persons or entities as may be prescribed, or in such circumstances as may be prescribed. 2013, c. 2, Sched. 8, s. 15. Reimbursement of insured person (3) An insurer is permitted to reimburse an insured person for a listed expense, whether or not the payment for which reimbursement is sought was made to the holder of a service provider’s licence. 2013, c. 2, Sched. 8, s. 15. Motor Vehicle Accident Claims Fund (4) This section applies, with necessary modifications, with respect to the Motor Vehicle Accident Claims Fund. 2013, c. 2, Sched. 8, s. 15. Section Amendments with date in force (d/m/y) 2013, c. 2, Sched. 8, s. 15 - 01/12/2014
PART VI AUTOMOBILE INSURANCE
Public registry re service provider’s licences
288.3 (1) The Chief Executive Officer shall maintain one or more registers listing the holders of a service provider’s licence and the former holders of such a licence. 2013, c. 2, Sched. 8, s. 16; 2018, c. 8, Sched. 13, s. 22. Same (2) The registers must contain such other information as may be prescribed. 2013, c. 2, Sched. 8, s. 16. Same (3) The information in a register shall be made available for inspection by the public without charge and in accordance with the regulations. 2013, c. 2, Sched. 8, s. 16. Note: On a day to be named by proclamation of the Lieutenant Governor, subsection 288.3 (3) of the Act is amended by striking out “the regulations” at the end and substituting “the Authority rules”. (See: 2017, c. 34, Sched. 21, s. 20) Section Amendments with date in force (d/m/y) 2013, c. 2, Sched. 8, s. 16 - 01/06/2014 2017, c. 34, Sched. 21, s. 20 - not in force 2018, c. 8, Sched. 13, s. 22 - 08/06/2019; CTS 04 SE 18 - 1
PART VI AUTOMOBILE INSURANCE
Service provider’s licence — attributes and duties
288.4 (1) The holder of a service provider’s licence is eligible to be paid directly by an insurer for listed expenses in connection with statutory accident benefits. 2013, c. 2, Sched. 8, s. 17. Standards for business systems and practices, etc. (2) It is a condition of a service provider’s licence that the licensee is required to comply with such standards as may be prescribed with respect to its business systems and practices, in connection with statutory accident benefits, and such standards as may be prescribed with respect to matters of integrity in the management of the licensee’s operations. 2013, c. 2, Sched. 8, s. 17. Invoices for listed expenses (3) It is a condition of a service provider’s licence that the licensee is required to submit invoices to the applicable insurer, or to such other person or entity as the insurer directs, for payment of listed expenses in connection with statutory accident benefits. 2013, c. 2, Sched. 8, s. 17. Other conditions (4) A service provider’s licence is subject to such other conditions as may be prescribed or as may be imposed by the Chief Executive Officer or Tribunal with respect to the matters described in subsection (2) and with respect to the administration of this Act and the Statutory Accident Benefits Schedule. 2013, c. 2, Sched. 8, s. 17; 2018, c. 8, Sched. 13, s. 22. Same (5) For greater certainty, a regulation prescribing conditions may require the licensee to submit periodic reports to the Chief Executive Officer. 2013, c. 2, Sched. 8, s. 17; 2018, c. 8, Sched. 13, s. 22. Note: On a day to be named by proclamation of the Lieutenant Governor, subsection 288.4 (5) of the Act is amended by striking out “a regulation” and substituting “an Authority rule”. (See: 2017, c. 34, Sched. 