It’s time for MPPs to stand up to insurers?

Saturday, July 14, 2012

It’s time for MPPs to stand up to insurers

By Alan Shanoff, QMI Agency

Last Updated: July 14In 2010 Ontario’s no fault auto insurance medical and rehabilitation benefits were cut in half to $50,000 for non-catastrophic impairment cases.

A new category of injuries labelled minor injuries was created, and for injuries deemed to fall in to that category benefits were cut to $3,500, a figure that experts say won’t provide sufficient services to adequately treat many patients.

Since these amounts include assessment and examination costs the actual amounts available for payment of benefits is even lower. Also, since the majority of accident victims suffer minor injuries, Ontarians now have the worst no fault benefits coverage in Canada. But at least Ontario laws require up to $1 million in medical and rehabilitation benefits for those who have suffered a catastrophic impairment in a motor vehicle accident.

Last month, however, the minister of finance released the report of the superintendent of financial services outlining recommendations that would reduce the already small number of people, about 650 per year, who qualify for catastrophic impairment benefits. While that would no doubt please the insurance lobby it would be a tragedy for the neediest accident victims who would see their benefits reduced by 95%, from $1 million to $50,000.

The impact of restricting the definition of catastrophic impairment was starkly illustrated with the contrast between the outcomes of accident victims Jorg Reichert and Jaisa Sulit, details of which were placed before the Standing Committee on Finance and Economic Affairs during their May 28 hearing.

Jaisa’s injuries included a burst fracture of part of her spinal cord. She was confined to a wheelchair for several months. Her injuries were accepted as catastrophic, entitling her to the benefits she required. With almost two years of physiotherapy, massage therapy, physiatry, occupational therapy and a dietician she can now walk with a pole and requires a wheelchair only for long distances. She is looking forward to returning to her career. Had she not been deemed catastrophic, she’d have exhausted her benefits within nine months of the accident.

As she told the committee, “catastrophic funding is why I’m able to continue to see a multidisciplinary rehab team that has not only helped me regain physical and functional abilities, but has helped me adjust to living a life with a disability.

Contrast Jaisa’s treatment with Jorg’s. Jorg’s accident left him with “serious and permanent” injuries including major depression, personality change and the loss of cognitive skills.

Prior to the accident Jorg was a “brilliant and successful businessman and entrepreneur.” He and his wife started the Movenpick and Marche restaurants in Canada. His insurer denied Jorg’s physicians’ catastrophic designation. The insurer cut off payment for treatment two years after the accident, with the $100,000 limit being reached. Had the accident occurred after September 2010 the limits would have been only $50,000.

More than four years after the accident Jorg has seen little improvement. The accident has wiped out the family’s savings.

Why is there a pressing need to amend the catastrophic impairment eligibility rules?

Only about 1% of all accident victims’ injuries are serious enough to be deemed catastrophic. These are the most vulnerable victims, the ones who require access to a wide variety of medical rehabilitation professionals, the ones for whom the current $50,000 cap is grotesquely inadequate.

Living as we are under a minority government we need to alert out MPPs that it’s time to stand up to the insurance lobby and support our most seriously injured car accident victims.

Clarification: In my May 27 column I mentioned that Nova Scotia has a minor injury cap of $7,956. This amount is a cap on the damages an injured person can recover in a lawsuit for pain, suffering and loss of enjoyment of life for a minor injury, not a cap on minor injury no fault benefits. The cap on no fault medical and rehabilitation benefits for any injury in Nova Scotia is $50,000.

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