Healthcare Providers Respond to Auto Reform Announcements with Cautious Optimism

Downloadable PDF: Media Release – Heathcare Providers Cautiously Optimistic About Auto Reform

FOR IMMEDIATE RELEASE
April 15, 2019

Healthcare Providers Respond to Auto Reform Announcements with Cautious Optimism

The Ontario Rehab Alliance (ORA), representing healthcare providers in the auto sector, sees much to applaud in the blueprint to improve the province’s auto insurance system presented in the 2019 Budget.

“On behalf of our seriously injured clients we are thrilled with the return to the higher level of coverage for catastrophic injuries and relieved that this government has protected other accident benefits after years of cuts”, says Laurie Davis, Executive Director of the ORA.

The ORA is fully supportive of the blueprint’s plan to reduce the regulatory burden on health providers, improve the Independent Medical Examination process and minimize red tape and other obstacles that delay treatment of serious injuries.

The ORA has been advocating for a number of these reforms in their discussions with government over the past months.

“Consumers need to know that they will get the support and treatment they need when they are injured. The right reforms can replace obstacles to care with proactive treatment, retain appropriate checks and balances and reduce disputes without increasing costs. This blueprint suggests we may be heading in the right direction,” says Ms. Davis.

The ORA is concerned about the announced intention to lower fees paid to healthcare providers treating accident victims. The association represents primarily small to medium sized providers across the province. Many are already struggling to compete for staff in the labour-short healthcare sector, particularly given the hourly rate freeze in effect since 2012 in the auto sector.

The healthcare association is also concerned about unintended consequences of encouraging claimants to be treated within the insurer’s Preferred Provider Network and restricting settlement of the medical-rehabilitation benefit. The ORA is worried that such changes could lead to disproportionate power in the hands of insurers while leaving claimants without recourse or independent oversight to ensure that they are treated fairly.

The association is cautiously optimistic that it can have productive discussions about its concerns and the potentially dire consequences given this government’s Open for Business focus and looks forward to working with government, insurers and other stakeholders on continuing improvements to the auto insurance system.

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Media contact: Laurie Davis at [email protected] , the telephone numbers above in letterhead or directly at (705) 957-4733.

It’s budget day tomorrow and we’re hoping for change

https://www.theglobeandmail.com/business/commentary/article-auto-insurance-regulation-in-ontario-needs-a-dramatic-overhaul/

Good News re: HST & AB

Ontario ministry issues guidance on paying HST on accident benefits

March 27, 2019   by Jason Contant

Ontario ministry issues guidance on paying HST on accident benefits

Needed: therapists, managers, and coordinators in the field of Traumatic Brain Injury in Ontario

Dear Members

I am Sareh Zarshenas, post-doctoral fellow, working under the supervision of Dr. Carolina Bottari at the University of Montreal and with Dr. Deirdre Dawson at the Rotman Research Institute, Baycrest. We are working on the project entitled

“smart home technology as a platform to implement cognitive interventions to facilitate safety and independence within the homes of individuals with traumatic brain injury: first steps towards a multi-site trial in Ontario”.

This project is funded by the Canadian Trauma Research Consortium and the ONF-REPAR and has received ethics approval from the REB at Baycrest.

We are looking for experienced occupational therapists, physical therapists, speech language pathologists, psychologists, personal support workers, behavioral therapists, occupational/ physical therapy assistants, managers/coordinators, and funders who have experience working with TBI patients in outpatient rehabilitation facilities as well as community settings to participate in a focus group or a personal interview.

Participants will receive $70

Please find attached below, more information on this project and do not hesitate to share this email with your colleagues.

Invitation letter smart home project

Potential participants please contact Sareh Zarshenas at  [email protected] If you have any questions about this project, please contact Dr. Dawson at [email protected]

Thank you so much for your consideration,

BSc., MSc., OT Reg. (Ont.), PhD.

Post-Doctoral Fellow,

University of Montreal, Faculty of Medicine

Centre for Interdisciplinary Research

in Rehabilitation of Greater Montreal (CRIR)

Office address: Department of Occupational Science

&Occupational Therapy, University of Toronto,

500 University Ave, Toronto, ON.

Your postal code is a big factor in determining your car insurance rates. Critics say it shouldn’t be- Patty Winsa

NEWS 05:50 AM by Patty Winsa Toronto Star

“When Pankaj Sallh and his family moved to Brampton from Mississauga last year, he had no idea that changing his postal code would be so costly.

The relocation resulted in a nearly 50 per cent increase in his car insurance with the same company, from $237 to $350 a month for two vehicles.

“To me, it’s unexplainable,” says Sallh. The 44-year-old engineer and his wife support two small children, as well as his parents and father-in-law. “Why should I pay more just because of the change of address?”

Read the whole article at the link below:

https://www.thespec.com/news-story/9215109-your-postal-code-is-a-big-factor-in-determining-your-car-insurance-rates-critics-say-it-shouldn-t-be/

ORA’s Auto Insurance Reform Submission

Dear members

Below is our just-posted Auto Insurance Reform submission. It certainly was challenging to stick to the 500 word limit when there’s so much to say. However, we do expect to have opportunities to say more in person to policy makers in the coming weeks and months. We also had a very interesting meeting with FSRA’s Board of Directors recently and I’ll share more about that soon.