21, s. 21 (1)) Principal representative (6) A licensee shall designate an individual as the licensee’s principal representative to exercise such powers and perform such duties as may be prescribed, and the individual so designated shall carry out his or her powers and duties in accordance with the regulations, if any. 2013, c. 2, Sched. 8, s. 17. Note: On a day to be named by proclamation of the Lieutenant Governor, subsection 288.4 (6) of the Act is amended by striking out “the regulations” and substituting “the Authority rules”. (See: 2017, c. 34, Sched. 21, s. 21 (2)) Same (7) An individual who satisfies the prescribed criteria is eligible to be designated as a licensee’s principal representative. 2013, c. 2, Sched. 8, s. 17. Section Amendments with date in force (d/m/y) 2013, c. 2, Sched. 8, s. 17 - 01/06/2014 2017, c. 34, Sched. 21, s. 21 (1, 2) - not in force 2018, c. 8, Sched. 13, s. 22 - 08/06/2019; CTS 04 SE 18 - 1 Issuance of service provider’s licence
PART VI AUTOMOBILE INSURANCE
Application
288.5 (1) A person or entity who wishes to apply for a service provider’s licence shall submit an application to the Chief Executive Officer in the manner required by the Chief Executive Officer and shall give the Chief Executive Officer such information, evidence and material as he or she may require and shall pay the applicable fee. 2013, c. 2, Sched. 8, s. 18; 2018, c. 8, Sched. 13, s. 22. Withdrawal of application (2) The applicant may withdraw the application at any time before the licence is issued. 2013, c. 2, Sched. 8, s. 18. Issuance of licence (3) The Chief Executive Officer shall issue a service provider’s licence to an applicant who satisfies the prescribed requirements relating to its business systems and practices and the management of its operations, (a)  unless the Chief Executive Officer believes, on reasonable grounds, that the applicant is not suitable to hold a licence having regard to such circumstances as may be prescribed relating to the applicant’s business systems and practices and the management of its operations or having regard to such other matters as the Chief Executive Officer considers appropriate; or (b)  unless an administrative penalty imposed on the applicant under Part XVIII.1 has not been paid. 2013, c. 2, Sched. 8, s. 18; 2018, c. 8, Sched. 13, s. 22. Not transferable (4) A service provider’s licence is not transferable. 2013, c. 2, Sched. 8, s. 18. Proposal to refuse application (5) If the Chief Executive Officer proposes to refuse to issue a service provider’s licence to an applicant, the Chief Executive Officer shall take the steps required by section 288.7. 2013, c. 2, Sched. 8, s. 18; 2018, c. 8, Sched. 13, s. 22. Proposal to impose conditions (6) If the Chief Executive Officer proposes to issue the service provider’s licence and, without the applicant’s consent, to impose conditions on the licence, the Chief Executive Officer shall take the steps required by section 288.7. 2013, c. 2, Sched. 8, s. 18; 2018, c. 8, Sched. 13, s. 22. Amendment of licence (7) The Chief Executive Officer may amend a service provider’s licence at any time. 2013, c. 2, Sched. 8, s. 18; 2018, c. 8, Sched. 13, s. 22. Proposal to amend (8) If the Chief Executive Officer proposes to amend a service provider’s licence without the licensee’s consent, the Chief Executive Officer shall take the steps required by section 288.7. 2013, c. 2, Sched. 8, s. 18; 2018, c. 8, Sched. 13, s. 22. Section Amendments with date in force (d/m/y) 2013, c. 2, Sched. 8, s. 18 - 01/06/2014 2018, c. 8, Sched. 13, s. 22 - 08/06/2019 Revocation, suspension or surrender of service provider’s licence
PART VI AUTOMOBILE INSURANCE
Chief Executive Officer’s proposal to refuse application, etc.
