Relief Ahead for Claimants, Attendant Care Providers and Case Managers

Attendant Care

In April FSCO will release a bulletin clarifying insurer obligation to pay the total monthly benefit calculated on the Form 1 for Attendant Care, and that the Levels are merely an aid to calculation. Further, they are making a revision to the Attendant Care Rate Guideline, removing the language that says that insurers are not liable to pay for expenses related to attendant care costs rendered to an insured person that exceed the maximum hourly rates The Guideline change makes the Bulletin enforceable, so that claimants and provider will be better able get these disputes resolved or make complaints to Market Conduct.   In sum, we will have a FSCO-supported return to pre-LAT decision status quo.

 

Case Management

The April bulletin will also provide clarification to insurers intended reinforce the payment of Regulated Providers in accordance with the rate assigned to their discipline in the PSG for Case Management services. As above, this is an intended return to the pre-LAT decision.

With luck this Bulletin will see the light of day before mid-April.

Canadian Underwriter Article

What Ontario needs to do to reduce auto insurance costs

 

https://www.canadianunderwriter.ca/insurance/ontario-needs-reduce-auto-insurance-costs-1004128918/

Fraud in the collision repair industry and distracted driving are among the issues that “need to be addressed” if Ontario auto insurers want to reduce the amount of money paid out on claims, said Willie Handler, principal of Willie Handler and Associates, in an interview Monday.

An interesting read from the Canadian Underwriter

RSA Canada endorses “all of the recommendations” in Marshall report

Willie Handler Article in Canadian Underwriter- An Interesting Read

Play it Again, Sam

Key features of Ontario’s
latest auto reform package
have been attempted before
– and ended in heartbreak.

Article Linked below:

Willie Handler Article in Canadian Underwriter

Government Announces Changes

The government has announced its proposed changes to Ontario Auto Insurance. The link below, has as much detail as currently available. As always, the devil will be in the detail, and will emerge as the panel and consultations gets into gear, and through our discussions with Finance and FSCO.

Highlights from the release – some ORA comments/notes in italics:

  1. Implementing standard treatment plans for common collision injuries such as sprains, strains and whiplash, changing the emphasis from cash payouts to ensuring appropriate care for victims – No specific reference here to ‘minor injuries’ but this is likely some version of the CTI; we’re hopeful that this language of ‘sprains, strains, whiplash’ means that brain injuries are no longer included. The intention is to have the first of these plans in place by spring 2018.
  2. Reducing diagnosis and treatment by instituting independent examination centres to assess more serious auto collision injuries – During the live stream reference was made to a bidding process for the ‘select few’ assessors who are held to higher standards, credible, independent and neutral. It is noteworthy that there is no mention of these being hospital based. We will hope and lobby for these assessors to have relevant rehab-related skills and knowledge. We are seeking clarification as to when in the claims’ life cycle these IEs will take place.
  3. Cracking down on fraud by launching the province’s first Serious Fraud Office in spring 2018. The office will focus on auto insurance fraud, which has been identified as one of the factors contributing to higher premiums
  4. Directing the Financial Services Commission of Ontario (FSCO) to review risk factors used by insurers to calculate premiums with the goal of ensuring drivers in certain parts of the province are not subject to unfairly high rates
  5. Ensuring that lawyers’ contingency fees are fair, reasonable and more transparent

The province will establish a panel to guide the enactment of reforms contained in the Fair Auto Insurance Plan.

https://news.ontario.ca/mof/en/2017/12/ontarios-fair-auto-insurance-plan.html

We will continue to keep you posted as we learn more.

Insurance assessment firms altered, ghostwrote accident victim reports

Kathy Tomlinson Reports: Read the Globe and Mail Article Here

“For Terry Blais, the ordeal of fighting for insurance coverage was worse than being hurt in a car accident.”

 

The Globe and Mail: Licensed to bill

“Doctors are taking in millions of dollars a year by putting their names to accident injury reports for the insurance industry. Some of these reports unfairly discredit injury claims, leaving victims intimidated and exhausted. But because the majority settle out of court, the practice is hidden from public scrutiny. Kathy Tomlinson investigates.”

