ID
2024-008

Type
Règle
Secteur
Assurance automobile
État
Période de commentaires du public terminée
Date
15 juillet 2024
Date de remise des commentaires
15 octobre 2024

Nous vous remercions de nous avoir fait part de vos commentaires sur la ligne directrice sur le service de signalement des fraudes ici proposée par l’ARSF.

La demande de soumissions est maintenant fermée.

Nous apprécions les commentaires et les questions reçus à ce jour et nous avons hâte de partager avec vous la version finale de la ligne directrice. Restez au fait des lignes directrices publiées dans notre salle de presse. Suivez-nous sur LinkedIn et inscrivez-vous à notre liste de diffusion pour obtenir des mises à jour rapides.

Afin de réduire les préjudices pour les consommateurs et de diminuer les coûts supplémentaires associés à la fraude à l’assurance automobile, l’Autorité ontarienne de réglementation des services financiers (ARSF) propose une nouvelle règle sur le signalement de la fraude à l’assurance automobile. Cette règle proposée permettra de mieux déterminer le montant de la fraude à l’assurance automobile dans la province, de détecter et d’évaluer les tendances de la fraude et d’établir une base de référence pour pouvoir assurer le suivi du montant de la fraude et le réduire à l’avenir. Après l’entrée en vigueur de la règle proposée, les sociétés d’assurance devront donner des renseignements particuliers à l’ARSF.

L’ARSF sollicite des commentaires sur la règle et la ligne directrice proposées qui portent sur ce qui suit :

  • une proposition de définition de ce qui constitue un « cas de fraude »
  • le moment où les assureurs doivent déclarer des renseignements sur un cas de fraude
  • la fréquence à laquelle les assureurs devront déclarer des renseignements sur des cas de fraude à l’ARSF
  • l’approche de l’ARSF de l’administration de la règle proposée

Après l’entrée en vigueur de la règle proposée, les assureurs devront fournir les renseignements prescrits à l’ARSF au sujet de la fraude à l’assurance automobile. Grâce à ces renseignements, l’ARSF déterminera ce qui peut être fait pour réduire la fraude et le préjudice subi par les consommateurs, ainsi que les coûts découlant de la fraude.

La période de consultation pour la proposition de règle est maintenant ouverte et se terminera le 15 octobre 2024. L’ARSF invite les intervenants à examiner la proposition de règle et de ligne directrice et à lui faire part de leurs commentaires.

Plus d’info :

L’ARSF continue de travailler au nom de l’ensemble des intervenants, y compris les consommateurs, pour garantir la sécurité financière, l’équité et le choix de toutes et tous. Pour en savoir plus : www.fsrao.ca.

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En soumettant un contenu, vous acceptez que votre document soit publié sur notre portail de participation et utilisé dans des rapports ou d’autres documents préparés par l’Autorité de réglementation des services financiers (ARSF) et qui pourraient rendus publics. Nous avons modéré le contenu pour nous assurer que toutes les publications sont respectueuses et professionnelles. La Loi sur l’accès à l’information et la protection de la vie privée, L.R.O. 1990, chap. F.31, s’applique à tout contenu publié en ligne.

Secteur Commentaire Date
Assurance IARD et assurance Générale
[2024-008] John Taylor - Ontario Mutual Insurance Association
Please find attached OMIA's submission.
Assurance automobile
[2024-008] Elliott Silverstein - CAA Insurance
On behalf of CAA Insurance, please find our comments related to this consultation.

Thank you.
Assurance automobile
[2024-008] Rhona DesRoches - FAIR Association of victims for Accident Insurance Reform
FAIR Association of victims for Accident Insurance Reform response to:
FSRA Consultation on Proposed Fraud Reporting Service Rule and Guidance ID 2024-008

We are pleased to see the Regulator take steps to identify fraud in the auto insurance industry to better protect the public. No one supports fraud and this is a positive step.

1. Definition of what constitutes a ‘fraud event’
Regarding the definition of a ‘fraud event’ at: 1. (e) “fraud event” means a deceptive act or omission, or series of deceptive acts or omissions intentionally committed by a person(s) to obtain advantage, financial gain, or benefits beyond that to which one is entitled to with regard to any policy, claim, provision of goods or services or other occurrence related to automobile insurance, and for greater clarity includes instances of:...

