Medical-Rehabilitation & Attendant Care - Summary of Cuts to Accident Benefits

Click here to email your MPP today about these cuts!

• Rehabilitation (“rehab”) benefits cover a range of medically necessary goods and services that aren’t funded in the public system such as physiotherapy, speech therapy, psychology, medications, accessibility renovations, nursing, wheelchairs, artificial limbs, etc.
• Attendant care (“AC”) benefits cover the services of personal support workers to assist with bathing, dressing, toileting, etc.
• All goods and services are always subject to the insurer’s determination of what is “reasonable and necessary”, so insurers can deny any request for rehab or AC services even if funds are available
• There are approximately 65,000 people injured in motor vehicle accidents in Ontario each year: minor injuries account for about 80% of all injuries, serious injuries account for about 19%, and catastrophic injuries account for just 1%; insurers have strong controls over which individuals get classified into which severity category

1996	2010	2014	Budget 2015
Rehab for Minor and Serious Injuries: $100,000 plus the cost of assessments; minor injuries were subject to care pathways AC for Serious Injuries: $72,000 Rehab for Catastrophic Injuries: $1,000,000 plus the cost of assessments Attendant Care for Catastrophic Injuries: $1,000,000	Rehab for Minor Injuries: $2,200 with an option for an additional $1,300; in-home assessments eliminated Rehab for Serious Injuries*: $50,000 including the cost of assessments (approximately a 65% cut in benefits) AC for Serious Injuries: $36,000 (a 50% cut) Rehab for Catastrophic Injuries: $1,000,000 including the cost of assessments (approximately a 20% cut in benefits) Attendant Care for Catastrophic Injuries: $1,000,000	Rehab for Minor Injuries: No further changes to limits but additional documentation required Rehab for Serious Injuries*: No further change to limits AC for Serious Injuries: $36,000 for outside caregivers; family member caregivers must demonstrate direct economic loss Rehab for Catastrophic Injuries: No further change to limits Attendant Care for Catastrophic Injuries: $1,000,000 for outside caregivers; family member caregivers must demonstrate direct economic loss	Rehab for Minor Injuries: Awaiting a report with recommendations Rehab and AC for Serious Injuries**: $65,000 combined (a $21,000 or additional 25% cut) Rehab and AC for Catastrophic Injuries**: $1,000,000 combined (a $1,000,000 or additional 50% cut) Budget also suggests changing the criteria for “catastrophic”

 
* Optional Benefits
In 2010, the government introduced “optional benefits” to allow buyers of auto insurance to buy better coverage.  Our members’ experience with agents and brokers is that this is rarely discussed when policy renewals come up and most brokers are unable to speak to what med-rehab and attendant care benefits cover.  Data from FSCO released a couple years ago confirmed that less than 2% of policy holders bought optional coverage.  This is in stark contrast to optional liability coverage which agents and brokers always encourage policy holders to increase from the mandated $200,000 to $1,000,000 or $2,000,000 (liability coverage pays for the rehabilitation and expenses of someone a policy holder injures in an accident, whereas accident benefits pay for one’s own rehabilitation and expenses when injured).  It is unconscionable that drivers in Ontario are encouraged to ensure they cover someone else’s health care needs to the tune of $2,000,000 in coverage, yet are told that they need less than $50,000 to cover their own health care needs.
 
** Combining Rehab and AC Benefits
The 2015 budget suggests combining rehabilitation and attendant care benefits into one fund, meaning the most seriously of injured people (e.g., those who are paralyzed, people with amputated legs or arms, individuals with severe brain damage, etc.) will be required to choose between getting help to maintain their personal hygiene (bathing, toileting, dressing, etc.) or getting rehabilitation to improve their functional abilities.  This represents one of the most distasteful slashes to the dignity of those with disabilities in the province of Ontario, and because of the small percentage of people who fall into these categories, the savings to insurance companies will be negligible.
 
SUMMARY OF IMPACT ON DISABLED ONTARIANS
Prior to the 2015 Budget announcement, Ontario had already devolved to having the worst rehab insurance coverage in the country on a weighted average basis (80% of injuries access up to $3,500, 19% access up to $50,000 and 1% up to $1,000,000 = weighted average of up to $22,300 in available rehab benefits, if the insurer approves the funding).  With the 2015 Budget announcement, this figure drops to an appalling $15,400.  In 6 years, the Ontario government has reduced rehab funding in the auto sector from a weighted average of $50,000 to $15,000 – and this in the context of publicly funded outpatient and home care rehab services being drastically reduced or eliminated in most jurisdictions across the province.

