Toronto Sun – The most generous benefits in North America? Sorry, Ontario strikes out

By: Alan Shanoff, Toronto Sun

Late last month the Insurance Bureau of Canada launched a media campaign claiming Ontario has one of the most generous benefits packages in North America.

Coincidentally Ontario’s Minister of Finance, Dwight Duncan, issued a press release claiming Ontario’s accident benefits remain the most generous in Canada.

Is this true or is it a sleight of hand to divert our attention from the fact Ontario’s car insurance premiums are the highest in the country?
Let’s start by looking at the majority of accident victims, those who suffer minor injuries such as sprains, strains and minor to moderate whiplash.

According to the 2011 Annual Report of the Office of the Auditor General of Ontario (the AGO Report) approximately 60% of accident victims suffer minor injuries. If you suffer a minor injury as a result of a car accident in Ontario your generous entitlement for medical rehabilitation benefits is a maximum of $3,500.

That figure includes the cost of assessments, examinations and reports, meaning that the actual amount available for treatment will be much lower. That figure is supposed to cover treatment for dislocation of joints, partial tears of tendons, ligaments and muscles, contusions, abrasions, lacerations, whiplash not exhibiting neurological signs as well as any clinically associated conditions.

In no other province or territory are any car accident victims limited to such a paltry sum as $3,500 for medically necessary treatment. No other province provides a cap on so-called minor injuries.

Strike One against Ontario having the most generous benefits in Canada.

Alright, let’s move on to moderate to major, but not catastrophic injuries, the category in which about 39% of all accident victims fall under according to the AGO Report.

Your generous entitlement for medical rehabilitation benefits is a maximum of $50,000. Prior to September 2010 this figure was a more generous $100,000 — but it was reduced as part of the war against fraud. Yes, Ontarians may pay an extra premium to reinstate the $100,000 benefit, but very few have taken up that option. That’s not surprising since our premiums are the highest in the country without purchasing optional coverage.

Our $50,000 compares favourably to Nova Scotia, PEI, Nunavut and the NWT which each have a limit of $25,000 and equals the limit in Alberta and New Brunswick. But it falls short of the limits in British Columbia, Manitoba and Saskatchewan.

Strike Two against Ontario having the most generous benefits in Canada.

OK, what about the catastrophic injury category? This is the category in which only about 1% of all accident victims fall according to the AGO Report. Less than 1,000 Ontarians fall under this category each year.

Ontario’s medical rehabilitation limit for catastrophic injuries maxes out at $1,000,000. That may seem like a lot of money, and it is, but it is supposed to cover a wide range of sophisticated and expensive treatments and may not be adequate for some catastrophically injured victims. No other province provides a special limit for catastrophic injuries although Manitoba, Saskatchewan and Quebec provide medical rehabilitation benefits in excess of Ontario’s $1,000,000 when medically warranted.

But, Manitoba and Quebec have pure no fault systems and don’t allow negligence lawsuits to recover damages for pain and suffering or economic losses while Saskatchewan’s medical rehabilitation benefits are reduced for those who have elected to purchased a tort-based insurance policy rather than the standard no-fault based policy which excludes negligence actions.

While Ontario permits negligence lawsuits there is an automatic deductible for claims under $100,000 and no claims are permitted unless they satisfy a stringent threshold test.

Regrettably, Ontario seems poised to go down the road of “modernizing” — meaning making it harder to qualify and reducing the number of claimants — the definition of catastrophic impairment following the recommendations of an eight-member panel, two of whom have been consultants to the IBC and two of whom have received research grants from the insurance industry.

And regardless of the amount of the benefits, you can’t have a “generous” system if insurers delay and deny claims to the extent that tens of thousands of accident victims remain in lengthy queues to achieve either a mediation or arbitration of their entitlement to benefits.

Strike Three — you’re out.

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