Help Distribute Important Survey of Individuals with Brain Injuries

The ORA is asking its members to assist in disseminating a survey to individuals with brain injuries sustained in motor vehicle collisions to obtain information about their experience with auto insurance claims.

Please see the attached letters from student researchers at McMaster University and Acquired Brain Injury Survivor Solutions (ABISS), an advocacy group.

ABISS MCMASTER.TBI Insurance Study Approval 2020

Letter & Survey for Participants

Letter to Organizations & Professionals Assisting with Survey Distribution.

This research has received ethics approval through McMaster University from the Hamilton Integrated Research Ethics Board. The researchers include:

  • Principal Investigator, Dr. Lyn Turkstra, Department of Rehabilitation Science, McMaster University
  • Research Supervisor, Sheila MacDonald, Assistant Professor (Adjunct), Department of Rehabilitation Science, McMaster University
  • Student Investigators: Laura Brooks, Yvette Hou, Daniella Reid, Aileen Zhou

Clinicians distributing the survey are asked to ensure objectivity and privacy by observing the following:

  • Allow the person to complete the survey in their private (non-therapy) time
  • Do not discuss, assist with, or document survey completion in clinical notes and records (reporting, chart notes, emails etc.).

If you have questions or need more information about the study itself, please contact student investigator Laura Brooks by email at [email protected], or call Dr. Turkstra at 905.525.9140 Extension 28648.

The goal of this research project is to help better understand the experiences that those with brain injury following a motor vehicle collision have with their auto insurance claims.

Data from surveys like is so badly needed to support our advocacy for changes. Please do what you can to support this initiative.

With thanks,

Laurie Davis 

Executive Director, ORA

 

<a href=’https://www.freepik.com/free-photos-vectors/background’>Background vector created by freepik – www.freepik.com</a>

ORA ED Laurie Davis shares thoughts on COVID-19 and Auto Accident Survivors

“We have people who are seriously and catastrophically injured who are in their own homes or in community settings and they are vulnerable”

How COVID-19 is probably affecting your auto claimants

ORA Pandemic Issues Letter to FSRA

ORA Pandemic Issues Letter to FSRA PDF

Sent via email
RE: FSRA’S GUIDANCE AND PROMPT RESPONSE SOUGHT RE PANDEMIC RELATED ISSUES

March 26, 2020
Dear Ann and Stuart,
The ORA is very gratified by the deferral of the AIR filing. Thank you for any contributions you may have made to that announcement.
Along with all healthcare providers we’ve been asked to do our part and help mitigate the impact of this pandemic on our most vulnerable populations and on our acute care sector. We are ready and anxious to do so. Help us do our part.
The ORA has been holding weekly consultations with our members to hear what their experiences and questions are during this pandemic. Below I’ve outlined the issues and requests for FSRA’s guidance and assistance that have emerged thus far. We appreciate that some may be out of scope for FSRA and would, in these cases, be grateful for suggestions or introductions as to where to redirect.

Suspension of Non-Essential Regulated Health Provider (RHP) Services by Ontario’s Chief Medical Officer of Health in the on March 19, 2020.
Early communications from some RHP members’ Colleges indicate that this directive is being interpreted to relate to in-person services though the wording of the directive is not clear. Though health care facilities and home care services have subsequently been deemed essential in Ontario we are concerned that insurers may be confused and are consequently denying approvals for services that may be safely delivered virtually and/or in-person in cases where that may be deemed essential.
A further concern is that while some services may not be considered essential in the early days of this pandemic its highly likely they may become essential in coming weeks

 

To read the whole letter please see link to PDF above

ORA Requests Fee Deferral in AIR Filling & FSRA Guidance for Pandemic Related Issues

ORA Pandemic Issues Letter to FSRA

Letter to MPP Cho re FSRA Licensing Fee Deferal

Ann MacKenzie, Senior Manager, Policy Interpretation
Stuart Wilkinson, Director, Policy Auto & P/C

Copied to:
Tim Bzowey, Executive Vice President, Auto/insurance Products, FSRA
Cobi Lechem, Senior Policy Advisor, Office of the Minister of Finance
Barbara Sulzenko-Laurie, VP Policy Development, Insurance Bureau of Canada
Sent via email

RE: FSRA’S GUIDANCE AND PROMPT RESPONSE SOUGHT RE PANDEMIC RELATED ISSUES

March 26, 2020

Dear Ann and Stuart,
The ORA is very gratified by the deferral of the AIR filing. Thank you for any contributions you may have made to that announcement.
Along with all healthcare providers we’ve been asked to do our part and help mitigate the impact of this pandemic on our most vulnerable populations and on our acute care sector. We are ready and anxious to do so. Help us do our part.