Numerous other changes have been made to the Accident Benefits package in the past 6 years, all designed to constantly boost insurers’ profitability and all on the backs of injured and vulnerable Ontarians.  The important balance between insurer profitability, premium levels and consumer protection was pushed to the brink in 2010 and will be completely destroyed with the 2015 Budget announcement.  Our government passes seatbelt, helmet and smoking laws to keep people safe.   And one of our most deeply held Canadian values is to provide a safety net for the most vulnerable among us.  The Ontario government needs to show that it cares as much about its citizens as it does about insurer profitability.  Disabled Ontarians and their families are too busy trying to get through basic daily activities with some dignity and hope; they can’t lobby the way the insurance industry can.  You, our MPP, need to be their voice. 

Please stop these proposed changes, review insurer profitability, and let the impact of all the other cuts take place before enacting any new regulations that further disadvantage injured Ontarians.

Source: http://www.ontariorehaballiance.com/page/insurancechanges

Bad news for crash victims

Finance Minister Charles Sousa’s claim Ontario has the most generous auto insurance benefits is nonsense

By Alan Shanoff, Toronto Sun

First posted: Saturday, May 30, 2015 07:00 PM EDT

Ontario Finance Minister Charles Sousa. (ANTONELLA ARTUSO/Toronto Sun)

 

TORONTO - Last month’s Ontario budget continued the erosion of accident benefits for victims in motor vehicle accidents.

The reductions are most significant for those suffering from catastrophic injuries.

Since 1996, these victims were entitled to reasonable and necessary medical and rehabilitation services up to $1 million, in addition to up to $1 million in attendant care benefits.

That combined coverage of $2 million will now be cut by 50% to a combined $1 million.

It’s puzzling why the government would want to cut back benefits to those who need it most, especially since only 1% of accident victims suffer catastrophic injuries.

Ontario Finance Minister Charles Sousa stated, “Ontario is the most generous in Canada when it comes to providing coverage for auto insurance.”
I guess he isn’t aware Manitoba, Saskatchewan and Quebec provide medical rehabilitation benefits in excess of Ontario’s $1 million, when medically warranted, for any motor vehicle accident victim.
At the other end of the spectrum, dealing with so-called minor injuries suffered by approximately 80% of accident victims, Ontario’s “generous” limit for medically necessary treatment is $3,500, including the cost of assessments, examinations and reports.

No other province mandates a cap on minor injuries.

Don’t think these “minor” injuries are insignificant.
They include dislocation of joints, partial tears of tendons, ligaments and muscles, contusions, abrasions, lacerations and whiplash not exhibiting neurological symptoms.

For serious injuries — neither minor nor catastrophic — medical and rehabilitation benefits are capped at $50,000 in Ontario. That compares favourably to Nova Scotia, PEI, Nunavut and the NWT, which each have a limit of $25,000, and equals the limit in Alberta and New Brunswick.
But it falls short of the limits in British Columbia, Manitoba and Saskatchewan.

So, the most generous benefits in Canada? Hardly.
The lowering of benefits for catastrophic injuries is only one of many prejudicial changes to auto insurance coverage announced in the budget.
There’s also enhanced barriers imposed on plaintiffs suing for negligence arising out of auto accidents.

Most people are unaware of two barriers on the right to sue for damages resulting from harm suffered in an at fault auto accident.

First, there is a threshold test that must be satisfied before anyone can succeed in winning a lawsuit.

This law, introduced in 1996 and made more stringent in 2003, bars successful lawsuits unless plaintiffs can establish they suffer “from permanent serious impairment of an important physical, mental or psychological function.”

To meet this test, various stringent conditions must be satisfied.

The threshold often prevents injured people from recovering damages for serious injuries that fail to meet its definition.

Second, there is a deductible that applies only to lawsuits against negligent auto drivers. It was increased from $15,000 to $30,000 in 2003 and applies to damages for pain and suffering of $100,000 or less.

The budget would index the deductible to inflation as of 2003.

According to personal injury lawyer Darcy Merkur, that would impose a deductible of about $37,000 on damage awards of about $123,000 or less. As an example, a damage award of $100,000 would be reduced to $63,000!

Having both a threshold and a deductible is redundant and only benefits insurance companies.
And why would the government choose to index amounts that favour insurance companies, while not indexing amounts that favour accident victims?
I didn’t see any proposal to index the minor injury cap of $3,500 or the medical/rehab cap of $50,000.