RECOMMENDATION: The wording be expanded to include: “committed by a person(s), business(es) or institution(s) to..”
The current language appears to specifically exclude businesses or institutions that are insurers and their associates or intermediaries.

3. Prescribed information under subsection 101.3(1) of the Act
In respect to: 3(2) An insurer shall within thirty days after the close of each quarter of the calendar year provide the information prescribed in subsection 3(1) of this Rule with respect to fraud events which in the preceding quarter the insurer has taken action or made a decision based on reasonable grounds for the insurer to believe that a fraud event has occurred or is likely to occur.

RECOMMENDATION: Insurers should have to provide information in subsection 3(1) within 30-60 days of the event rather than after the close of each quarter.
If all insurers report at the same time the effectiveness of the Regulator may be compromised by being overwhelmed. Perhaps it is presumptuous to assume that the Regulator might take action to protect vulnerable claimants but stale-dated fraud reporting is less helpful.

GENERAL COMMENT:
If the “purpose of collecting this information is to support the more effective assessment and detection of automobile insurance fraud in Ontario” and to support “FSRA’s goal of reducing consumer harm caused through fraud” then there should be some statement about what FSRA does with this information other than “information that has been collected will be available for insurers to access to enable the assessing and detecting of fraud” in a second phase. What about consumer access to industry fraud?

Not only is the hunt for fraud left entirely to insurers (who are themselves often fraudulent in their claims practices) but it also ignores the claimant experience where insurers’ (and their intermediaries) fraud is a very real issue tens of thousands of Ontario’s claimants face every day.

Where, in this document, is the protection of vulnerable injured car crash claimants who are exposed to the fraud? This shouldn’t just be about protecting insurer profits but rather about protecting people who are scammed along the claims corridor.

This document goes back and forth about prescribed information required but fails to inspire confidence as it becomes clear this is about gathering information to identify fraud and carefully doesn’t mention any action to be taken by Fraud Reporting Service (“FRS”).

FSRA has taken some recent action to address fraud in the medical examination process with the Dr. Romeo Vitelli case but the failure to put the interests of consumers as a high priority is obvious. We cannot tell if any action was taken against the assessment center, Novo Medical Services Inc., for whom this psychologist prepared the medical reports that were at the center of FSRA’s investigation.

In 2019, Dr. Vitelli entered into an Acknowledgement and Undertaking with the College of Psychologists following allegations of professional misconduct as a result of a complaint from a claimant and FSCO and FSRA were informed of the College’s actions.

According to the FSRA website https://teao.fsrao.ca:7179/api/enforcement/downloadDocument?Id=2653&lang=en :
In 2019,
FSRA received an investigative report in support of Aviva’s allegations. Documents in the report establish that Novo Medical submitted seven Psychological Evaluation Reports and one Catastrophic Impairment Determination Psychological Evaluation Report (dated between April 21, 2017 and May 4, 2018) for claimants (AK, CD, GC, JH, MM, MR, and NK). Sections of the reports are identical. The reports also include identical quotations presented as the claimants’ verbatim descriptions of their injuries and symptoms. (for claimants (AK, CD, GC, JH, MM, MR, and NK)).
and;
On June 23, 2020, FSRA received a Business Activity Complaint Form from Desjardins General Insurance Group (“Desjardins”) alleging that Novo Medical and Dr. Vitelli engaged in practices that contravene the Act. (five psychological assessment reports for claimants (NH, AL, KH, JS, and RR)).
and;
FSRA received an investigative report from Intact Insurance (“Intact”). (claimant (SR)).

Despite insurers reporting they had been defrauded there was no action taken by FSRA until February 8, 2021, when FSRA investigators interviewed Dr. Vitelli. It was during this process that “Dr. Vitelli also stated that Novo Medical’s staff used his Treatment Plan for another claimant as a template, by switching out the names and pronouns where necessary. Dr. Vitelli did not confirm the content and accuracy of the Treatment Plans he completed.”

Finally in 2021 action was taken by FSRA with the suggestion “an administrative penalty in the amount of $50,000 should be imposed on Dr. Vitelli for knowingly making false or misleading representations to insurers in order to obtain payment for goods or services provided, contrary to section 447(2)(a.3) of the Act.”

