Toronto Sun – Risky business

Why reduce insurance benefits for Ontarians who need them most?

Following closely on the heels of the announcement by Ontario Finance Minister Charles Sousa of a targeted 15% reduction in car insurance premiums, to be phased in over two years, we had a spokesman for the Insurance Bureau of Canada chillingly proclaim, “we’re hoping that they (the provincial government) quickly introduce a new definition of catastrophic impairment. If you want to see some rate reductions, that’s the place to start to make sure that unnecessary costs related to catastrophic injuries are taken out so that money goes to people who really need it.”

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Dr. Jason Mazzarella – Contending with Chronic Pain

Surveys find two-thirds of professionals find pain is not well managed, and insurance companies face challenges when trying to quickly resolve motor vehicle accident claims involving complaints of chronic pain.

By: Dr. Jason Mazzarella

In Canada, insurers are under fire due to the reports of chronic pain post motor vehicle accident collision. Recent findings have further complicated the chronic pain issue in Canada.

The World Health Organization has stated on recommendations set forth by the International Association for the Study of Pain that chronic pain treatment is a basic human right.1 The Canadian Pain Coalition at the September 3, 2010 International Pain Summit in Montreal stated that “access to pain management is a fundamental human right.2 And court judgments, including Martin vs. Workers Compensation Board of Nova Scotia, addressed severity of pain as a violation of the Canadian Charter of Rights.3

These findings provide further evidence of the struggles insures have when trying resolve motor vehicle accident claims in a timely and efficient manner. These current findings are then complicated further by the current legal system that acknowledges chronic pain to be a primarily subjective experience thus allowing any doctor to make a comment on need based on patient response.

The truth is that In Canada an estimated 6 to 7 million people suffer from chronic persistent pain.4 The Canadian Pain Study in 2002 reports that chronic pain patients make up to 40% of the population, and most doctors are ill-equipped to assess or treat these conditions due to an overall lack of education and training.

Dr. Jovey, president of the Canadian Pain Society, reported that two-thirds of physicians and two-thirds of patients believe chronic pain is not well managed, and that due to the shortage of pain specialists, family physicians are forced to provide the bulk of pain management care.5

The overall lack of whiplash and chronic pain specific training is leading to an environment in which providers (DCs, psychologists, GPs, neurologists, physiatrists, orthopedic surgeons) are stepping into the gray area of their scopes in order to make medical opinions. These medical opinions can then lead to further expenditures and disability. If a plaintiff chronic pain doctor indicates to a patient that a chronic pain process is present, this changes the ideology of the injured person, their belief in their functional abilities and their long-term outcome. Research has shown that a patient's perception of pain is as important as the actual pain present.6

On the same hand, if the insurer prematurely denies benefits for those suffering from pain, research has shown that the cause of pain can continue to exacerbate. In general MVAs, the majority of initial pain symptoms are due to nociceptive input, such as tissue damage resulting in a painful response. However, if this tissue damage is not appropriately and timely treated, continued nociceptive input can lead to neuropathic pain, compressive pain or psychogenic pain, further complicating the overall recovery outlook.7

Whiplash and chronic pain research has evolved greatly over the last two decades. We now know how occupants react inside a vehicle during specific vector collisions at different speeds dependent on crash variables, speeds and risk factors. We also know that chronic pain can be objectively found through specific orthopedic testing and special tests such as fMRI and PET scans.

Whiplash and chronic pain education is the key to overall reduced liability in regards to chronic pain and motor vehicle trauma. Doctors who deny benefits based on assumption and opinion, allow for increased litigation potential, as well as reduced client retention on the insurer's part. Doctors without specific training who freely deliver chronic pain diagnosis based solely on subjective reports allow for flooding of the claims process as well as psychological related adverse effects on client.

As insurers, the answer is simple. Require specific postgraduate training from both the plaintiff IME and defense IME firms chosen doctors. Those requesting chronic pain assessments related to motor vehicle trauma or denial of chronic pain benefits related to motor vehicle trauma should have post graduate training in whiplash traumatology as well as in chronic pain from a CME (continuing medical education) or CCE (continuing chiropractic education) approved organization.

The current standard in Canada is the Canadian Academy of Pain Management. Those recognized with a Diplomat in Pain Management have obtained this through several qualifying control steps (completed through the AAPM). First, the doctor must have enough CME or CCE training in pain management to be approved to sit for the qualifying examination by a panel of pain experts. Secondly, the doctor must pass a rigorous and comprehensive multidisciplinary pain management test. Thirdly, and most importantly the doctor must maintain 100 hours of continuing education per cycle.

In my view, this is just as important as pain medicine, as medicine in general is every changing and continued maintenance of education is required to ensure the best possible outcomes for those injured.

By requesting this specific education from your IME assessors, the overall quality of care will be enhanced and the overall duration of symptoms along with overall disability, and need for additional benefit will be reduced.

Dr. Jason Mazzarella, DC, DAAPM, DCAPM, DAAETS, FIAMA, MVC-FRA, CBIS, CMVT, CATSM, CPM, is a specialist in chronic pain and one of only 26 Pain Management Diplomats in Canada.

1. World Health Organization.
Retrieved May 28, 2013.

2. The Status of Pain in Canada – moving toward a Canadian Pain Strategy Recommended by theCanadian Pain Coalition, The National Voice of People with Pain.

3. Judgments of the Supreme Court of Canada. Retrieved May 28, 2013

4. Definition of Chronic Pain from the Supreme Court of Canada.

5. Health Canada Meeting Re: Scheduling of Tramadol Ottawa, December 5th 2006. Roman D. Jovey MD, President Canadian Pain Society.

6. Barry L, Guo Z, Kerns R, Duong B, Reid MC: Functional self-efficacy and pain-related disability among older veterans with chronic pain in a primary care setting. Pain 104 (2003) 131-137

7. Woolf CJ: Central Sensitization: Implications for the diagnosis and treatment of pain. Pain 152 (2011) S2-S – Double-sided Rule on Disclosure?

FSCO interpretations on surveillance practices leave a lot to be desired

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Canadian – FSCO clears auto insurance mediation backlog

The Financial Services Commission of Ontario (FSCO) has eliminated its mediation backlog for disputes related to auto insurance claims, although that does mean that arbitration applications are increasing.

As of Aug. 19, the regulator had eliminated the “unprecedented” backlog of applications for mediation, which began around 2008.

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Desjardins General Insurance Group reports solid second quarter and half-year results

Desjardins General Insurance Group reports solid second quarter and half-year results For the first six months of the year, net income was $67.9 million, down from $99.7 million for the same period in 2012, which benefited from unseasonably mild weather in the first quarter. The ROE for the first six months was 14.2%, down from 24.8% in 2012. Direct written premiums rose by 6.2% to $1,067.0 million and the combined ratio was 94.1%, up 1.2 percentage points from the same period last year.

Ontario government will mandate 15% reduction in auto premiums within 2 years Insurance industry wants to see more cost saving measures

IBAO CEO Randy Carroll in a press release on Friday. “There is an inherent risk that the result of today’s announcement could result in future availability and affordability concerns for consumers in this province. Regardless of the type of business that you are running, you cannot reduce revenue without implementing cost reduction measures and expect to succeed, it just doesn’t work.”

Income replacement should go with the driver, not with the car

Ontario’s car insurance system needs further reforms. Young males under the age of 25 should have the same premiums for any car. Income replacement should go with the driver, not with the car.