Auto insurers routinely deny treatment plans, therapists say

By Ellen Roseman

Suppose you’re driving your car with three passengers and you hit a deer. No one is hurt, except the animal.

Your insurance company quickly pays $24,000 to cover repairs to your damaged car. It’s happy to protect you from financial harm after an accident.

Now suppose you and your passengers are all injured after hitting the deer. This time, the insurance company is slower to respond.

It may turn down your requests to be repaid for rehabilitation treatments not covered by the health care system (such as physiotherapy or psychological counselling). It may treat you as fakers, exaggerating your injuries.

You and your passengers are entitled to maximum benefits of $3,500 each, or $14,000 in total, under Ontario’s minor injury guideline. That’s far less than the $24,000 paid for car repairs. But you may fight for months — perhaps even years — to get the amount owed to you.

I heard this story at the Hamilton Medical-Legal Society Spring Symposium last weekend. The driver who hit the deer and escaped injury is married to an occupational therapist. He knows how tough it is to get accident benefits if you’re hurt in a collision.

In a speech to the group, I said Ontario was protecting insurers’ profits at the expense of accident victims’ rights to timely treatment. Many professionals agreed with me. On Sept. 1, 2010, the Liberal government slashed accident benefits, hoping to stop car insurance rates from rising before the election of October 2011. There used to be a maximum limit for $100,000.

Today, 20 per cent of victims get benefits of up to $50,000 for moderate to major injuries. Meanwhile, 70 to 80 per cent of victims with minor injuries have their medical and rehabilitation benefits capped at $3,500.

Even if you want to buy extra insurance coverage for minor injuries, you can’t. You’re stuck with this bare-bones limit, the lowest in Canada.

The government still has a $1 million limit on treatments for those with “catastrophic impairment.” But it will soon bring in a new definition that is expected to make benefits harder to get. Health professionals talked despairingly about patients losing precious time for recovery when adjusters refused to pay for recommended treatments.

Lawyers talked about the Financial Services Commission of Ontario’s failure to meet a 60-day time limit to mediate disputes between insurers and clients. Injured people can wait a year or more to be heard.

The courts are starting to recognize victims’ rights. In a recent case (McQueen vs. Echelon), a woman was awarded $25,000 for mental stress after her insurer made 21 denials of benefits over a three-year period.

“Routine and rubber-stamp denials are illegal,” said the plaintiff’s lawyer Lou Ferro, “and insurance companies will be penalized by making them pay aggravated damages on top of the cost of the benefit.”

Last week, an Ontario Legislature committee voted to hold public hearings on car insurance. Something is wrong when 42 per cent of treatment plans are rejected, up from 11 per cent before, says NDP MPP Rosario Marchese.

Many people working in the rehabilitation field think Ontario’s recent insurance reforms have veered too far in the wrong direction.

Let’s hope the three parties — after hearing testimony from accident victims — can come up with suggestions on reversing the unfair treatment.

Ellen Roseman writes about personal finance and consumer issues. You can reach her at [email protected] or


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