As FAIR Association of Victims for Accident Insurance Reform says, “The budget does nothing to ensure that insurer claims management practices are fair and there has been no action (to deal with) ... the biased and corrupt insurer medical examination reports that are disqualifying innocent and legitimate accident victims.”

The government also announced it intends to amend the catastrophic impairment definition.
Does anyone doubt that these amendments will only serve to benefit insurance companies by restricting the number of victims who would otherwise qualify for the enhanced benefits applicable to the catastrophically impaired?

Source: http://www.torontosun.com/2015/05/30/bad-news-for-crash-victims

 

Ontario auto insurance - what are we buying into? FAIR submission

Hello



FAIR was not chosen, nor were any of our members who also applied for an appearance, to speak to auto accident victim issues and the deep cuts to coverage at the Standing Committee on General Government in respect to Bill 91.



Below and attached is our submission to the Standing Committee fyi. As consumers who forced to buy a product that does more harm than good for half of Ontario's MVA victims already and whose coverage is about to be slashed in half, there ought to be a public outcry. So if you paid your premium last week, by the time Bill 91 passes, you will have $1 million less coverage if you are catastrophically injured. No rebate, no notice in the mail, it's just done. You'll find out when you get in an auto accident or on your next premium renewal in the small print. It doesn't just affect you, it affects that person you might accidentally hit with your car, and now that person will also have only $1 million for med/rehab and only 5 years to collect it (as opposed to $2 million and 10 yrs right now). As if people who are so traumatically injured, perhaps in a wheelchair, or seriously brain injured are magically better in just 60 months. It takes longer than that for many victims to just get to court to even hold their insurer accountable. 



We pay insurance in that off-chance that we get in an accident so we, and those we injure, have coverage and so we won't be dependent on our families and loved ones or a burden on society. But the reality is that over the past 25 years our coverage is now only a fraction of what it was when Ontario entered into the No-Fault insurance system in 1990. We have no meaningful way to hold this industry accountable except in individual circumstances and at great personal expense. It's an industry that now poses a direct threat to our economy when it is the taxpayer who is paying a premium for benefits that are increasingly difficult to get when you need them and when you factor in the download to the tax payer through the use of our public systems.



Something that seems to get lost in all of the rhetoric and in the complexity of the Insurance Act with all of the changes and stripping of benefits is this: there isn't much difference between the person that is 52% whole body impairment (serious injury) or the person who is 55% or catastrophically injured. But there's a big difference in the amount of coverage available. A $935,000.00 difference. Certainly an amount insurers will fight hard to hold onto. It is these thresholds like the MIG cap at $3500 (80% of claims) vs serious injury vs catastrophic injury categories that is feeding the adversarial system and leaving victims high and dry.



These specialized treatments that we talk about, and the timing that is so very important to recovery, aren't available in our public systems and are outside our public coverage with OHIP. Only a few will be able to afford what is necessary for a best recovery scenario. The rest will pay out of pocket if they can. Most will go without. Many will not recover without assistance. Will it be you? Will it be you that will end up on welfare or ODSP or CPP Disability? Or the people you accidentally injured? How would it feel to know the treatment to make you better is there but you can't afford it? This is already happening to half of all auto accident victims.



"We take you now to a dark land where fraud is rife, corruption abounds and the government seems powerless. No, not some calcified dictatorship in Africa or South America. This is Ontario, home to Canada’s worst auto insurance system, a vast subculture of lawyers, health-care operators, inept regulators and gaming politicians who cannot or will not come to grips with a regulatory failure that costs motorists billions." Terence Corcoran http://business.
When we talk about fraud (a great distraction away from the poor coverage and access) we need to talk about the fact that Ontario's insurers are selling us a product that only works for half of those who pay and we need to look at the fraud in the system that allows that to happen. http://www.



Sent to our MPPS and  media.



Rhona DesRoches
FAIR, Board Chair



Tammy Kirkwood
FAIR, Vice Chair
www.fairassociation.ca 



                                                                               
 May 25, 2015



Why is our Government allowing Ontario’s wealthy insurers to slash benefits to the most injured of auto accident victims?



The 2015 budget is an absolute windfall for Ontario’s insurers who are the beneficiaries of Building Ontario Up by building up their already substantial profits on the backs of Ontario’s seriously injured auto accident victims.



