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

Auto Accident Benefit Cuts: Lobbying Update, Action and Resources - Please circulate!

From the Ontario Rehab Alliance:

Subject: Auto Accident Benefit Cuts: Lobbying Update, Action and Resources - Please circulate!
Importance: High

Dear Members,

The Budget (Bill 91) has passed second reading. Most likely it will soon be referred to committee – but the plan is likely to pass it before the house rises in June. Auto insurance changes are a relatively small aspect of this broad bill so it remains unlikely that we can effectively block passage with a majority government in place, though we’ll try our best. Our focus is very much on influencing the regulations to mitigate the harm to the seriously and catastrophically injured.

The ORA Board is currently working with a collection of other associations on various fronts to these ends, but we also need your help!

1.      Petition – the petition we shared with you the other day is gaining momentum. If you haven’t yet done so please sign and distribute to colleagues, clients, and friends:
https://www.change.org/p/ontario-mpps-finance-minister-charles-sousa-stop-reducing-ontario-accident-benefits
2.      Rally – the rally planned for next Tuesday, May 12 is being rescheduled to better improve the chance of making an impact with a well- organized and well attended event. This has the support and involvement of OTLA, a number of law firms as well as the ORA and FAIR. Likely other associations will get involved as well. We will keep you posted on the date and details but it will most likely take place in the first days of June.
3.      MPP & Government Outreach – the ORA and OTLA are jointly organizing a multi-stakeholder strategy session for next week. The goal is to develop common messaging and collectively contact and meet with as many MPPS and decision-makers as possible in the short time available. We have invited representatives of the professional associations, and groups such as OBIA and Spinal Cord Injury.
4.      Please continue your own outreach to MPPs –politicians respond to constituents with greater alacrity than they may do to organizations.  Thanks to those of you who have and have written to tell us. It would be super helpful if you could please also/instead complete this survey so that we have all the info in one place - https://www.surveymonkey.com/r/T278MDC
5.      MPP Contact and Issue Info – We’ve revised our home page to reflect the importance of this issue to the public. Follow this link to find the backgrounder we shared with you a week or so ago – the red link at the top takes you to MPP contact info. http://ontariorehaballiance.com/page/insurancechanges
6.      Key Messages -  Auto insurance changes in the 2015 Budget catastrophically injure the injured. Ontarian’s will not be properly protected by insurance if they are injured. The proposed changes help insurers’ profits by shifting responsibility to unpaid family caregivers and the public purse. Our challenged health and social services are unable to absorb this impact.
7.      Outline & Analysis of the Proposed Changes  - This article provides an excellent summary of the proposed changes and the impact: http://www.lawtimesnews.com/201505044652/commentary/insurance-changes-a-catastrophic-ambush
8.      Next Steps

·        Once the regulations have been posted we will analyze, consult, comment and refine our messaging

·        We will share these insights and messages with you to incorporate into your efforts

·        We will continue to keep you posted on the rally and other actions as they evolve

Please distribute this email widely!! All hands are needed on deck!

Laurie Davis, Executive Director

lauriedavis@ontariorehaballiance.com

Office:      705 745 1546

Mobile:    705 957 4733

www.ontariorehaballiance.com

51 Sophia Street, Peterborough

K9H 1C9, ON

Personal injury lawyer launches challenge against Bill 15

by Donald Horne | 26 Jan 2015

 A lawyer has launched a constitutional challenge on behalf of automobile accident victims aimed directly at Bill 15.

Lawyer and advocate Joseph Campisi is launching a constitutional challenge in the Ontario Superior Courts, seeking a declaration that parts of the legislation that were recently passed by the Liberal Government are discriminatory and unconstitutional and should be inoperative.

“The right to access the Superior Courts is a fundamental right for Canadians.  I am concerned that the recent proclaimed legislation will deny this right to individuals who have been severely disabled,” said personal injury lawyer Joseph Campisi.  “Historically, the deck has been stacked against automobile victims. The recent amendments to the legislation have turned a bad situation into a worse one for these vulnerable individuals.”

In the fall, of 2014, the Ontario passed Bill 15, which took aim at fraud in the insurance industry with the aim of reducing insurance rates.

One of the legislative amendments changes how disputes between insurers and insured are settled, which has raised the ire of groups like FAIR and those in the health care industry, like the Ontario Rehab Alliance.

Historically, disputes could be brought before the Superior Courts or before arbitrators with expertise in interpreting insurance law.  Bill 15 has changed how disputes are resolved by giving the sole adjudicative power to individuals who will be appointed “at the whim of the Liberal Government,” said Campisi.

“No longer will these individuals be allowed to have the assurance of impartiality and independence that is a cornerstone of our justice system when litigating a claim against their own insurance company,” said Campisi. “I could not stand idly by and let this happen.”

These are the same decision makers who jurisdiction on matters ranging from film classification to upholstered and stuffed articles, Campisi went on to say, adding that unlike historical appointments individuals without any specialization or guaranteed independence or impartiality will be ruling on disputes that can run into the millions of dollars and will determine the quality of life that an automobile victim will face going forward.

“This application will challenge Bill 15 on the basis that it violates disabled person’s Charter s.15 (1) right to be free from discrimination,” he said. “Bill 15 is also being challenged based on s.96 of the Constitution which relates to the public’s right to have access to the courts.  The way in which Bill 15 is drafted opens the door to political interference.  The government of the day can choose who will hear any dispute and if the government does not agree with the arbitrator’s decisions, the government can get rid of the adjudicator the next day.  When it comes to lobbying the government there is little doubt as to who has the deeper pockets; automobile insurers or accident victims.  Introducing such laws is undemocratic and detracts from the rule of law.  This legal challenge will fight for disabled individuals’ right to fair treatment and the public’s right to access the impartial court system.”