Click here to view the article

Government Moving on Marshall Report!

Somewhat buried in the November 14th Fall Economic statement from the Minister of Finance was the news that within the next few weeks the government will announce new measures aimed at “transforming important aspects of auto insurance to create a more efficient system focused on timely care for victims and sustained savings for consumers”.

This statement follows a reference  to the Marshall Report and cites key recommendations (below):

  • Improving how the common injuries are treated and managed, so that accident victims receive more timely care and further impairments do not develop due to delayed treatment;

  • Establishing a system of single neutral medical assessments to provide patients with the best care options;

  • Implementing lifetime management of care for catastrophically injured individuals;

  • Creating a strong, independent auto insurance regulator that is more proactive and empowered to address flaws in the system; and

  • Reviewing the auto insurance rate regulation framework to enable more innovation and competition that would give a greater number of options to consumers.

Translation? It’s all guesswork but… it is looks like we will see the CTI, or a reasonable facsimile put into place, that there’s a high likelihood of a WSIB-like hospital-

based IEC system with little dispute or wiggle room on findings, potentially a change in cash settlement practices for catastrophic injuries, more regulatory muscle for FSRA (the new regulator), and greater flexibility and responsiveness to insurer rate increase requests to enable increased options for consumer. (This last rationale is for those who think Santa is real).

I’m afraid that little to none of this is good news for our members – and I’m sorry. But we will do our utmost to stay engaged and keep you informed of developments. In addition to reading the between-the-lines-tea-leaves of the statement, we are meeting this week with the Finance Minister’s lead hand on this file to see what more we can learn and to look for opportunities to influence the shape of things to come. I will also be reaching out to other associations so that we might combine our efforts where our interests align.

As always, we’ll keep you posted.

“Ontario’s crowded hospitals don’t need even more exams” – WILLIE HANDLER

We are delighted to see Ontario auto insurance policy expert and consultant Willie Handler’s recent piece. His views on the Marshall Report line up beautifully with those we expressed in our submission. Fingers crossed that government will take heed.

Click Here to View the Article 

Cost Reductions are a Good News Story for Ontario Drivers & Auto Insurers

The Ontario Rehab Alliance (ORA) congratulates the Ontario government on reducing auto insurance premiums and claims costs.

The recently released annual report from GISA (the General Insurance Statistical Agency) shows two remarkable trends in 2016:

Despite a 10% increase in the number of insured vehicles to a record of 7.5 million, total net
Accident Benefits premiums dipped for the fifth straight year in a row to total $3.047 billion,
representing a 19.4% reduction from 2012 ($3.782 billion).

The reduction in net Accident Benefits premiums is a direct result of the decrease in average
cost per claim which dipped to $34,047, the lowest in last 5 years. The most recent average
claim cost represents a 12% reduction over the previous year.

The ORA notes that these trends are all the more remarkable because the GISA data does not reflect the
additional reductions in Accident Benefits claim costs that are expected from subsequent changes to the
Catastrophic Injury definition, reduction in Catastrophic and Non-Catastrophic benefits and the
transition to the Licensing Appeals Tribunal (LAT), which is expected to improve dispute resolution in the sector.

“Such dramatic reductions in both premiums and claim costs indicate that the government’s previous
strategy is now bearing fruit” says Ms. Laurie Davis, Executive Director of the ORA. “Rushing in with new recommendations based on dated data risks undoing everything the government has accomplished to date and may introduce new unpredictable costs to the system”, she adds. Ms. Davis is referring here to the recently published “Fair Benefits, Fairly Delivered” report by Mr. David Marshall which calls for a
broad system overhaul, with many of its recommendations based on 2013 financial data which
preceded many of government initiatives which led to the recent reductions.

“We congratulate Minister Sousa on his success to date and urge him to press pause on consideration of
any further reform until the last wave of changes works itself through the system and benefits are
realized. Victims of Ontario’s motor vehicle crashes have been through enough changes in the past
decade and deserve some respite”, says Ms. Davis

Please Click Here for the Full Release: Cost Reductions a Good News Story