 Consumers and accident victims alike are already being short-changed when the coverage they purchased isn’t there when they need it. According to the Auditor General’s 2011 report on auto insurance about half of all claims end up in court trying to get what they paid for and that isn’t any more acceptable than purchasing a car and finding out that the brakes only work half the time. 



Ontario’s wealthy insurance companies have had an "easy ride for over 20 years" according to the recent Schulich School of Business report on Ontario’s insurance industry.  Insurers have overcharged Ontario drivers by billions and are making 17% on their investments while claimants, who have paid in good faith, are left hanging out to dry at a time when they need assistance.



How can it be that our government, under the guise of protecting victims, is proposing to cut over a $1 million dollars in coverage for the most seriously injured among us? How is that fiscally responsible?
Victims don’t just disappear when insurers fail to live up to the promise of coverage; they just end up on our public support systems at the tax-payers’ expense.



The Budget does nothing to ensure that insurer claims management practices are fair and there has been no action on FAIR’s concerns about the biased and corrupt insurer medical examination (IME) reports that are disqualifying innocent and legitimate accident victims every day. The auto insurance landscape should be cleaned up but instead we see Ontario’s auto insurers being rewarded handsomely for disqualifying as many claims as they manage to handle through the biased medical opinions that have poisoned our insurance system, our courts, and are causing such hardship for legitimate claimants.



We can only speculate why our government is under such significant pressure to support the abuses and dysfunction in our insurance system. The new LAT system and increasing the $30,000 deductible requires that our MPPs ignore the Charter rights of all accident victims to access to our courts. We would like to know why our elected officials are willing to create a third class citizen by making our courts unaffordable and inaccessible. It is no small thing to denigrate the most vulnerable members of our society so an elite industry can profit.



We have no doubt that the new Tribunal hearings system will benefit Ontario’s insurers who are still doing nothing about their excessive claims turn down rate because our Government isn’t even asking that the insurers be accountable for their shoddy claims handling practices. This inaction on the insurance file has led to the unprecedented volume of cases in our civil court system. The new LAT system will be faster but it will still punish victims and be based on Ontario’s insurers’ dependence on their deceptive and dishonest medical reports.



Ontario insurance is an adversarial delay and deny business model and profits depend on the turn down of claims. But who is paying for that?  Well, first the victims who endure the endless bogus medical examinations required by our insurers in order for them to deny to access benefits. There are now so many thresholds and quantifiers of injury because insurers and the IBC work very hard to keep injured Ontarians at the lowest level of coverage. It’s a simple plan because the more levels of coverage there are; the more opportunity there is for an insurer to deny the claim.



According to HCAI data insurers have consistently spent more on medical assessments than they do on treatment. There’s a reason for this and it has nothing to do with returning their customers to wellness; it has to do with ‘shopping’ for medical opinions until the insurer gets what they want, an excuse to turn down the claim. All of these coverage issues are ultimately worked out in our courts at a cost to the taxpayer. This costs Ontario’s insurers nothing and the biggest price is paid by the victims who are more likely than not going to have to pay for their own recovery while caught in the system. This isn’t coverage; it’s a false impression of comfort that just isn’t there. It’s now a fantasy of coverage our government is forcing us to buy.



Even small changes such as the “require goods and services not explicitly listed in the Statutory Accident Benefits Schedule (SABS) to be “essential” and agreed on by the insurer” will become a point of contention and lead to even more cases in our courts if these changes pass into law.



Many of our members are already on public supports.  There were over 42,000 Ontario Disability Support Program (ODSP) applications last year and too many of them are auto accident claimants who are forced to wait many years for their benefits and who are already going without the treatment they need for recovery.



There are 61,063 auto insurance cases on the docket in Ontario courts, there are over 25,000 claims at the Financial Services Commission DRS unit, and many of our members are already on ODSP and CPP disability so Ontario’s insurers are well on the road to paying less than their fair share of MVA expenses and we already have a distorted form of public auto insurance.



Why is the Ontario government willing to allow insurers to shave more than a million dollars of coverage from our policies and willing to punish victims in a way we haven’t seen before?  There are about 600 or so catastrophically injured MVA victims every year and so this will be an immediate saving of $600 million in just the first year alone. Victims will be downloaded to the public systems that are not set up to service their disabilities and unlike the fantasy world of protecting claimants in Building Ontario Up, victims will be sacrificed to build up insurer profits.  These seriously injured individuals will face a lifetime of increased physical, emotional and financial challenges if Bill 91 is passed as is.



