Drastic Cuts to Accident Benefits Ahead

The provincial government is quietly pushing forward a bill that slashes the insurance coverage available for people injured in Ontario car accidents....

More / source: http://oatleyvigmond.com/drastic-cuts-to-accident-benefits-ahead/#.VXHpvlJqS1A 

Whats on the Public Register at CPSO?

Wondering about that assessor you are going to see?

What is on the Public Register (http://www.cpso.on.ca/Public-)

You have the right to contact HPARB and ask whether or not the insurer assessor to whom they are being sent has any CPSO censures that were appealed to them. HPARB decisions are publicly accessible. http://www.hparb.

The Health Professions Appeal and Review Board is an independent adjudicative agency.
On request, it:

• Reviews decisions made by the Inquiries, Complaints and Reports Committees of the self-regulating health professions Colleges in Ontario;
  
• Conducts reviews and hearings of orders of the Registration Committees of the Colleges; and
  
• Holds hearings concerning physicians' hospital privileges under the Public Hospitals Act.
  

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

ACCIDENT BENEFIT COALITION - why not join?

The Accident Benefit Coalition (ABC) consists of a membership of Ontarians concerned with issues surrounding the provinces' mandatory Accident Benefits. It  was founded by NeuroConnect and FAIR Association and is committed to advocating for Accident Victims in Ontario.

The Accident Benefit Coalition (ABC) is comprised of organizations concerned about the proposed reduction to Ontario's Accident Benefits.

Please click here to sign the Petition asking the Government to Stop Reducing Accident Benefits.

Thank you to everyone who attended the #rally4accidentvictims on June 3rd.

Please click here for pictures of the event.

http://www.accidentbenefitcoalition.com/

Hundreds rally against cuts to auto insurance benefits

By Maryam Shah, Toronto Sun

First posted: Wednesday, June 03, 2015 08:22 PM EDT | Updated: Wednesday, June 03, 2015 08:27 PM EDT  

TORONTO - Changes to auto insurance benefits for motor vehicle accident victims passed in the Ontario legislature Wednesday as part of the provincial budget.

“God help us all,” Tammy Kirkwood said upon hearing the news. “We’re getting a lot less coverage for a lot more money and I’m not sure why.”

Kirkwood was one of hundreds of protesters at Queen’s Park rallying against reductions in auto insurance benefits which they say will have the most effect on victims with catastrophic injuries.

The 47-year-old Orillia woman said protesters were “flabbergasted” that the provincial government “was trying to disable our resources and our funding to recover.”

Part of the changes to auto insurance rules under the new budget mean that combined coverage for medical, rehabilitation and attendant care benefits for the catastrophically injured will be cut in half from its current cap of $2 million to $1 million.

Kirkwood survived a 2008 collision when a dump truck hit her car. She had to be pried free from her vehicle by firefighters, and was deemed catastrophically injured.

She says she was only able to move forward because she had access to the services she needed.

Unable to return to work, Kirkwood now volunteers as an advocate with FAIR Association of Victims for Accident Insurance Reform.

New Democratic Party MPP Jagmeet Singh spoke at the rally in support of their cause.

The cuts affect “the most vulnerable people,” such as people with brain and spinal cord injuries, he said.

“They need benefit coverage ... to live an at least somewhat decent life,” Singh pointed out.

A spokesman for Finance Minister Charles Sousa said the government is “working hard to create a fair and affordable insurance system” for the province’s 9.4 million drivers.

Ontario is “the only province in Canada to offer exclusive catastrophic coverage,” Kelsey Ingram said in an e-mail.

“Catastrophically impaired claimants will also continue to be able to sue an at-fault party to recover damages for health-care expenses and potentially other claims,” she added.

The provincial government is also committed to making sure any savings from these changes do not result in “excess profits” for insurance companies, Ingram said.

“This is about lowering premiums while providing support and protection for all Ontario drivers,” she said.

maryam.shah@sunmedia.ca

MD watchdog becoming less secretive

The College of Physicians and Surgeons will post on its website whether MDs have been "orally cautioned" for mistakes...

More/ source: http://www.thestar.com/life/health_wellness/2015/06/01/md-watchdog-becoming-less-secretive.html

 

Simplify ODSP process

Published on Fri May 29 2015

 

Re: Ontario rethinks complex disability reviews, May 17 

Ontario rethinks complex disability reviews, May 17

In her interview with Laurie Monsebraaten, Mary Marrone of the Income Security Advocacy Centre gives us pause when she describes the process of Ontario Disability Support Program (ODSP) medical reviews as flawed, wasteful, and “careless with people’s lives.” 

As a physician and a member of the Select Committee on Mental Health and Addictions, being careless with people’s lives is the last thing Helena Jaczek, the Minister of Community and Social Services, would want.

That’s why Ontario’s registered nurses, nurse practitioners, and nursing students urge her to simplify the ODSP application process. Right now, it is so complicated that more than half of community legal clinic cases involve ODSP appeals. 

With more than half of these appeals being eventually approved by the Social Benefits Tribunal, this is not accountability but “denial by design.” We can and must be ever careful with the lives of every Ontarian, especially those most in danger due to health and disability challenges.

