Ontario plans to cut benefits to worst accident victims, groups charge


Published On Thu Jun 21 2012

Dana Flavelle Business Reporter


It has taken two years and $140,000 for Jaisa Sulit to regain a nearly normal life after a motorcycle accident squeezed her spine and put her in a wheelchair.

Under Ontario’s latest proposed changes in auto insurance benefits, Sulit says she wouldn’t have qualified for even half that much.

“I understand the government is trying to keep insurance premiums low. But I’m afraid for the people out there who get injured and don’t get the benefits that they rightfully deserve,” said the 30-year-old Toronto resident.

Insurance benefits that paid for physical, emotional and vocation rehabilitation helped her reach the stage where she can walk with a cane and is looking forward to return to work this fall on a modified schedule, she said.

Under the new rules, her recovery could have been much longer and slower and perhaps not as complete, she fears.

As part of the government’s review of the auto insurance industry, which has already led to changes in other accident benefits, the province is considering a new definition of “catastrophic impairment.”

While the maximum benefit would remain $1 million, critics say the new definition would cut in half the number of people who qualify for it.

Catastrophic injuries make up 1 per cent of the 65,000 Ontarians injured in car accidents every year. That’s about 650 people a year.

The auto insurance industry says the government is just trying to modernize the way catastrophic injuries are defined and assessed, to remove grey areas and reduce the need to sue to get the benefits.

“In the past, there’s been uncertainty for people with severe and catastrophic injuries where they’ve opened up litigation. The lawyers end up getting a chunk of any settlement,” said Pete Karageorgos, manager consumer relations, in the Ontario office of the Insurance Bureau of Canada.

This isn’t the first time the province has reduced auto insurance accident benefits.

In September 2010, the maximum benefit for a severe injury was capped at $50,000, down from $100,000. About 20 per cent of accident victims qualify.

Benefits for minor injuries, which used to be in the same category as severe injuries, were capped at $3,500.

As part of the review process, the province asked the Financial Services Commission of Ontario, which regulates the auto insurance industry, to examine the definition of catastrophic impairment.

The commission says the Ontario government is committed to ensuring that those who are most seriously injured in car accidents receive appropriate treatment in a timely manner.

The recommendations in the Superintendent’s Report on the Definition of Catastrophic Impairment in the Statutory Accident Benefits Schedule would make it easier for children with traumatic brain injuries to receive necessary treatment quickly, and also introduce interim benefits for adults whose cases are still being assessed.

“Overall, Ontario’s accident benefits remain the most generous in Canada when compared to other provinces with similar auto insurance marketplaces,” the commission noted in an email response to the Star.

Critics say it’s not enough.

“We believe the class of seriously injured people who so badly need the funds for their care and rehabilitation is going to shrink significantly,” said Roger Oatley, a personal injury lawyer with Oatley Vigmond LLP.

Oatley is one of four personal injury lawyers who resigned en masse from a provincial advisory committee in protest over the proposed changes.

The changes are also opposed by the Alliance of Community Medical & Rehabilitation Providers, the Consumers’ Association of Canada, the Ontario Safety League and the Ontario Trial Lawyers Association.

Together the group has taken out newspaper ads that ask: “If the Ontario Government won’t protect you, who will?”

The previous changes in Ontario’s auto insurance benefits were designed to stabilize the province’s skyrocketing insurance rates.

The average premium declined slightly, 0.18 per cent, in the first three months of this year, the financial services commission reported in April.

Individual drivers may see their rates go up or down depending on their insurance company and their driving record.

The auto insurance industry argues that the spiraling cost of unnecessary assessments and fraud is raising costs for all drivers.

Insurance company executives say sketchy medical clinics and rehabilitation centres milk the insurance system by sending victims of minor accidents for dozens of questionable medical assessments.

Accident benefits still account for about one-third — the biggest chunk — of overall auto insurance premiums.




Goldhawk Fights Back- am 740 Interview

Pat Brown

If the Ontario Government Won’t Protect You, Who Will?

Tell the government to protect the people of Ontario and say NO to the insurance companies. Stop yet another auto insurance “reform”. Contact Your MPP Today!

Auto Insurance Benefits Drop in Ontario



Changes to accident benefits in Ontario may significantly reduce benefits

Written by Jennifer Brown

Posted Date: June 12, 2012


Accident victims in Ontario who suffer severe brain injuries or paralysis may find they no longer qualify for catastrophic coverage as the Ontario government looks to implement another round of cuts to auto insurance benefits, this time cutting coverage for devastating injuries.


“There’s a really large concern about what injured persons are going to be able to access,” says Maria Capulong with Carranza LLP in Toronto. “There were already changes made as of Sept. 1, 2010, and now we’re looking at what appears to be another potential clawback on what injured people are going to be able to access.


“Whereas someone with non-catastrophic injuries has access to up to $100,000 limit on accident benefits that was scaled to $50,000 and now the definition of catastrophic is being narrowed and a lot of persons with serious injuries won’t be able to meet that definition and will be capped at $50,000.”