ORA Auto Insurance Reform Submission PDF

Raise auto accident benefits: Ontario politician

Singh said he plans to “work with stakeholders involved to determine that specific number and find out where we need to go to make sure that every single Ontarian has the protections they need if they get into an accident”  View full article here

October 31, 2018   by Greg Meckbach

Gurratan Singh is the brother of federal NDP leader Jagmeet Singh. He is the current MPP representing Brampton East with a Parliamentary role in critiquing Auto Insurance. Further details to his political career can be found here

Accident victims denied millions in benefits by insurers, lawsuits allege- Toronto Star

“Six auto insurance giants have withheld hundreds of millions of dollars in HST payments from Ontario car accident victims in defiance of repeated demands from the provincial regulator, according to a series of class-action lawsuits — obtained exclusively by the Toronto Star — claiming $600 million in damages.”

Follow the link below for full article:

https://www.thestar.com/news/investigations/2018/11/01/accident-victims-denied-millions-in-benefits-by-insurers-lawsuits-allege.html?fbclid=IwAR2zl9Qhy7h0Oeq1YAe2Db_jCVwlsvylE_B22HxjWeL7nM3RBLwWnA7v8Pk

A ‘startling turn of events’: Judge rules case points to improper influence in Ontario auto insurance disputes | National Post

Link to the Article Here

Mary Shuttleworth was the front seat passenger in her friend’s Pontiac Sunfire on a winding Ontario country road early one rainy morning in 2012 when a pickup truck came around a corner, clipped it on the front headlight, and sent it spinning into a ditch, where it landed “with the nose pointed up, looking at the stars.”

The airbags deployed. Her head was pinned between the seat and the door frame, and rescuers had to use the Jaws of Life to get her out. It was her 49th birthday.

Today, nearly six years later, the physical toll of a traumatic brain injury, soft tissue injuries and post-concussive syndrome has left her unable to work, with frequent nausea and vertigo, and fearful of becoming a burden to her family.

But when a newly constituted Ontario government tribunal considered whether her injuries were “catastrophic” — in the first such case to come before it after major reform of the auto insurance industry — the controversial outcome has thrown Ontario’s no-fault car insurance regime into confusion.

Thanks to an anonymous letter mailed to Shuttleworth’s lawyer, Gary Mazin, alleging improper influence in the Licence Appeal Tribunal, a judge has found there is reasonable basis to believe the decision to deny Shuttleworth benefits “did not reflect the independent decision of the adjudicator.”

According to the letter, the adjudicator initially decided to approve Shuttleworth’s benefits, only to have the denial ordered from on high by the adjudicator’s boss.

“Justice must not only be done; it must be seen to be done,” wrote Justice Julie A. Thorburn.

Shuttleworth’s denial of coverage was therefore overturned and sent back for a new hearing. This decision is likely to prompt a flurry of new lawsuits alleging improper influence in the denial of benefits, according to Mazin.

One legal industry commentary called the decision a “startling turn of events.”

The tipster’s letter included information that could only be known to an insider, and it claimed the adjudicator of Shuttleworth’s case, Susan Sapin, originally decided that Shuttleworth’s injuries really were “catastrophic,” which under the law means a 55 per cent impairment of the “whole person,” as judged by a scorecard system.

The letter claimed Sapin’s boss, Linda Lamoureux, executive director of the tribunal’s parent organization, Safety, Licensing Appeals and Standards Ontario, “changed the decision,” and that as a result, Sapin “hesitated to sign this order.”

That led Mazin to file an access to information request for the tribunal’s internal communications about the case and policies on how decisions are made. That request turned up correspondence between Lamoureux and Sapin reflecting a lengthy back-and-forth process of consultation and revision, which was initiated by Lamoureux.

Justice must not only be done; it must be seen to be done

Thorburn found that the process of adjudicating cases like this can fairly involve consultation with colleagues, and that an adjudicator’s boss commenting on a decision does not necessarily prove that there was improper influence. But, in this case, the adjudicator appears to have learned of the executive director’s review of the case after it happened, and without asking for it.

“I make no finding of any actual impropriety having occurred on the facts of this case,” Thorburn wrote. There was no proof that Lamoureux “did anything to force” Sapin to change her decision. But the process by which it was decided “did not meet the minimum standards required to ensure both the existence and the appearance of adjudicative independence of the adjudicator’s decision.”

Unless the consultation process is voluntary and clearly limited to advice, as opposed to control, there will always be a “reasonable basis to believe that the decision did not reflect the independent decision of the adjudicator,” the judge found.

In an interview Monday, Shuttleworth said she has already begun the evaluation process again.

Since 1990, Ontario has had no-fault insurance, which took these disputes out of the civil courts and means that every car insurance policy in the province offers benefits regardless of who was at fault.

Until 2016, these kinds of disputes between insured people and insurance companies were heard by a different tribunal of the Financial Services Commission of Ontario.

As the first case about catastrophic injuries under the new LAT tribunal, Mazin said there was likely concern about the kind of message the decision might send about whether the tribunal is sympathetic to claimants or insurance companies.

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Relief Ahead for Claimants, Attendant Care Providers and Case Managers

Attendant Care

In April FSCO will release a bulletin clarifying insurer obligation to pay the total monthly benefit calculated on the Form 1 for Attendant Care, and that the Levels are merely an aid to calculation. Further, they are making a revision to the Attendant Care Rate Guideline, removing the language that says that insurers are not liable to pay for expenses related to attendant care costs rendered to an insured person that exceed the maximum hourly rates.  The Guideline change makes the Bulletin enforceable, so that claimants and provider will be better able get these disputes resolved or make complaints to Market Conduct.   In sum, we will have a FSCO-supported return to pre-LAT decision status quo.

Case Management

The April bulletin will also provide clarification to insurers intended reinforce the payment of Regulated Providers in accordance with the rate assigned to their discipline in the PSG for Case Management services. As above, this is an intended return to the pre-LAT decision.

With luck this Bulletin will see the light of day before mid-April.