The public was eventually informed in a press release on “Nov. 22, 2023 /CNW/ - The Financial Services Regulatory Authority of Ontario (FSRA) has imposed a compliance order and administrative penalty of $15,000 against Romeo Vitelli (Vitelli).”

For 4 years innocent injured claimants interests were ignored, first by the College of Psychologists (CPO) whom the Regulator relies on to enforce quality control and then by FSRA during the process of deciding what to do about the fraud.

We could find no evidence that Novo Medical Services Inc. was ever held accountable for their participation in harming the most seriously injured car crash survivors. Nova Medical is still actively in business providing assessments of Ontario’s auto insurance claimants for insurers.

FAIR’s files indicate there are likely more victims of the fraudulent reports as well as through ‘expert’ evidence at hearings where Dr. Vitelli’s testimony was often criticized. There is also evidence that more than one assessment center used the services of Dr.Vitelli “through four healthcare clinics” mentioned on the CPO website document at https://cpbao.ca/wp-content/uploads/Notice-of-Hearing-Vitelle-Dr.-Romeo-2.pdf.

As of May 2024 the CPO https://members.cpbao.ca/public_register/show/1461 has listed the current referrals of Dr. Vitelli to the Discipline Committee.

We see no evidence that the 13 plus victims of this fraud were informed by FSRA or the CPO that they’d been scammed and that their cases had been tainted by the fraudulent and uncaring actions of Dr. Vitelli and Nova Medical.

To this day AK, CD, GC, JH, MM, MR, NK, NH, AL, KH, JS, RR, and SK may all still be in the dark about how their cases and access to rehabilitation were recklessly ignored by the insurer’s choice of assessment centers.

We bring up this particular case for several reasons but the most important is that there is no point to gathering information if there is no intent to protect the public’s interest. It should never be just about insurer profit and gain over informing the public in a timely fashion and this should be reflected in the proposed Rule and Guidance.

Timely reporting from insurers coupled with judicious action from the Regulator would better protect claimants. The promise to follow through on the insurer reporting fraud is missing in this Guidance along with a willingness to share fraud trends with the public and not just insurers.

Taking steps to enforce compliance with Dr. Vitelli was an important mile-stone for the Regulator and we recognize this. The problem lies in the two and half years from the Notice of Proposal to Impose Administrative Penalties on March 31, 2021 to informing the public on November 22, 2023 in a press release. It appears that for two and a half years vulnerable claimants lacked protection because FSRA withheld this information. This should never happen.

The investigation and the conclusion record poses other serious questions related to the outcomes for the victims of this fraud.

It’s still an open question whether Dr. Vitelli will be able to continue to provide services for auto insurers through medical examinations and testimony going forward. None of that is clear in the information on the College of Psychologists (CPO) website or in FSRA’s documentation and neither contribute to public confidence in the automobile insurance sector.

In this instance insurers did the right thing but we can tell you we routinely hear about bogus insurer medical exams and this Guidance presents deaf ears to claimants who are harmed in the current system that relies on the Regulator to take action to protect them. What about Nova? Should they have been subject to an Administrative Penalty and/or closed out of performing these medical assessments?

Our suggestion to include businesses and institutions in the wording is based on this case above as is our comment about the importance of timeliness in reporting fraud.

Something needs to be done about the regulatory hole that exists for assessment centers who currently have no oversight and who, in this case, appear to have participated in, or should have known about, the fraud taking place.

Consumers believe the Regulator has a distinct obligation to follow-through on the fraud they find by way of informing victims of that fraud and, by extension, to protect the potential or future victims from the perpetrators by barring the fraudulent players from activity in the auto insurance medical landscape. This can be done by closing the door to Health Claims for Auto Insurance (HCAI) access. There should be an active dialogue to disclose this type of medical fraud activity between relevant Colleges and FSRA. Further, the Colleges should also be required to participate in cleaning up this fertile ground for fraud that harms Ontario’s patients.

Thank you for the opportunity to voice our concerns.

