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Table of time periods relevant to SABS:

These tables set out important time periods relevant to the Statutory Accident Benefits Schedule - Accidents on or after November 1, 1996.

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TABLE OF TIME PERIODS RELEVANT TO SABS

This table sets out important time periods relevant to the Statutory Accident Benefits Schedule - Accidents on or after November 1, 1996, O. Reg. 403/96 amended to O. Reg. 35/10, which was filed on February 26, 2010 and O. Reg. 34/10, which takes effect September 1, 2010.

We have not included in any detail the time periods that may be set out in Parts X - XIV. For a list of actions that will not be taken on or after September 1, 2010 in respect of an accident that occurred on or after November 1, 1996 and before September 1, 2010, see O. Reg. 35/10, s. 3(1.5).

This table is intended as a guideline only.  The statutory provisions listed must be consulted.

Topic
Section
Description of Step
Time Period
Lost Educational Expenses
21(3)
Insured: furnish completed disability certificate
15 bus. days after receiving request from insurer [failing which no lost education expenses are payable until certificate furnished – s. 21(4)]
Death Benefit
26(1)(a)
Insurer: pay death benefit in respect of insured who dies as result of accident
180 days after accident
26(1)(b)
Insurer: pay death benefit in respect of insured who was continuously disabled as result of accident for 156 week period
156 weeks after accident
Notice of Intention to Apply for Benefits
32(1)
Insured: notify insurer of intention to apply for a benefit
7 days after circumstances giving rise to entitlement [failing which (if no reasonable explanation for failure) insurer may delay payment or determination until the later of 45 days after insurer receives application, or 10 bus. days after insured complies with s. 33(1) or (2) request – s. 32(10)]
Application for Benefits
32(5)
Insured: submit a completed and signed application for benefits to insurer
30 days after receiving forms from insurer
32(6)
Insurer: inform applicant that application form for benefits is incomplete or unsigned and indicate what is missing
10 bus. days after receiving incomplete or unsigned application
32(9)
Insured: submit an additional application if required by the insurer
30 days after receiving additional forms
Information from Applicant for Benefits
33(1)
Insured: provide information required to assess entitlement, statutory declaration, address and proof of identity
10 bus. days after receiving request from insurer
Specified Benefits
35(1)
Insurer: notify insured of required election where insured may qualify for more than one of income replacement, non-earner or caregiver benefits
10 bus. days after receiving application [insured must make election within 30 days after receiving notice]
35(2)
Insurer: notify insured may re-elect caregiver benefit despite previously election in s. 35(1) if determined insured suffered catastrophic impairment
10 bus. days of date of determination [insured must make election within 30 days after receiving notice]
36(4)
Insurer: either (a) pay the benefit, (b) notify insured of refusal to pay, reasons and advise of requirement of s. 44 exam, or (c) make a s. 33(1) or (2) request
10 bus. days after insurer receives application and completed disability certificate [failing which insurer must pay specified benefit from date insurer received application to date insurer gives notice in s. 36(4)(b) – s. 36(6)]
36(5)
Insurer: either (a) pay the benefit, or (b) notify insured of refusal to pay, reasons and advise of requirement of s. 44 exam
10 bus. days after insured complies with s. 33(1) or (2) request [failing which insurer must pay specified benefit from date insurer received application to date insurer gives notice in s. 36(4)(b) – s. 36(6)]
36(7)
Insurer: (a) provide copy of s. 44 report to insured and person completing disability certificate, and (b) provide notice of specified benefits it agrees and does not agree to pay and reasons
10 days after receiving s. 44 exam report
36(8)
Insurer: pay specified benefit if insurer determines insured is entitled to benefit where a s. 42 exam was conducted
10 bus. days after delivering notice in s. 36(7)(b)
36(9)
Insurer: pay income replacement benefit, non-earner benefit or caregiver benefit
at least once every 2 weeks (subject to any prepayment)
37(1)(a)
Insured: submit a further completed disability certificate on request by insurer determining continued entitlement
15 bus. days after receiving request from insurer [failing which no specified benefits payable for period between day 15 and day insurer receives completed disability certificate – s. 37(3)]
37(5)
Insurer: provide copy of s. 44 report to insured and person who completed disability certificate
10 bus. days after receiving s. 44 exam report
37(6)
Insurer: provide to insured notice of determination with amount of specified benefit it agrees to pay or refuses to pay, reasons and date of last payment
10 bus. days after receiving s. 44 exam report
Medical and Rehabilitation Benefits
38(2)(b)
Insured: submit expense for ambulance or other ER services
5 bus. days after accident [failing which insurer is not liable to pay medical/ rehabilitation expense/ examination that was incurred before insured submitted treatment and assessment plan]
38(8)
Insurer: notify insured of goods, services, assessments and examinations in treatment plan that insurer agrees to pay or refuses to pay and reasons
10 bus. days after receiving treatment and assessment plan
38(11)
Insurer: if no notice given under s. 38(8), insurer is prohibited from taking the position that insured has impairment to which Minor Injury Guideline applies, and shall pay for goods and services in treatment and assessment plan