Capulong’s firm was involved in the case of Aviva Canada Inc. v Pastore in which Anna Pastore suffered a several ankle injury in a car accident and also sustained serious psychological impairments, including a recognized pain disorder.


And in December 2011 the Ontario Court of Appeal restored clarity on when catastrophic impairment should be considered for accident victims stating psychological and physical should be combined for the determination. The case involved Robert Kusnierz who suffered serious physical injuries in a 2001 car accident, including a below-knee amputation. He also suffered from psychological problems including depression. The Court of Appeal found the judge at Kusnierz’ 2010 trial against his insurance company, The Economical Mutual Insurance Co., erred when he concluded that Kusnierz’ psychological impairments should not be combined with his physical impairments, and that Kusnierz had therefore not sustained a catastrophic impairment.


Currently, accident victims who are deemed to have suffered a catastrophic injury are eligible for basic medical and rehabilitation benefits of up to $1 million. But if the province accepts the recommendations of an expert panel being tabled today (read report here), the catastrophic injury threshold will be raised significantly.


This will result in far fewer accident victims qualifying for catastrophic injury benefits. Those denied under the proposed new rules will instead be eligible for a maximum of $50,000 in basic benefits.


“The definition of catastrophic used to include the combination of psychological and physical impairments and they are trying to get rid of that,” says Capulong. “I think a lot of the general public aren’t aware of this.”


“We estimate that the number of cases deemed catastrophic will be reduced by half if these changes are implemented,” said Andrew Murray, president of the Ontario Trial Lawyers Association, in a statement issued today.


The OTLA, Alliance of Community Medical and Rehabilitation Providers, and Ontario Safety League are holding a press conference at Queen’s Park today to put out their message that the Ontario government is about to implement another round of cuts to auto insurance benefits.


Ontario group fears cuts to catastrophic injury insurance



A group of Ontario lawyers and medical professionals claims the provincial government is about to change the way it pays insurance benefits to those who suffer devastating injuries in automobile collisions.

Andrew Murray, president of the Ontario Trial Lawyers Association, says Ontario is set to slash the number of people eligible for catastrophic injury coverage in half.

The change would reduce the amount that auto insurance companies would be required to pay out to those suffering from the most devastating motor vehicle injuries.

While the government has not introduced the changes, Murray said they are contained in a report by the Catastrophic Impairment Expert Panel.

“Our desire to have this addressed now is related to our fear that we are about to witness a disaster,” Murray told a press conference on Tuesday.

Currently, accident victims who suffer brain injury, paralysis or other “catastrophic” injuries are eligible for medical and rehabilitation benefits of up to $1 million. Those who would be denied under the new rules would be eligible for a maximum of $50,000 in basic benefits.

The change means less money would be paid out through car insurance companies and could result in lower insurance premiums.

Murray said that catastrophic impairment coverage is paid in about one per cent of all cases, meaning that while the change would be “disastrous” for a few hundred people, it would not be enough to affect insurance premiums in any meaningful way.

Murray said his association was seeking to secure a more inclusive definition of catastrophic impairment, which would allow more people to apply for assistance

Nick Gurevich, president of the Alliance of Community Medical and Rehabilitation Providers, said the changes would disadvantage the most severely injured and vulnerable victims, including those with severe brain injury, spinal cord injuries, psychiatric and behavioral issues.

Gurevich said victims would be shortchanged on the amount of assistance they receive and would be forced to live a life “without independence or dignity.”

Ontario Government Poised to Make Deep Cuts To Auto Insurance Benefits ? Again


TORONTO, June 12, 2012 /CNW/ – The Ontario government is about to implement another round of cuts to auto insurance benefits, this time slashing coverage for devastating injuries.

“If the government goes ahead with this, it will hurt a lot of very vulnerable people,” says Nick Gurevich, President of the Alliance of Community Medical and Rehabilitation Providers.

Severely Injured May No Longer Be Protected

Accident victims with severe brain injuries or paralysis, for example, may find they no longer qualify for catastrophic coverage. Those unable to work again, who face years of therapy and life in a wheelchair, may be denied the benefits they need.

Currently, accident victims who are deemed to have suffered a catastrophic (CAT) injury are eligible for basic medical and rehabilitation benefits of up to $1 million. But if the province accepts the recommendations of an expert panel, the CAT threshold will be raised significantly.

This will result in far fewer accident victims qualifying for CAT benefits. Those denied under the proposed new rules will instead be eligible for a maximum of only $50,000 in basic benefits.

“We estimate that the number of cases deemed catastrophic will be reduced by half if these changes are implemented,” says Andrew Murray, President of the Ontario Trial Lawyers Association (OTLA).

Media Availability

Groups concerned about the rights of accident victims have come together to oppose the changes. Along with accident survivors and rehabilitation professionals, they will be available to the media today:

When: Tuesday, June 12, 9:45 a.m.
Where: Media Studio, Legislative Building, Queen’s Park, Toronto

Victims Speak Out

Jaisa Sulit considers herself lucky that she was in a motorcycle accident before any changes to CAT. She was left with a spinal cord injury which qualified for the higher benefits. This funding made two years of intensive therapy possible, and she is now able to walk again.

