Ontario’s adjusters are sounding the alarm about potential disputes arising from reduced access to optional accident benefits immediately following the implementation of the province’s auto insurance reforms on July 1.
As it currently stands, once the reforms take effect on July 1, non-renewed auto policies after that date will not have OPCF-47 endorsement forms attached. Those forms ensure access to auto optional benefits available through more than one policy. In other words, some drivers may lose access to optional benefits that they’d otherwise be entitled to receive by virtue of being named insureds on other auto policies.
Under Ontario’s accident benefits legislation, the OPCF-47 form, which is part of the auto insurance policy, allows drivers who have purchased optional accident benefits to claim those benefits from their own insurer, thus overriding the statutory priority of payment rules. In exchange for this override, they agree not to make a claim under any other policy.
For example, if Anne is injured in an accident while in a car driven by Fred, Ontario’s accident benefits priority rules say Anne must claim from Fred’s insurer first. Let’s say Fred’s policy doesn’t have optional benefits. Without the OPCF-47 form, Anne would not be able to override that priority of payment to access the optional benefits she purchased from her own insurer.
Ontario adjusters are concerned about what will happen on or after July 1, 2026, when mandatory benefits in existing non-renewed policies are converted into optional benefits.
“The policy itself is going to look the same on June 30 as it does on July 1. Nothing magically changes,” Laurie Walker, a 40-year veteran of the claims industry and president of Walker Consulting & Auditing, told delegates attending the Ontario Insurance Adjusters Association (OIAA) conference in Toronto Thursday. “The hitch, though, is [that] until that [auto] policy renews, all the existing coverages revert to what we call optional.
“If my date of loss is June 30, I can access priority of payments, and I can access those benefits. But after July 1, there’s no OPCF-47 attached to that policy.
“On June 30, it was a standard policy. It came with $400 a week in income replacement benefits and all the variety of benefits. But on July 1, those now become optional. The policy still carries it, but that policy does not have that OPCF-47 [endorsement]. So the problem is, I might not be able to access those benefits because that endorsement is lacking.”
Walker, a past president of the OIAA, gave the hypothetical example of getting into a crash and having a proof of loss on June 30.
On that pre-reform date, she would have access to two policies, she explained. She would have her own renewed policy, which theoretically offers just the basic $65,000 in medical coverage. But she would also have access to optional benefits coverage on her husband’s policy, which has not renewed yet.
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But as of July 1, since there is no longer an OPCF-47 attached to her husband’s non-renewed policy, she would not have access to her husband’s optional coverage, even though she is listed as a driver or “spouse” on her husband’s policy.
Walker wants the Financial Services Regulatory Authority of Ontario (FSRA) to issue guidance for what happens between the time the reforms launch on July 1 and when all of Ontario’s existing auto policies are renewed.
One solution, Walker says, is for FSRA, as Ontario’s insurance regulator, to issue a bulletin outlining how to handle the missing OPCF-47 forms on non-renewed policies as of July 1.
“If we don’t have a directive to add that OPCF-47 in some way, shape or form, we are going to have multiple disputes,” Walker said. “My hope and belief and my prayer…is that FSRA will issue a bulletin or guideline…
“I am hoping that they come up with a bulletin that says, ‘Listen, effective July 1, all existing policies that have not yet renewed shall be deemed to carry the OPCF-47.’ That will allow the transfer [i.e. to another policy carrying the optional benefits, thus bypassing existing priority of payment rules].”
At this suggestion, Walker turned to her fellow panellist Callie Matthews, a training and research officer at the Ontario Mutual Insurance Association, who is actively working in working groups with FSRA to prepare the reforms. “I’m working on it,” Matthews quipped, pretending to be defensive. The light-hearted exchange suggested it’s an issue already known to FSRA.