for period starting 11th bus. day after day insurer receives application and ending on day insurer gives notice in s. 38(8)
38(13)
Insurer: provide copy of s. 44 report to insured and health professional who prepared treatment and assessment plan
10 bus. days after receiving s. 44 report
38(14)
Insurer: notify insured re: what goods and services insurer agrees to pay, refuses to pay and reasons, determination re: Minor Injury Guideline and reasons
10 bus. days after receiving report
38(15)
Insurer: pay for goods and services agreed to in notice under s. 38(8) or (14) or is required to pay
30 days after receiving invoice
39(2)(c)
Insurer: pay for medical or rehab. expenses for which insurer has notified insured it will pay without submission of a treatment and assessment plan
30 days after receiving invoice
Minor Injury Guidelines
40(2)
Claimant: submit a treatment confirmation form
time specified in applicable Minor Injury guideline
40(3)
Insurer: send notice to claimant and health practitioner acknowledging receipt of treatment confirmation form and advising if claimant is an insured person with respect to accident
5 bus. days after receiving treatment confirmation form
40(4)
Insurer: pay each invoice for goods/services in s. 15 or 16 provided in accordance with Minor Injury Guideline if claimant submits application under s. 32
30 days after receiving invoice for goods and services
41(2)
Insurer: pay expenses in notice to insured who submits s. 32 application
30 days after receiving invoice
Attendant Care Benefits
42(3)
Insurer: provide notice to insured advising which expenses the insurer agrees to pay and reasons
10 bus. days after receiving assessment of attendant care needs
42(6)
Insurer: pay attendant care benefits, and pending receipt of s. 44 report, calculate amount based on assessment of attendant care needs
10 bus. days after receiving assessment of attendant care needs
42(7)
Insured: provide to insurer assessment of attendant care needs so insurer can determine continued entitlement to and amount of attendant care benefits
15 bus. days after insured receives notice requesting assessment of attendant care needs
42(13)
Insurer: provide to insured and person who prepared assessment insurer’s determination re: what attendant care benefits and expenses insurer agrees and refuses to pay for, reasons, and copy of s. 44 exam report
10 bus. days after receiving s. 44 exam report
42(16)
Insurer: provide to insured notice of determination that insured is not entitled, by reason of s. 20, to attendant care benefits beyond 104 weeks after accident, and reasons therefore
not less than 10 bus. days before date of last payment of benefit
Parts IV & V Expenses & Benefits
43(1) & (2)
Insurer: pay death, funeral or Part IV benefit, or provide notice of refusal to insured with reasons
30 days after receiving application for benefits
Insurer’s Exams (s.44 exams)
44(6)
Insurer: provide notice to insured under s. 44(5) of s. 44 exam, including date, time, location, reasons for exam, type of exam, whether attendance necessary and info. re: conductor of exam
not less than 5 bus. days before exam unless otherwise agreed
44(7)
Insurer: provide notice to insured advising of change in type of exam, requiring attendance, advising of date, time and location of exam (where previous notice was given to insured indicated attendance not required, but conductor of exam requires attendance)
at least 5 bus. days before examination
44(9)(1)
Insurer & Insured: if attendance is not required, provide to person(s) conducting exam all relevant prior test and exam results, documents and other information necessary for review of insured’s medical condition
5 bus. days after notice of s. 44 exam received by insured [failing which possible sanctions depending on the reason for the s. 44 exam – see ss. 37(7), 42(14)]
44(9)(2)
Insurer & Insured: if attendance is required, provide to person(s) conducting exam all relevant prior test and exam results, documents and other information necessary for review of insured’s medical condition
not later than 5 bus. days before scheduled exam
Catastrophic Impairment
45(3)
Insurer: provide to insured notice accepting or denying catastrophic impairment and notice requiring s. 44 exam
10 bus. days after receiving application for determination of catastrophic impairment
45(5)
Insurer: provide to insured and person who prepared application insurer’s determination and reasons re: catastrophic impairment, and copy of s. 44 exam report
10 bus. days after receiving s. 44 exam report
Explanation of Benefit Amounts
50(4)
Insurer: deliver benefit statement if amounts in s. 50(3) have changed from previous statement
once a year, commencing not later than 12 months after determination of catastrophic impairment, or once every 2 months, commencing not later than 2 months after application for benefits made
Repayments to Insurer
52(3)
Insurer: provide notice of amount required to be repaid and possibility of deduction from income replacement or caregiver benefit if applicable
within 12 months after payment made [failing which, the insured is not required to repay unless it was originally paid as result of wilful misrepresentation or fraud]
Limitation Periods for Proceedings
56(1)
Insured: commence mediation or evaluation under s. 280 or 280.1 of Insurance Act, or court proceeding or arbitration under s. 281(1)(a) or (b) of Insurance Act
within 2 years after insurer’s refusal to pay claimed amount
56(2)
Insured: may commence court proceeding or arbitration under s. 281(1)(a) or (b) of Insurance Act
within 90 days after mediator reports or within 30 days after evaluator reports, whichever is later.
Notices & Delivery
64
For general rules regarding the computation of time, modes of service, deemed delivery dates, etc. see s. 64 in its entirety

 

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