We are very concerned about the changes to the Catastrophic Impairment designation. The direction and the insurer presence on the CAT Panel haven’t inspired confidence that the industry will do the right thing here. At one point only 75% of that Panel agreed that paraplegia or quadriplegia was a catastrophic injury. Now the potential that the industry will separate mental and physical injuries as if they were unrelated is another danger for injured victims and this too will lead to increased court challenges.



Why is our government indexing the court deductible of $30,000 for tort claims but not considering indexing the inadequate $400/wk income replacement for victims that has also stayed the same for well over a decade now? Here is a clear demonstration of the imbalance in how our government views auto insurance when the insurer’s income from the deductible (and it is the insurer who gets to hang on to that $30,000) is indexed to inflation and yet MVA victims are expected to survive on an amount that is lower than our minimum wage and far below the poverty line.



It is an illusion to say that we are ensuring affordable insurance by allowing insurers to pay injured victims less and simultaneously be downloading the cost of victims to the taxpayers who are also the same drivers looking for a break on insurance premiums.



The system is broken and no matter how much our government is willing to give to insurers and take away from the injured, it will still be broken and dysfunctional. We are asking you to put a moratorium on these changes until further review can be done to ensure that Ontario’s auto insurance is providing the coverage we need. We need to look at changing the system, making it more reliable for victims and easier to navigate. These are procedural changes that insurers must make and it is up to government to ensure that they do so.



Thank you for the opportunity to present our point of view. We think it is important that you hear from victims and hope that next time the Standing Committee will invite actual victims to these hearings on issues that affect them rather than just listening to Ontario’s insurers.



FAIR Association of Victims for Accident Insurance Reform is a grass roots not-for-profit that advocates for Ontario’s auto accident victims.



‘FAIR – supporting auto accident victims through advocacy and education’

FAIR Association of Victims for Accident Insurance Reform
579A Lakeshore Rd. E., PO Box 39522, Mississauga, ON, L5G 4S6 mailto:fairautoinsurance@
http://www.fairassociation.ca/

Government slashes benefits to seriously injured MVA victims and calls it “Promoting consumer protection”

It’s a sad day for Ontario consumers when our government puts the interests of big business insurance companies ahead of the health and well-being of Ontario’s injured auto accident victims. The slashes to auto insurance coverage in the 2015 budget  can only be seen as a step closer to public auto insurance when with every cost saving solution the IBC comes up with in order to curtail claims means the unsuspecting tax-payer will pay more of the costs for victims through our publicly funded programs.

View our latest media release:  FAIR reaction to Budget April 28 2015

Ontario already has an auto insurance claims disaster:  Ontario’s Auto Accident Victims in Crisis

We’ve been overpaying for years: Returns on Equity for Automobile Insurance Companies in Ontario

What are auto accident victims losing so Insurers can gain greater profit on the backs of the injured?

The definition of catastrophic is set to be severely restricted to make the definition consistent with the latest medical evidence. That will likely mean that combining physical and psychological impairments will no longer be permitted. This will see many severely accident victims without adequate coverage.

 

Coverage available for catastrophically impaired victims will be cut in half. The limit of $1 million each ($2 million right now for both) for med/rehab and attendant care will be limited to $1 million total for both med/rehab AND attendant care combined. There will be optional coverage available at an added cost.

 

The standard duration for med/rehab benefits will be reduced to 5 years instead of the previous 10-year maximum, except for children. Costs for care will then fall on Ontario’s taxpayers through OHIP and various public supports.

 

Non-catastrophic coverage will be reduced. If the budget is passed, med/rehab and attendant care coverage will be $65,000, down from the current combined total of $86,000. Consumers will have an option to increase this coverage up to $1 million at an added cost.

 

The six month waiting period for non-earner benefits will be eliminated the duration of non-earner benefits will be limited to two years after the accident.

 

The government will be introducing amendments to the Insurance Act to adjust the deductible and the disappearing deductible amount to reflect inflation since 2003 and link it to future changes in inflation. The deductible or the amount you insurer is ‘allowed’ to keep when a claimant takes the insurer to court is presently $30,000 for cases in civil court that are worth less than $100,000. This is already a deterrent to victims’ ability to hold insurers accountable. There will be further changes to allow for the effect of the tort deductible to be taken into account when determining a party’s entitlement to costs.

 

Call or write to your MPP and tell them you expect better at: http://www.ontla.on.ca/web/members/member_addresses.do?locale=en 

Source: http://www.fairassociation.ca/