FSRA | SABS Forms – Settlement Disclosure Notice

Settlement Disclosure Notice – SABS

The Settlement Disclosure Notice is a comprehensive document provided by an insurer to a claimant in the event of a cash settlement agreement for statutory accident benefits. It outlines critical information and legal requirements that the claimant must understand before finalizing the settlement. Key points include:

• Notice and Caution: The insurer must inform the claimant about the irrevocable nature of the settlement, the importance of independent advice, and the 2-business-day rescission period.
• Settlement Details: Specifies the amounts offered for various benefits such as income replacement, non-earner, caregiver, medical, rehabilitation, attendant care, death, funeral, and other expenses.
• Consequences of Settlement: Explains the permanent waiver of rights to future claims or disputes regarding the benefits settled.
• Benefit Descriptions: Provides detailed descriptions of different types of statutory accident benefits and optional benefits, including income replacement, non-earner, caregiver, medical, rehabilitation, attendant care, death, and funeral benefits.
• Insurer’s Acknowledgment: Confirms the insurer’s compliance with disclosure obligations.
• Insured’s Acknowledgment: Requires the claimant’s acknowledgment of receiving and understanding the notice, including considering independent advice.

This document ensures that claimants are fully informed about the implications of their settlement and the benefits they are relinquishing, thereby promoting informed decision-making and transparency in the settlement process.

Filling out this form is crucial to ensure that both the claimant and the insurer are clear about the terms and conditions of the settlement. Follow these steps to complete the form accurately:

Insurer’s Offer to Settle Benefits

1. • Enter the amount offered for each category of benefits:
     • Income Replacement Benefits
     • Non-Earner Benefits
     • Caregiver Benefits
     • Medical Benefits
     • Rehabilitation Benefits
     • Attendant Care Benefits
     • Death and Funeral Benefits
     • Other Expenses (specify if applicable)
   • Total all the amounts offered and enter the sum in the “Total Offer” field.
   • Indicate if the offer includes all previously approved expenses by checking the appropriate box.

Insurer’s Disclosure and Acknowledgment

1. • Fill in the insurer’s name, policy number, claim number, and date of loss.
   • Ensure the insurer certifies the information by signing and dating the form. Print the name and telephone number of the insurer or the authorized representative.
   • Include the name and telephone number of the insurer’s complaint officer for any potential disputes.

Insured’s Acknowledgment

1. • The claimant (insured) should print their name, sign, and date the form to acknowledge receipt and understanding of the Settlement Disclosure Notice.
   • The claimant should consider checking the option boxes confirming whether they have sought independent legal, financial, or medical advice before signing.

Reading and Understanding the Notice

1. • Carefully read the entire Settlement Disclosure Notice. Ensure that you understand the terms, the amounts being offered, and the consequences of settling your claim.
   • Pay special attention to the section titled “What does it mean if you settle your claim?” to understand the long-term implications of the settlement.

Rescission Period

1. • Note the 2-business-day period to change your mind after signing the Settlement Disclosure Notice or the release. If you decide to rescind the settlement, deliver a written notice to the insurer and return any received money within this timeframe.

Important Considerations

• Independent Advice: It is highly recommended to seek independent legal, financial, and medical advice before entering into any settlement, especially if you have catastrophic impairments.
• Medical Records: You have the right to access and obtain a copy of any medical information related to your claim from your insurer at their expense.

By carefully following these steps and fully understanding each section of the Settlement Disclosure Notice, you can ensure that the form is filled out correctly and that you are making an informed decision regarding your settlement.