Cost of Goods Guideline now available
The Guideline will be effective for any Treatment and Assessment Plan (OCF-18) and Auto Insurance Standard Invoice (OCF-21) submitted in respect of a medical or rehabilitation benefit claim made under the new SABS or old SABS, after the date of publication in the Ontario Gazette. (Jan.14th 2011)
This Guideline has been developed as a result of a recommendation by the Auto Insurance Anti-fraud Task Force in its interim report regarding measures that should be undertaken as soon as possible. Consistent with Ontario’s crackdown on criminal and opportunistic automobile insurance fraud, the interim report suggested the creation of “a guideline to address the issue of insurers being invoiced for medical devices at prices considerably higher than their normal retail value”.
FSCO’s guideline provides direction concerning the appropriate interpretation of the term “reasonable” in these sections.
“For the purposes of this Guideline, the retail price is the lowest price, including delivery charges (if delivery is required), duties and taxes, that would be payable by or on behalf of an insured person to acquire an item of goods from a source that is available to a member of the general public in Ontario,” the guideline states. “Where a retail price exists for an item of goods, a ‘reasonable’ expense for that item…is that retail price, or the price actually paid or payable by or on behalf of the insured person to acquire the item, whichever is lower.”
…in the event of a dispute over whether an expense for an item is ‘reasonable,’ the onus is on the insurer to provide reasonable evidence of the retail price of the item.”
Reasonable evidence includes (but is not limited to) “an advertisement; written confirmation from a vendor; or any other reliable form of proof of the retail price.”