288.7 (1) This section applies if the Chief Executive Officer proposes to do any of the following things: 1.  Refuse to issue a service provider’s licence to an applicant. 2.  Issue a service provider’s licence and, without the applicant’s consent, impose conditions. 3.  Amend a service provider’s licence without the licensee’s consent. 4.  Revoke a service provider’s licence under subsection 288.6 (1) without the licensee’s consent. 5.  Suspend a service provider’s licence under subsection 288.6 (1) without the licensee’s consent. 6.  Refuse to allow the surrender of a service provider’s licence. 7.  Allow the surrender of a service provider’s licence and, without the applicant’s consent, impose conditions in connection with the surrender. 2013, c. 2, Sched. 8, s. 18; 2018, c. 8, Sched. 13, s. 22. Notice of proposal (2) The Chief Executive Officer shall give written notice of the proposal to the applicant or licensee, including the reasons for the proposal; the Chief Executive Officer shall also inform the applicant or licensee that he, she or it can request a hearing by the Tribunal about the proposal and shall advise the applicant or licensee about the process for requesting a hearing. 2013, c. 2, Sched. 8, s. 18; 2018, c. 8, Sched. 13, s. 22. Hearing requested (3) If the applicant or licensee requests a hearing in writing within 15 days after the notice under subsection (2) is given, the Tribunal shall hold a hearing. 2013, c. 2, Sched. 8, s. 18. Order (4) The Tribunal may, by order, direct the Chief Executive Officer to carry out the proposal, with or without changes, or substitute its opinion for that of the Chief Executive Officer, and the Tribunal may impose such conditions as it considers appropriate in the circumstances. 2013, c. 2, Sched. 8, s. 18; 2018, c. 8, Sched. 13, s. 22. Appeal (5) A party to a hearing held by the Tribunal may appeal the order of the Tribunal to the Divisional Court. 2013, c. 2, Sched. 8, s. 18. Effect of appeal (6) An order of the Tribunal takes effect immediately, but if the order is appealed, the Tribunal may grant a stay of the order until the appeal is finally determined. 2013, c. 2, Sched. 8, s. 18. Hearing not requested (7) If the applicant or licensee does not request a hearing, or does not make the request in accordance with subsection (3), the Chief Executive Officer may carry out the proposal. 2013, c. 2, Sched. 8, s. 18; 2018, c. 8, Sched. 13, s. 22. Section Amendments with date in force (d/m/y) 2013, c. 2, Sched. 8, s. 18 - 01/06/2014 2018, c. 8, Sched. 13, s. 22 - 08/06/2019 Changes to Statutory Accident Benefits Schedule
PART VI AUTOMOBILE INSURANCE
Review of this Part
289 (1) The Chief Executive Officer shall undertake a review of this Part and any related regulations or rules at least every three years or more often at the request of the Minister. 2018, c. 8, Sched. 13, s. 11. Report (2) The Chief Executive Officer shall give a report to the Minister setting out the results of the review, any recommendations made by the Chief Executive Officer and such other information as the Minister may request. 2018, c. 8, Sched. 13, s. 11. Initial review (3) The Chief Executive Officer shall begin a review under this section within three years after the day section 11 of Schedule 13 to the Plan for Care and Opportunity Act (Budget Measures), 2018 comes into force. 2018, c. 8, Sched. 13, s. 11. Minister appointed reviewer (4) The Minister may at any time appoint a person other than the Chief Executive Officer to undertake a review of this Part and any related regulations or rules and to provide a report to the Minister setting out the results of the review, any recommendations made by the person and such other information as the Minister may request. 2018, c. 8, Sched. 13, s. 11. Section Amendments with date in force (d/m/y) 1993, c. 10, s. 1 (1) - 01/01/1994 2013, c. 2, Sched. 8, s. 19 - 16/08/2013 2018, c. 8, Sched. 13, s. 11 - 08/06/2019 289.1 Repealed: 2013, c. 2, Sched. 8, s. 19. Section Amendments with date in force (d/m/y) 2013, c. 2, Sched. 8, s. 19 - 16/08/2013 PART VII   ACCIDENT AND SICKNESS INSURANCE
PART VII ACCIDENT AND SICKNESS INSURANCE
Application of Part
