A business that submits OCF-21 forms throughHealth Claims for Auto Insurance(HCAI), must be licensed by the Financial Services Regulatory Authority of Ontario (FSRA) in order to invoice and receive payment for any listed expenses directly from auto insurers.

Do I need a licence?

Scenario

Yes

No

You provide goods and services to Statutory Accident Benefits Schedule (SABS) claimants for which you submit invoices through HCAI and receive payment directly from automobile insurers

x

 

Sole proprietor paid directly by automobile insurers who occasionally does work at another facility

x

 

Business that only occasionally submits forms through HCAI

x

 

You provide assessment and examination services for a business

 

x

You are an “Authorizing Officer,” overseeing your facility’s billing on HCAI

 

x

You only submit OCF-18 and OCF-23 forms through HCAI, and invoice your claimants directly

 

x

You work for a facility that submits OCF-21 forms through HCAI on your behalf and pays you directly

 

x

Branch office for a large business

 

x

Holding company/corporation that owns licensee’s business

 

x

Business that does not operate in Ontario but may provide goods or services to someone involved in a motor vehicle accident in Ontario

 

x

Service provider licences are issued at the business or legal entity level (e.g., sole proprietorship, corporation, partnership) rather than for each location. Only one licence is needed for all facilities, branches or locations operated by a service provider.

Licence eligibility

To be eligible for a service provider licence, all facilities are required to be registered, enrolled and in good standing in HCAI.

Once a licence is issued, it will continue indefinitely, as long as the licensee complies with the law, consistently files an Annual Information Return (AIR) and pays the annual regulatory fee.

What happens when FSRA proposes to refuse a licence application?

If the CEO of the Financial Services Regulatory Authority of Ontario (CEO) proposes to refuse to issue a service provider licence, a Notice of Proposal process is initiated.

If your business is served a Notice of Proposal by the CEO, you may choose to withdraw your business’ application. No further action will be taken.

Alternatively, you may choose to request a hearing before the Financial Services Tribunal (FST). Procedures and timelines for requesting a hearing before the FST will be provided in the Notice of Proposal. A request for a hearing must be in writing and made within 15 days after the Notice of Proposal is given.

If a hearing is requested, the FST's decision will prevail. The FST may direct the CEO to carry out the proposal, with or without changes or substitute its opinion for that of the CEO and may impose such conditions as it considers appropriate in the circumstances.

If a party disputes an FST decision, it can appeal the order to the Ontario Divisional Court.

If you do not request a hearing in writing within 15 days after the Notice of Proposal is given, the CEO may refuse to issue your licence.

When a CEO's decision is rendered, the applicant's names and details of the matter may be published on FSRA's website. No information will be published regarding withdrawn applications.

About the Principal Representative

A Principal Representative is the person designated by the service provider to be the primary contact with FSRA and who is primarily responsible for the service provider’s licence and compliance with the law.

Who can be designated as a Principal Representative?

A Principal Representative must have one of the following positions in relation to the service provider:

  • A director or officer of the corporation if the licensee is a corporation
  • A partner, if the licensee is a partnership, other than a limited partnership
  • A general partner, director or officer of a corporation that is a general partner if the licensee is a limited partnership
  • A sole proprietor

Note that the Principal Representative does not have to be a regulated health professional.

Duties of a Principal Representative

The Principal Representative's duties are to:

  • Ensure that the licensee and every person authorized to provide specified goods or services on its behalf comply with the Insurance Act (Ontario).
  • Ensure that the licensee's business systems, practices and management of the licensee's operations are carried out in accordance with the law and with integrity and honesty.
  • Report to FSRA certain important changes in the service provider’s business within five business days
  • File an Annual Information Return (AIR) to FSRA every year
  • Provide attestations on the licensee’s behalf about the licensee and about the licensee’s compliance with the Insurance Act (Ontario), as may be required by the CEO of the Financial Services Regulatory Authority of Ontario.
  • Make recommendations to the licensee regarding changes in its business systems, practices and the management of its operations, as necessary.
  • Ensure that a system of supervision is in place to ensure that all requirements under the law are met.

Licence fees

When applying or reapplying for a service provider licence, applicants are required to pay a two-component fee consisting of:

  1. A licence application fee
    The $337 one-time fee covers the cost of assessing the application for satisfaction of the regulatory requirements and determining whether the applicant qualifies for a licence.
  2. A regulatory fee
    The annual regulatory fee (ARF) covers the cost of regulating the service provider sector. The fee is proportional, and varies based on the size and nature of the applicant's business.

The ARF is calculated according to the following formula:

$15 multiplied by the total number of unique Statutory Accident Benefits Schedule (SABS) claimants in the calendar year before the year in which the application is made.

plus

$128 multiplied by the applicant's total number of business locations at the time the application is made.

The ARF is prorated, based on a fiscal year cycle that begins April 1 and ends March 31. For example, if the applicant is applying to obtain a licence that is effective December 1, 2020, the ARF would be prorated for the period December 1, 2020 to March 31, 2021 (four months).

Using this same example, the full ARF would be payable by the licensee beginning in April 1, 2021, and every year thereafter, as directed by FSRA. FSRA will ensure the organization’s billings are legitimate, investigate complaints and conduct audits to ensure service providers are complying with the law. The amount of the ARF will vary by the size and complexity of a business. A small business treating few SABS claimants will pay proportionately less than a multi-location business treating many SABS claimants.

If the total amount of the ARF owed is less than $5,000, you must pay by credit card or debit. Total amounts owed greater than $5,000 are payable by cheque only.

Health Claims for Auto Insurance(HCAI) registration

Ontario Regulation 90/14 requires a licensed service provider to submit an OCF-21 for a listed expense using the name and licence number that corresponds to the service provider’s licence. As such, the name you register in HCAI must match either the legal or trade name you registered with FSRA, and must be listed on the Public Registry of Licensed Service Providers.

If you operate one or more of your facilities using a trade name, and the trade name is not currently listed on the FSRA public registry, you must register it with FSRA before you submit an OCF-21 form for a listed expense.

The Principal Representative can add a trade name to a service provider licence by logging into their FSRA account and submitting a supplemental application.

Please note, where a legal or trade name is longer than 50 characters, you may match your legal or trade name up to the first 50 characters, as it is registered with FSRA and appears on the Public Registry of Licensed Service Providers. Insurers will be able to validate your name using the first 50 characters.

More information

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