The Ontario government is completing a review on what constitutes a “catastrophic impairment” when a person is injured in a car accident. The definition is critical: a person who has suffered a catastrophic impairment is entitled to access much greater levels of benefits for care and treatment. This is not akin to a lottery ticket. A catastrophically injured person must still prove that the benefits are reasonable and necessary. All the definition does is raise the ceiling so that the most seriously injured accident victims may gain access to the treatment and care that they legitimately need. Last week, an expert medical panel completed a review of the definition of catastrophic impairment. The recommendations are based on a technical review. In yesterday’s Toronto Star, Dale Orlando wrote an article urging the Ontario government to consider not just rigid technical definitions but also to consider the real needs of severely injured individuals.
The text of the article is reproduced below:
‘Catastrophic impairment’: What’s at stake
Published On Sun Apr 17 2011
President of the Ontario Trial Lawyers Association
“If any changes are to be made to this definition of injury, the government should ensure that everyone who needs the additional level of coverage has access to it. It is important to remember that, just because someone is deemed to be catastrophically impaired, that does not confer an automatic right to benefits. They must demonstrate need on an ongoing basis in order to receive benefits from their insurer.”
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The Financial Services Commission of Ontario (www.fsco.gov.on.ca) has now commenced a review of the “Catastrophic Definition”. The outcome of this review will have a dramatic impact on the victims who suffer severe disabilities in car crashes. For those deemed to be “catastrophic”, it can mean the ability to access essential services to live independently and with dignity. For those that are not, it can mean a life of limited help, despair and a stalled recovery. The stakes are very high!
The FSCO has now appointed an Expert Medical Panel to make recommendations regarding the definition and the assessment process. Careful attention will be made on people suffering traumatic brain injuries, paralysis, spinal cord injuries, severe mental and psychological disorders, and those suffering from multiple broken bones.
Many lawyers, doctors, rehabilitation professionals and treating providers are looking forward to the review. It is hoped that it will finally address the many holes that are within the system. Holes that have resulted in many seriously disabled victims being left out in the cold when it comes to basic care services and rehabilitation treatment. Treatment that will help them get better and integrated back into society and the workforce.
The last changes made by the Ontario Government to the insurance system was in September of 2010. These changes saw a drastic reduction in benefits to those suffering less severe injuries. The intent was to eliminate and drastically reduce benefits flowing to people suffering minor injuries. By cutting the flow, it would mean insurance companies would not have to raise auto insurance premiums to the driving public. It was also seen as a way of making sure greater benefits could flow to the more seriously disabled victims. As some would say, soft tissue injuries would have to take a back seat to the seriously injured.
Although the review process is to look at ways of making the present system better and more efficient, some fear that it will be used as a vehicle by the insurance industry to make it harder for people to be deemed “catastrophic”. This of course would mean people who otherwise would have up to two million in benefits available to meet their needs, would be reduced down to a bare bones package that is exhausted normally with one to two years. This of course cannot be the intent of the review. The review ought to ensure greater access is given to the seriously injured. Substantial savings have already been afforded to the insurance industry as cited in my previous blogs. To now go after the seriously injured and seek to reduce their benefits is just wrong.
Many are confident that the medical panel, FSCO and the Ministry will ensure these seriously injured persons are protected. An expansive approach with the definition must be done. A definition that recognizes all serious injuries. A definition that takes into consideration the collective impact of all injuries on the disabled. It should never be forgotten that there are no windfalls that happen when one is deemed “catastrophic.” Even if someone is found to suffer a catastrophic injury, they still must prove the need for benefits. It simply does not mean money falls on to their lap and they keep it. The money goes to rehabilitation, home modifications, mobility aids, and attendant care. The disabled person still must prove they need the services ( the wheelchair ramp, the wheel chair lift, the helper to get dressed etc.). If they don’t prove it, they don’t get it. If the definition is expanded, it simply means those who need it can access it beyond the temporal and monetary caps of $3,500 or $50,000 as set out in my previous blogs.
If the panel or FSCO or the Ministry seek to tighten up the definition, which would be contrary to the intent of the review, then many severely disabled individuals will be shut out from accessing the rehabilitation and medical help needed to live with dignity and independence. Of course further restriction would simply mean greater savings to the insurance industry. This time however, it will be on the backs of the severely disabled.
In an earlier post, we criticized a Toronto Star column for biased coverage of recent auto insurance changes. The column, which was written by a Joel Cohen, a representative of the auto industry, presented misleading and unsupported facts about accident victims. We printed Dale Orlando’s response to the column on our blog and urged the Star to do the same. To its credit, the Toronto Star did publish Dale Orlando’s response. A link to his response can be found here (Mr. Orlando’s letter appears below the first letter).