FAIR Association of victims for Accident Insurance Reform



Assurance automobile
[2024-008] Ryan Stein - Definity Insurance
Good afternoon,
Thank you for the opportunity to participate in the consultation for the fraud reporting service. Attached is a response from Definity Insurance.
Sincerely,
Ryan
Assurance automobile
[2024-008] Karin Ots - Aviva Canada
Attached is Aviva's submission to FSRA Fraud Reporting Service consultation..
Assurance automobile
[2024-008] Craig Bran - Co-operators
Intersectoriel
[2024-008] Danielle Wilkinson - Equite Association
Please accept the attached consultation submission on behalf of Equite Association.
Fournisseurs de services de santé
[2024-008] Laurie Davis - Ontario Rehab Alliance
To whom it may concern,

Please see attached for the Ontario Rehab Alliance's comments on the Consultation on Proposed Fraud Reporting Service Rule and Guidance
ID 2024-008

We welcome the opportunity to discuss our comments or respond to any questions you may have. Please feel free to reach out to the ORA at [email protected] or to myself directly, Laurie Davis, Executive Director of the Ontario Rehab Alliance - [email protected]

Sincerely,
Laurie Davis
Executive Director
The Ontario Rehab Alliance
Assurance automobile
[2024-008] Amanda Dean - Insurance Bureau of Canada
Please see the attached submission for your consideration. Thank you
[2024-008] Derrick Ajmo - Heartland Mutual Insurance
Hi there,

The below are the concerns that Heartland would like to submit regarding the proposed Fraud Reporting Service Rule.

1. Fraud is usually never alleged unless proven in court. Typically, insurers will never deny a claim under fraud unless we have proof which we then turn over to the authorities. Typically, the authorities deem this low value and nothing is done. Therefore, without a conviction, how can we allege fraud towards an insured or vendor under the proposed guidelines.
2. The verbal presentation indicated that the insured or vendor identifying information would not be required to be reported however the documents released indicate that insured name and contact details must be listed on the FSRA reporting system. If we do indeed need to declare the insured or vendor name on the site and this information gets released to the public, the insurer could be exposed to a bad faith claim. Will FSRA regulations or rules exempt this reporting from being disclosed to the relevant parties and/or will FSRA compensate the insurer if found to be acting in bad faith due to reporting the insured or vendor of fraud based upon what later on could be deemed unproven allegations by a court?
3. What safeguards will FSRA undertake to ensure that this information is not inadvertently released to the public? With FSRA compensate insurers for the unauthorized release of the data should the system be compromised? Is there a concern by FSRA of the reputational harm to individual insureds and vendors should these unproven allegations of fraud be released into the public domain.
4. Will this information submitted by the insurer be subject to release to the public under Freedom of Information or be open to being subpoenaed in a court case involving said insurer.
5. As the goal of this is to gather the extent of the fraud being perpetrated in auto insurance, how will the information gathered be released to the public or insurers in a manner that will protect insurers from any potential bad faith allegations due to the data that has been reported to FSRA by them?

If there is another format that the above feedback needs to be submitted to FSRA, please let me know and I will provide.

Regards
Derrick Ajmo
[2024-008] Laurence L. Wymant - Unica Insurance
Please find enclosed Unica Insurance’s feedback on the proposed Fraud Reporting Service Rule and Guidance
Fournisseurs de services de santé
[2024-008] Ralph Palumbo - The Hillcrest Consulting Group Inc.
Attached are the submissions from the Ontario Psychological Association (OPA) on FSRA's Proposed Fraud Reporting Service Rule and Guidance.

The OPA would be pleased to discuss its submissions with FSRA at any time.

Respectfully submitted,

Ralph Palumbo
Assurance automobile
[2024-008] Andrew Papadimitropoulos - TD Insurance
Attached is TD Insurance feedback on FRS Guidance
Assurance automobile
[2024-008] Sarah Fong - Travelers Canada
Please find attached Travelers Canada's submission to FSRA's Consultation on Proposed Fraud Reporting Service Rule and Guidance.
Assurance automobile
[2024-008] Giuseppina Marra - Desjardins Group
Bonjour,
Le Mouvement Desjardins soumet à l'attention de l’Autorité ontarienne de réglementation des services financiers ses commentaires relatifs à la consultation publique sur le projet de règle et ligne directrice proposées sur le service de signalement des fraudes.
Nous vous réitérons nos sincères remerciements pour l’occasion offerte de soumettre nos commentaires.

Bien cordialement.

Aucune question n'a encore été posée sur cette consultation.