291 (1) Despite any agreement, condition or stipulation to the contrary, but subject to a regulation made under paragraph 26.0.1 of subsection 121 (1), this Part applies to contracts made in Ontario on or after the 1st day of October, 1970. R.S.O. 1990, c. I.8, s. 291 (1); 2012, c. 8, Sched. 23, s. 34 (1). Idem (2) In the case of contracts made before and in effect on that day, (a)  this section and sections 290, 292, 292.1, 293, 302, 305, 306, 307 and 311, and sections 313 to 329 of this Part apply; and (b)  sections 230, 231, 232, 233, 235, 242 and 245 of The Insurance Act, being chapter 190 of the Revised Statutes of Ontario, 1960, as it existed immediately before the 1st day of October, 1970, continue to apply. R.S.O. 1990, c. I.8, s. 291 (2); 2014, c. 7, Sched. 14, s. 5. Exceptions (3) This Part does not apply to, (a)  insurance undertaken by an insurer as part of a contract of life insurance whereby the insurer undertakes to pay an additional amount of insurance money in the event of the death by accident of the person whose life is insured; (b)  Repealed: 2012, c. 8, Sched. 23, s. 34 (2). (c)  insurance undertaken by an insurer as part of a contract of life insurance whereby the insurer undertakes to pay insurance money or to provide other benefits in the event that the person whose life is insured becomes disabled as a result of bodily injury or disease, except as provided in the regulations; or (d)  insurance provided under section 265 or 268.  R.S.O. 1990, c. I.8, s. 291 (3); 2002, c. 18, Sched. H, s. 4 (26, 27); 2012, c. 8, Sched. 23, s. 34 (2, 3). Section Amendments with date in force (d/m/y) 2002, c. 18, Sched. H, s. 4 (26, 27) - 30/04/2007 2012, c. 8, Sched. 23, s. 34 (1-3) - 01/07/2016 2014, c. 7, Sched. 14, s. 5 - 01/07/2016
PART VII ACCIDENT AND SICKNESS INSURANCE
Group insurance
292 In the case of a contract of group insurance made with an insurer authorized to transact insurance in Ontario at the time the contract was made, this Part applies in determining, (a)  the rights and status of beneficiaries and personal representatives as recipients of insurance money, if the group person insured was resident in Ontario at the time he or she became insured; and (b)  the rights and obligations of the group person insured if the person was resident in Ontario at the time he or she became insured.  R.S.O. 1990, c. I.8, s. 292.
PART VII ACCIDENT AND SICKNESS INSURANCE
Application of ss. 126 and 131
292.1 Sections 126 and 131 apply to a contract of accident and sickness insurance.  2012, c. 8, Sched. 23, s. 35. Section Amendments with date in force (d/m/y) 2012, c. 8, Sched. 23, s. 35 - 01/07/2016
PART VII ACCIDENT AND SICKNESS INSURANCE
Contents of policy
294 (1) This section does not apply to, (a)  a contract of group insurance; (a.1)  a contract of creditor’s group insurance; or (b)  a contract made by a fraternal society. R.S.O. 1990, c. I.8, s. 294 (1); 2012, c. 8, Sched. 23, s. 37 (1). Same (2) An insurer shall include the following information in the policy: 1.  The name or a sufficient description of the insured and of the person insured. 2.  The amount or the method of determining the amount of the insurance money payable and the conditions under which it becomes payable. 3.  The amount or the method of determining the amount of the premium and the period of grace, if any, within which it may be paid. 4.  The conditions upon which the contract may be reinstated if it lapses. 5.  The term of the insurance or the method of determining the day upon which the insurance commences and terminates. 6.  The following statement: Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Limitations Act, 2002. R.S.O. 1990, c. I.8, s. 294 (2); 2012, c. 8, Sched. 23, s. 37 (2); 2013, c. 2, Sched. 8, s. 20. Notice on front page of policy (3) Where a policy contains a provision removing or restricting the right of the insured to designate persons to whom or for whose benefit insurance money is to be payable, the front page of the policy must include the following statement in conspicuous bold type: This policy contains a provision removing or restricting the right of the insured to designate persons to whom or for whose benefit insurance money is to be payable. 2012, c. 8, Sched. 23, s. 37 (3). Section Amendments with date in force (d/m/y) 2012, c. 8, Sched. 23, s. 37 (1, 2) - 01/07/2016 2013, c. 2, Sched. 8, s. 20 - 01/07/2016