O. Reg. 458/03: Statutory Accident Benefits Schedule - Accidents on or after November 1, 1996

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ontario regulation 458/03

made under the

Insurance Act

Made: December 23, 2003
Filed: December 24, 2003
Printed in The Ontario Gazette: January 10, 2004

Amending O. Reg. 403/96

(Statutory Accident Benefits Schedule — Accidents on or after November 1, 1996)

1. Subsection 2 (1) of Ontario Regulation 403/96 is amended by adding the following definitions:

“Grade I Whiplash Guideline” means the Pre-approved Framework Guideline entitled Pre-approved Framework Guideline for Whiplash Associated Disorder Grade I Injuries With or Without Complaint of Back Symptoms; (“lignes directrices pour les entorses cervicales de stade I”)

“Grade II Whiplash Guideline” means the Pre-approved Framework Guideline entitled Pre-approved Framework Guideline for Whiplash Associated Disorder Grade II Injuries With or Without Complaint of Back Symptoms; (“lignes directrices pour les entorses cervicales de stade II”)

2. Section 4 of the Regulation is amended by adding the following subsection:

(2) Despite subsection (1), paragraph 3 of that subsection applies only if the accident occurs before April 15, 2004.

3. Subsection 5 (2) of the Regulation is amended by striking out “or” at the end of clause (b) and by adding the following clauses:

(d) for any period longer than 12 weeks after the accident, in the case of an insured person whose impairment comes within the Grade I Whiplash Guideline, if the accident occurred after April 14, 2004; or

(e) for any period longer than 16 weeks after the accident, in the case of an insured person whose impairment comes within the Grade II Whiplash Guideline, if the accident occurred after April 14, 2004.

4. Subsection 14 (6) of the Regulation is revoked and the following substituted:

(6) The insurer is not liable to pay a medical benefit under clause (2) (g) for expenses related to,

(a) the first 50 kilometres of transportation in the insured person’s automobile to and from a treatment session if the accident occurred before April 15, 2004; or

(b) the first 50 kilometres of transportation to and from a treatment session if the accident occurred after April 14, 2004, unless the insured person sustained a catastrophic impairment as a result of the accident.

5. Subsection 15 (12) of the Regulation is revoked and the following substituted:

(12) The insurer is not liable to pay a rehabilitation benefit under clause (5) (k) for expenses related to,

(a) the first 50 kilometres of transportation in the insured person’s automobile to and from a counselling or training session if the accident occurred before April 15, 2004; or

(b) the first 50 kilometres of transportation to and from a counselling or training session if the accident occurred after April 14, 2004, unless the insured person sustained a catastrophic impairment as a result of the accident.

6. (1) Section 16 of the Regulation is amended by adding the following subsection:

(1.1) Despite subsection (1), no attendant care benefit is payable to an insured person whose impairment comes within the Grade I Whiplash Guideline or the Grade II Whiplash Guideline if the accident occurred after April 14, 2004.

(2) Paragraph 3 of subsection 16 (5) of the Regulation is revoked and the following substituted:

3. If the accident occurred on or after October 1, 2003 and the optional medical, rehabilitation and attendant care benefit referred to in section 27 has been purchased and applies to the insured person, the amount of the attendant care benefit payable in respect of the insured person shall not exceed the monthly limit under subsection 27 (5).

7. Subsections 19 (2) and (3) of the Regulation are revoked and the following substituted:

(2) The amount of the attendant care benefit paid in respect of an insured person shall not exceed, for any one accident,

(a) $1,000,000, if the insured person sustained a catastrophic impairment as a result of the accident;

(b) nil, if the accident occurred after April 14, 2004 and the insured person sustained an impairment that comes within the Grade I Whiplash Guideline or the Grade II Whiplash Guideline; or

(c) $72,000 in any other case.

(3) If the optional medical, rehabilitation and attendant care benefit referred to in section 27 was purchased and applies to the insured person, the maximum limits fixed by the optional benefit apply and subsection (1) and clauses (2) (a) and (c) do not apply.

8. Subsection 24 (4) of the Regulation is revoked and the following substituted:

(4) The insurer is not liable under subsection (1.6) to pay for expenses related to,

(a) the first 50 kilometres of transportation in the insured person’s automobile to and from an examination or assessment if the examination or assessment relates to an accident that occurred before April 15, 2004; or

(b) the first 50 kilometres of transportation to and from an examination or assessment if the examination or assessment relates to an accident that occurred after April 14, 2004, unless the insured person sustained a catastrophic impairment as a result of the accident.

9. (1) Subparagraph 3 ii of subsection 27 (1) of the Regulation is revoked and the following substituted:

ii. The amount of the attendant care benefit paid in respect of an insured person shall not exceed, for any one accident,

A. $2,000,000, if the insured person sustained a catastrophic impairment as a result of the accident,

B. $1,072,000 in any case in which the insured person did not sustain as a result of the accident,

1. a catastrophic impairment, or

2. an impairment that comes within the Grade I Whiplash Guideline or the Grade II Whiplash Guideline, if the accident occurred after April 14, 2004, or

C. nil, if the accident occurred after April 14, 2004 and the insured person sustained an impairment that comes within the Grade I Whiplash Guideline or the Grade II Whiplash Guideline.

(2) Subsection 27 (5) of the Regulation is revoked and the following substituted:

(5) The maximum monthly attendant care benefit payable in respect of an insured person shall not exceed $6,000 if the benefit is payable in respect of an accident that occurs on or after October 1, 2003.

10. Section 37 of the Regulation is amended by adding the following subsection:

(5.1) Paragraphs 2 and 3 of subsection (3) and subsections (4) and (5) do not apply if,

(a) the notice under clause (1) (b) relates to the entitlement of the person to receive an income replacement benefit; and 

(b) the notice is given for the reason that the person is not entitled to continue to receive the benefit because the period during which the benefit is payable is limited by clause 5 (2) (d) or (e).

11. Part XIV of the Regulation is amended by adding the following section:

Unreported Income

64.1 (1) If, under the Income Tax Act (Canada) or legislation of another jurisdiction that imposes a tax calculated by reference to income, a person is required to report the amount of his or her income, the person’s income before an accident that occurs after April 14, 2004 shall be determined for the purposes of this Regulation without reference to any income the person has failed to report contrary to that Act or legislation.

(2) Where the amount of a person’s income before an accident is determined for the purposes of this Regulation in accordance with subsection (1), the amount of the income may be adjusted to reflect any change in the amount of the person’s income reported or determined in accordance with the Income Tax Act (Canada) or legislation of another jurisdiction that imposes a tax calculated by reference to income.

12. Subsections 68 (3) and (5) are amended by striking out “certified mail or registered mail” wherever it appears.

 

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