Doris Grinspun, CEO, Registered Nurses’ Association of Ontario, Toronto

Source: http://www.thestar.com/opinion/letters_to_the_editors/2015/05/29/simplify-odsp-process.html

 

Ontario's 25-Year No-Fault Journey

Ontario's auto insurance system is unrecognizable, and it is time to stop tinkering. The concept of using an insurance system to provide a social safety net is flawed, perhaps requiring in its place a system where private insurance companies provide both third-party liability and physical damage coverage while a Crown corporation delivers accident benefits.....

 

More/ source: By: Willie Handler, Consultant, Willie Handler and Associates 2015-05-01
 http://www.canadianunderwriter.ca/news/ontarios-25-year-no-fault-journey/1003649700/?type=Print%20Archives

Injured worker on hunger strike for compensation hearing

After 18 days with only water and broth to drink, Jimmy Velgakis says he just wants a chance to tell his side of the story.

MARCO CHOWN OVED / TORONTO STAR Order this photo

 

Former city worker Jimmy Velgakis holds vigil outside Queen's Park, where he's holding a hunger strike to make his case for workers compensation. 

By: Marco Chown Oved Staff Reporter, Published on Fri May 29 2015

 

After more than 20 years, Jimmy Velgakis is still angry.

With a sign around his neck, he’s been standing in front of Queen’s Park for the past 18 days on a hunger strike. The former city ice rink worker injured his back lifting a piece of plywood on the job in 1991 and has never received the workers’ compensation benefits he says he’s due.

When he tells his story, Velgakis’ voice grows louder and his deep tan takes on a reddish hue.

“I have the injury. I prove that and they refuse to pay me,” he says in a thick Greek accent. “When I get to a second tribunal, they kick me out of the room. They don’t allow me to talk. They play with me.”

As he reaches his crescendo, the 74-year-old mustachioed man stops and stumbles backward. After nearly three weeks with only water and broth to sustain him, he says, these flashes of weakness hit with increasing frequency.

It’s Velgakis’ third hunger strike in the past four years. The last two ended with promises that he would get a new hearing and be given an opportunity to tell his side of the story. Both times, a full hearing didn’t materialize.

“At every turn this poor man has just been shut down. He really is literally at the end of his tether right now. We tried everything to convince him not to do this, but he insisted,” said NDP MPP Cheri DiNovo, who went on a 10-day hunger strike with Velgakis in 2013.

DiNovo, who plans to highlight Velgakis’ case in a statement to the House on Monday in honour of injured worker’s day, has tried to get the premier, minister of labour and Toronto city hall involved, but says she has been rebuffed at every turn.

“It’s a matter of justice. He’s been fighting for years. It’s very indicative of what injured workers have to go through with (the Workplace Safety and Insurance Board). He’s just not letting it go. Why should he?” she said.

The WSIB declined to comment and referred the Star to the Workplace Safety Insurance Appeals Tribunal. The WSIAT doesn’t normally comment about individual worker’s cases, said acting general counsel Michelle Alton.

“We are aware of Mr. Velgakis’ hunger strike. The tribunal hopes he takes care of himself and he stays healthy,” she said.

After his injury, Velgakis continued to work for three years in a role that had been adapted for his bad back. When the city laid him off in 1994, he was given a one-time payout and signed away — unwittingly, he says — his right to pursue further claims.

In 1996, Velgakis won a decision recognizing his injury and granting him benefits, but he only got a few days of payments before they were cut off.

At the next hearing, his temper got the best of him and he was asked to leave while his future was decided without him. His claim was rejected.

Velgakis rented out his basement and asked his brother in England for some help to make ends meet, but soon the pressure became too much. He says his marriage fell apart and he grew estranged from his two daughters. He now lives off a half-pension from the city and CPP.

Marion Endicott, of Injured Workers’ Consultants, represents Velgakis free of charge. While acknowledging that he’s exhausted his legal avenues for recourse, she argues that he should be given a new hearing on humanitarian grounds.

“Jimmy has been the victim of an insidious transformation of our workers’ compensation system from an inquiry-based one to an adversarial one,” Endicott said. “Jimmy’s fighting not only for himself, he’s fighting for all injured workers — the only difference is that he’s not giving up.”

 

 

Source: www.thestar.com/news/gta/2015/05/29/injured-worker-on-hunger-strike-for-compensation-hearing.html

 

Hospitals still use flawed secrecy law to review medical errors

As the government drags its heels over amending the health secrecy act, hundreds of critical care incidents are still being investigated under the flawed legislation, the Star has learned.

By: Olivia Carville Staff Reporter, Published on Fri May 29 2015

Hospitals continue to invoke a controversial health secrecy law when they investigate critical medical errors, despite a government report that in March highlighted serious flaws in the legislation.

In the past week, the Star has surveyed 15 hospitals in the GTA and found more than 200 critical or severe incidents had been handled under the act since April 2014 — most of those while the legislation was under active review by the province. This includes at least 11 patient deaths...

More/ source: http://www.thestar.com/life/health_wellness/2015/05/29/hospitals-still-use-flawed-secrecy-law-to-review-medical-errors.html