Barb Taylor, the director of policy at the Insurance Bureau of Canada, had spoken out last Thursday on what she saw as “strong opponents” of those fighting for change in the insurance industry. Click here for the article, 15 per cent target for Ontario auto 'does not compute'

“We have strong opponents. These groups also have the ear of government and will seek media attention. Specifically, I am talking about trial lawyers, medical rehab providers and the NDP,” Taylor told those gathered for the 2015 Crystal Ball conference. “We are asking the (Ontario) government to require personal injury lawyers and paralegals who represent auto insurance claimants to submit to the Superintendent all information about their fees – including contingency fee arrangements, disbursements, court awarded and settled costs, and referral arrangements."

Source: http://www.insurancebusiness.ca/news/personal-injury-lawyer-launches-challenge-against-bill-15-187471.aspx?p=2

Ontario Rehab Alliance PRESENTATION ON GENERAL GOVERNMENT’S HEARINGS ON BILL 15

PRESENTATION TO THE STANDING COMMITTEE ON GENERAL GOVERNMENT’S HEARINGS ON BILL 15
November 5, 2014

We represent the Ontario Rehab Alliance, a non-profit association representing over 100 companies
that employ more than 4500 healthcare professionals. These are the primary providers of rehabilitation
services to the 65,000 Ontarians injured each year in auto accidents. We share an adherence to ethical
and effective business practices and strive to keep services reasonably priced and of the highest quality.
We take every opportunity to offer constructive input into policy and regulatory change. We made
presentations to the Dispute Resolution System Review panel, the Pre-Budget Hearings, the Minister of
Finance’s Pre-Budget Consultation, and made a thorough submission to FSCO’s Three Year Review of
Auto Insurance. We are very proud of our work on fraud prevention. We are on record supporting
service provider licensing since the concept was first proposed by the Anti- Fraud Task Force, and are
proud to be a participant in FSCO’s Service Providers Licensing Forum.
We support this government’s commitment to anti-fraud. It is essential that we deter fraudulent players
and focus resources on legitimate claimants. Too many of the changes made to auto insurance have
been across-the-board cuts that improved insurer profitability at the expense of accident benefits
coverage for all.
We appreciate that this government is looking for savings to support reducing the cost of premiums by
15%. The two-year expedited timing of this must not be used as an excuse for more changes that will
disadvantage victims. We see firsthand the heartbreaking consequences of the cuts made in 2010 and
subsequent regulatory changes. Many of our seriously injured patients are running out of coverage
before they are better.
We applaud the components of Bill 15 that expedite dispute resolution, and extend anti-fraud measures
to towing and storage. We note the proposed Towing & Storage Bill of Rights, with its obligation to
disclose information to consumers, and suggest this might be a model for the Accident Benefits side of
the equation.
When it comes to auto insurance consumers do not know what they are buying and they are not getting
what they think they paid for. Tragically, most don’t find this out until they are injured. Most drivers
assume that they are covered by the basic package, and the shortfall will be picked up by our public
healthcare system. But they’re wrong. The public system cannot and does not address the gaps. The
current cap of $50,000 in med/rehab benefits for serious, non-catastrophic injuries is all-too-often
insufficient.When changes to the Statutory Accident Benefits Schedule were made in 2010, there was much talk of
improved consumer choice, with insured drivers having the option to ‘buy up’ to access up to $100,000
in med/rehab benefits. Only 1.4% of drivers have done this. Even when they do buy up, their benefit
limits are subject to the $3,500 Minor Injury Guideline, intended to capture 80% of claimants. How
many drivers have any idea about this?
Many of those injured will never return to their pre-accident health and function levels. Many will find
themselves fighting a losing battle with their own insurer to get the benefits they paid for. Many will
lose their employment, homes and most tragically, families.
Consumers must be better informed. Brokers, too, must be better informed and held accountable for
providing this information to consumers at time of purchase and renewal. Policy language must be
clearer.
The thing about insurance is that we only really find out what we’ve bought when we’ve been in an
accident.
The accountability and transparency that anti-fraud measures demand of service providers must be
extended to insurers. Changes to the dispute resolution system to streamline the process will remove
the right of claimants to pursue court action. Disputes will be determined by arbitrators without the
power to award punitive damages, as do the courts, eliminating an important tool to keep insurer
misbehaviour in check.
Experience has demonstrated that the current system does not effectively respond to insurer
misbehaviour and bad faith. The system requires more – not fewer – mechanisms by which insurers can
be held accountable.
We are very concerned by the latest attempt to save even more money for insurers with the proposed
regulation change to drastically decrease the interest rate required of insurers on all disputed benefits.
This will eliminate one of the few mechanisms that reflect the reality that insurers exploit their financial
strength at the expense of claimants. The proposed change will reduce the penalty interest rate insurers
pay below the rate of return from their investments, creating an incentive for insurers to deny benefits.
Though this change impacts claims in the dispute system, we experience daily the negative side effects
from the lack of accountability for misbehaving insurers. Some insurers do behave responsibly; too
many do not.
Savings achieved changes must be passed onto consumers and insurer misbehaviour must be addressed
if auto insurance is to do what it is intended for: protect us in the event that we need it.
Thank you.