We applaud the Toronto Star for presenting an alternate viewpoint on this important issue.
After September 1, 2010, car insurance companies and brokers across Ontario will be presenting consumers with new choices for their auto insurance renewals. A daunting process is ahead. The insurance system in Ontario is one of the most complicated systems in North America.
Even though car insurance is a major budgetary item for many families, many consumers are unfamiliar with the coverage they actually have. After September 1, consumers will be given a number of choices as to amount of benefits they wish to purchase. By giving such a choice, the intent was to give them a break on premiums being paid.
The new basic auto policy being sold contains far less benefits than what existed before September 1. With benefits being drastically reduced, one would of course expect to see some significant reductions in how much one has to pay in premiums.
Therefore it is absolutely critical that each consumer ask their insurance company and brokers what are they buying and at what price. Like shopping in a supermarket, each item ought to have a price tag. Read more of this article »
[This is the fifth of a five part series by Patrick Brown on upcoming changes to auto insurance]
Injured accident victims will have a significant amount of their benefits reduced due to assessment costs. Despite the dramatic slashing of benefits reported in my previous blogs, consumers will also face further reductions based on the fact that the cost of assessments will come out of the amount of benefits available.
For example, if a consumer is injured in a car accident and the injuries are not considered to be catastrophic, they presently have $100,000 in benefits for medical and rehabilitation treatment. Any assessment costs to obtain the benefit are over and above the $100,000.
Under the new standard policy without buy ups, the consumer will only have $50,000 available in benefit dollars. That $50,000 includes assessments costs. Therefore, if $5,000 is paid for an assessment to obtain the benefit, then the amount available to the injured person is reduced down to $45,000. Read more of this article »
Patrick Brown has made a series of posts recently discussing the changes to auto insurance in Ontario. In today’s Toronto Star, James Daw provides a useful illustration of what a lower premium may cost you in the long run, in terms of reduced benefits and coverage.
The table below is taken from Mr. Daw’s article:
[This is the fourth part of a series by Patrick Brown on upcoming changes to Ontario's Auto Insurance Laws]
Starting September 1, 2010, many family members who provide basic care needs to their injured family members will be cut out from receiving any compensation for these essential services. The new law eliminates any benefits going to a family member who help the disabled family member unless they show they suffered an “economic loss” because of it.
This will have a devastating impact on families who chose to have family members look after their severely injured loved ones. The new law was passed at the request of the insurance industry. It will force families to use outside agencies. Right now for instances, if a family member is hit by a car and suffers serious injury to the extent they can no longer dress, bathe or feed themselves, a benefit is available up to either 3,000 or 6,000 per month so that other families members can help. Under the new system, this funding will stop unless mom, dad or sibling can show they lost money somehow [i.e. they have to quit work or miss work without pay]. The only way to access the benefit is to have a third party care agency come in and provide the services. Read more of this article »
This is the third of a series by Patrick Brown on the upcoming changes to auto insurance in Ontario.
After September 1, 2010, if you are hurt in a car accident and are deemed to suffer a “minor injury”, do not expect to get much help. Although the legislative intent was to simplify the system, reduce extraordinary assessment and administrative expense and reduce the number of smaller claims, this new category of injury may have a significant impact on injuries that may be anything but “minor”.
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This is the second of a series where Patrick Brown discusses the upcoming changes to auto insurance.
The Ontario Government has now stepped up and restored both dignity and respect to the senior community and those families that have lost a loved one at the hands of a bad driver.
The Minister of Finance announced that effective September 1, 20010, the deductible in auto related wrongful death cases will be eliminated. The right to a grandparent to receive compensation when they lose a grandchild will be restored. As well, grandchildren will also be able to advance meaningful claims for compensation when they lose a grandparent to a negligent driver.
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This is the first of a series where Patrick Brown discusses the upcoming changes to auto insurance.
Starting this September, if you are injured in a car accident, the benefits available to assist you in getting better will be drastically reduced.
The insurance industry has set it self up, once again, for record profits. Following intensive lobbying by the insurance industry, the Ministry of Finance released the new Regulations for Auto Insurance on www.e-laws.gov.on.ca. These regulations are now law. As of September 1, 2010, all persons who are injured in an incident involving a car (this includes cyclists and pedestrians) will face reduced benefits when hurt.
Dollars used to care for the injured victims will be deflected away from the insurance industry to the public health system. The last time the government gave a break to the auto insurance industry was in 2003 when they reduced compensation to be paid out to victims of accidents. Back in 2003 the industry was crying poor and pressing the panic button on rising health care costs and increased premiums. After the 2003 changes were made profits soared. In 2004, Canada’s property and casualty insurance industry made $4.7 billion. It went on to make $4.6 billion in 2005 and about $5.8 billion in 2006. Read more of this article »