“But under the proposed new CAT definition, I would not qualify. I would receive only $50,000 in funding, and that would be exhausted in the first several months. I wouldn’t be on the road to having my life back,” Sulit notes.

Dino Le Donne is also thankful that he didn’t have to rely on just $50,000 to see him through. Surviving a horrific crash that left him with broken bones, a collapsed lung and a serious brain injury, he has undergone years of treatment. Today, he is back to work and a productive member of society.

“No way I could have made this recovery if I was excluded from CAT benefits, which would be the case under these new proposals,” he explains. “How can there be any justification for taking away the benefits that help people in desperate need rebuild their lives?”

Brian Patterson, General Manager of the Ontario Safety League (OSL), notes that under the proposed new rules “accident victims who no longer qualify for CAT benefits could find themselves paying hundreds of thousands of dollars in medical, rehabilitation and support costs out of their own pockets.”

Ad Campaign

Ads warning of the impact of the proposed cuts began appearing in newspapers today. Ontarians can go to www.ontariorehaballiance.com/mpp/ to send an email to their MPP expressing their concern.

The “Expert Panel”

The proposed changes are contained in a report by the Catastrophic Impairment Expert Panel, which was appointed by FSCO. It should be noted that half of the panel members have been consultants for the insurance industry association.

About the Alliance of Community Medical and Rehabilitation Providers

The Alliance represents 84 companies and about 3,500 health care providers including nurses, physiotherapists, occupational therapists, speech language pathologists, chiropractors, psychologists, rehabilitation therapists, social workers, personal support workers and case managers. It is these individuals who are the primary providers of healthcare and rehabilitative services to Ontarians who are injured in automobile accidents. Visit www.ontariorehaballiance.com for further information.

About the Ontario Trial Lawyers Association

The Ontario Trial Lawyers Association (OTLA) was formed in 1991, by lawyers acting for victims. Our purpose is to promote access to justice for all Ontarians, preserve and improve the civil justice system, and advocate for the rights of those who have suffered injury and losses as the result of wrongdoing by others. Visit www.otla.com for further information.

About the Ontario Safety League

The Ontario Safety League was formed in 1913 by a group of business and community leaders in response to the increasing threats to public safety brought about by the automobile. The mission was to reduce preventable deaths, injuries and destruction on Ontario’s roads through public education and safety awareness.
For further information:

To arrange interviews or further information, contact:

Niki Kerimova
[email protected]

John Karapita, Director of Public Affairs
cell 289-242-8577
[email protected]


Position Paper on Select Committee Meetings

Alliance's position after meetings and presentation to Select Committee Representatives.

Please click here to download the document.

Auto insurance injury benefits in Ontario plummet

 Date: June 12, 2012

New figures released by Ontario's insurance industry regulator show that auto insurance companies are paying out dramatically less in accident benefits over the past two years.

Figures released Tuesday by the Financial Services Commission of Ontario show that insurance companies were paying $300 in injury benefits for every car on Ontario's roads in 2012. That's well down from the $764 paid out on average in 2010.

Yet the average premium hasn't dropped anywhere near that rate — auditor general Jim McCarter said in a report last December that Ontario drivers pay significantly more for auto insurance than other Canadians.

 “It's not a system that's working. It's not a system that's fair,” said NDP Leader Andrea Horwath.

 “The only people benefiting by the Liberals' initiatives in auto insurance [are] the insurance companies themselves.”

 But Ontario Finance Minister Dwight Duncan said things are improving.

 “Ontario's benefits are now equal to the rest of the country,” he said. “They were way out of line before.”

 Catastrophic injury benefit changes proposed

 The new numbers come as FSCO urges the Ontario government to cut benefits even further. The agency is recommending that those applying for catastrophic injury benefits will have to meet stricter criteria in order to receive the maximum $1 million in benefit coverage.

Lawyers and therapists say this could cut insurance payouts for many victims of serious accidents who have suffered severe spinal cord injuries, paraplegia or who have to undergo amputations.

 Jaisa Sulit, who partially severed her spinal cord in a motorcycle accident two years ago, is thankful for the coverage she received. Because of her insurance benefits, she was able to undergo extensive rehabilitation for two years and is now able to walk with the aid of a support stick. She hopes to go back to work later this year.

 But under the new rules, she would have only had coverage for half a year and isn't sure if she would be where she is now without that funding.

 “I am very scared for anyone who is ever going be in my shoes,” she told CBC News in an interview.

 “They are not going to have the resources they need to get their life back on track.”

 Adam Wagman, a personal injury lawyer, says it is important to talk about this issue, because it is “going to get pushed through if people don't know anything about it.”

 About 800 people suffered catastrophic injuries such as severe brain impairment or paraplegia in 2009, the last year in which such statistics are available. That accounted for about one per cent of all auto accident-related injuries.

 The government hasn't yet decided whether to make the change. Duncan said he wants to hear from the public first.

CBC: Auto Insurance Benefits Drop