Not for car crash victims, but for the insurers’ doctors who examine them
By Alan Shanoff, Toronto Sun
pay higher premiums for auto insurance.(SUN FILE PHOTO)
TORONTO - The Ontario Health Claims Database, August 2014 Report, was issued earlier this month.
It discloses data for auto insurance health claims expenses for six-month reporting periods, beginning January 1, 2011 and ending June 30, 2014.
It will be interesting to see how the insurance industry explains the inconvenient numbers and statistics disclosed in the Report.
Perhaps the most alarming statistic relates to the number and cost of insurer-initiated medical examinations (IMEs).
These are the so-called independent examinations insurance companies force accident victims to take.
Victims have long complained about the number of examinations they are required to attend as well as the quality of the examinations and examiners.
In 2011, insurers spent $132,950,124 on these IMEs.
They spent $453,923,425 on all health claims expenses, meaning insurers gave their medical experts 29.3 cents out of every dollar they spent on health claims expenses.
They ordered IMEs for 26,957 of 59,080 claimants, almost one out of of every two claimants.
They paid an average of $4,930 per claimant examined to their medical experts.
Yet the total average amount paid per claimant, including payment for treatment, was $7,683.
The numbers dipped in 2012 when insurers only spent $99,060,443 on IMEs.
But there were fewer claimants, only 54,440, and the total amount paid on all health claims expenses dipped to $364,621,262 so insurers still gave their medical experts 27.1 cents out of every dollar they spent on health claims expenses.
They ordered IMEs for 21,529 out of 54,440 claimants, paying an average of $4,601 per claimant examined to their medical experts. Yet the total average amount paid per claimant was only $6,697.
In 2013, insurers spent $64,945,218 on IMEs for 55,799 claimants. The total amount paid for health claims expenses plummeted to $262,089,955 so insurers gave their medical experts 24.8 cents out of every dollar spent on health claim expenses.
They ordered IMEs for 17,465 out of 55,799 claimants paying an average of $3,718 per claimant examined to their medical experts. Yet the average amount paid per claimant dropped to $4,697.
These numbers tell us a shocking story.
The average amount of health claims paid per claimant has dropped a significant amount from $7,683 in 2011, to $4,697 in 2013.
Insurers spend a disproportionate amount of money on medical experts.
While the gross numbers are dropping, they still take up almost 25% of all health claims expenses.
Again, while the numbers are dropping, insurers order examinations for huge numbers of claimants, about 46% in 2011, 40% in 2012 and 31% in 2013.
Insurers are also paying huge amounts to their experts for missed or canceled appointments, about $16.6 million in 2011, $10.6 million in 2012 and $7.8 million in 2013.
The average amount paid for missed or canceled appointments was $1,308 per claimant in 2011, $1,193 per claimant in 2012 and $1,120 per claimant in 2013. Paying over $1,000 for a canceled appointment is ridiculous.
While the Report highlights aggregate amounts paid to insurer medical experts, it also highlights diminishing average amounts paid per claimant in every six-month period from January 1, 2011 to June 30, 2014: $7,901 to $7,472 to $6,858 to $6,554 to $5,557 to $3,934 to $1,790.
Because of on-going treatment for injuries, these numbers will increase with the passage of time but the trend is very clear.
Of course, insurance fraud has a large impact on insurance expenses, but perhaps insurers should focus more on what they are paying their medical experts.
Clearly, many physicians are getting rich by providing insurance assessments.
It’s no wonder some physicians appear to be beholden to the insurance companies.
Perhaps it’s time we initiated the same disclosure that British Columbia mandates, whereby each physician and expert who provides services to an auto insurer is listed in an annual report, along with the aggregate amount paid during the year.
Source: http://www.torontosun.com/2014/08/30/auto-insurance-bomnanza
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