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.




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