Written by Simrin Pardal
Over the past few months, several service providers have noticed an increase in denials of expense claims for provider travel time as part of their treatment plans.
The Financial Services Regulatory Authority of Ontario (FSRA) has noted that they have received inquiries from service providers related to the increase in denials of provider travel time expense claims.
Upon reviewing data from Health Claims for Auto Insurance, FSRA has been able to confirm that across the industry, insurers have been making a greater number of denials for service provider travel time expenses.
As part of sections 15 and 16 of the Statutory Accident Benefits Schedule (SABS), insurers have statutory obligations to pay for reasonable and necessary medical and rehabilitation expenses, which may include service provider travel time expenses.
Insured individuals are generally expected to travel to their health care provider’s place of business to seek medical and rehabilitation services. However, this may not always be possible due to an individual’s circumstances.
In addition, some services are better to be provided at home such as Occupational Therapy to train clients to return to daily functions, or Social Work to witness the family dynamic at home.
An OCF-18 (Treatment and Assessment Plan) may be filled out by a service provider on the insured individual’s behalf to seek the insurer’s prior agreement to pay for the provision of medical and rehabilitation services and the provider’s travel time in order to provide these services.
For instance, the service provider may travel to and from the insured individual’s home, workplace, school, or other functional community settings in order to provide these services.
In cases where an OCF-18 is submitted, the SABS requires that the insurer agrees to and pays for as much of the service provider’s travel time that is deemed “reasonable and necessary” given the circumstances.
The maximum hourly rate which is payable by an insurer for travel time is governed by the Professional Services Guideline.
Any disagreements between an insured individual and an insurer for proposed medical or rehabilitation services and provider travel time that is deemed “reasonable and necessary” would be managed through the dispute resolution process.
In terms of mileage, the SABS mentions that auto insurers are liable only for transportation expenses related to the transportation of the insured person and the insured person’s aide or attendant.
Any mileage expenses related to the transportation of anyone else, such as a service provider are not authorized transportation expenses under the SABS. Thus, auto insurers are not obligated to pay for any such expenses even if paying for service provider travel time is deemed reasonable and necessary.
On July 29, 2025, FSRA issued an announcement stating:
“FSRA is reminding insurers of their statutory obligations to pay for reasonable and necessary medical and rehabilitation expenses, as outlined in sections 15 and 16 of the Statutory Accident Benefits Schedule (SABS). These may include provider travel time expenses.
FSRA continues to monitor this issue and expects insurers to fully comply with regulatory requirements.”
References
Financial Services Regulatory Authority of Ontario. (2025). Listed expenses for service providers in Ontario. Financial Services Regulatory Authority of Ontario. https://www.fsrao.ca/licensing/health-service-providers/listed-expenses-service-providers-ontario
Financial Services Regulatory Authority of Ontario. (2025, July 29). Service provider travel time expense claims. https://www.fsrao.ca/announcements/service-provider-travel-time-expense-claims