The ORA has been holding weekly consultations with our members to hear what their experiences and questions are during this pandemic. Below I’ve outlined the issues and requests for FSRA’s guidance and assistance that have emerged thus far. We appreciate that some may be out of scope for FSRA and would, in these cases, be grateful for suggestions or introductions as to where to redirect.

—Click the links above to view the entire letter. —

 

 

 

ICBC’s bold change to auto insurance

BC’s newly announced no-fault care-based auto injuries benefits include a minor injury cap of $5,500 for pain and suffering, an increase in accident benefits to $300,000 and up to 7.5 million for catastrophic injuries. And a premium rate reduction of 20% for drivers.

Might Ontario be contemplating something similar with the yet-to-be-unveiled Care not Cash model?

 

Read all about it:

The story behind ICBC’s bold change to auto insurance

ORA Input to CPSO Third Party Reports Policy Consult

ORA Input to CPSO Third Party Reports Policy Consult PDF

DATE: January 31, 2020
TO: College of Physicians and Surgeons Consultation
RE: Third Party Reports

The Ontario Rehab Alliance appreciates this opportunity to comment on the proposed policy, and thanks the College for reaching out to us with the invitation. Our comments are as follows:

Objectivity
RE # 29. Physicians must state any findings or opinions contained in a report in a way that is objective and free from personal bias; and # 30. Physicians must not include comments unrelated to the physician’s professional opinion, or that are extraneous to the requesting party’s stated objectives.

Comment: We commend the intention to ensure objectivity but believe that goal might be best accomplished by extending the policy to address the larger issue of physician objectivity and the conflicts of interest that arise when a physician routinely and frequently undertakes IME assignments from an insurer. Objectivity and/or the perception of objectivity may be compromised where such patterns exist and significant income from such assignments is involved. We suggest that the policy could address such circumstances by requiring disclosure and transparency regarding such
relationships.

Scope of Expertise & Knowledge
RE # 37. In situations where a physician is asked to answer questions, or provide an opinion that is beyond their expertise or experience, or which requires access to information they do not have, physicians are advised to discuss the matter with the requesting party, and explain that they may not be able to answer every question asked, or provide the opinion sought.

a. If the party will not amend their request, or is otherwise unresponsive to the concerns expressed, physicians
must:
i. restrict their statements to matters that are within their area(s) of expertise and about which they have sufficient information, and
ii. indicate clearly the reasons for which they are unable to fulfill all the elements of the third party’s request.

Comment: We commend the intention of this policy. If the intention is to ensure that limitations of scope and expertise are respected and acknowledged, this policy would be most effective if it restricted physicians from taking on assignments beyond their expertise or experience, or which require access to information they do not have.

With thanks, again, for this opportunity to contribute.

Sincerely,

Laurie Davis, Executive Director

Lack of Knowledge About Auto Insurance Continues to Hurt Ontario Drivers

An annual survey on Ontario Auto Insurance reveals that Ontario drivers are becoming slightly more aware of optional coverage, but drivers continue to be insufficiently protected particularly when it comes to medical benefits and income replacement benefits.

Link to the article on Exchange Magazine: http://www.exchangemagazine.com/2019/week48/Thursday/19112812.htm?fbclid=IwAR1Uv5ZEhj9WmGocisFO9mOUKkauCyf7FRWdCKBAuk32VT6B0ZXRWk6le9k

The third annual survey from Deutschmann Law looked at optional coverage, the deductible for general damages and included questions regarding close calls, auto safety features and roundabouts.

The survey reveals that 10 years after the introduction of optional benefit coverage, 30% of drivers are still unaware of the opportunity to purchase optional coverage. This has increased from 25% of drivers in 2017.

In 2010 accident victims had their medical and rehab benefits reduced from the basic coverage of $100,000.00 for everyone, to $3,500.00 for almost 80% of accident victims with the option to purchase additional coverage for medical and income benefits.

While people are aware of the availability of optional coverage, only 8% have purchased additional coverage. Of those, increased liability coverage was the most popular (71%) followed by increased medical coverage (50%) and then increased weekly income benefits (16%).

Though 75% of people were aware of a deductible that applies for property damage, only 52% were aware of a deductible for pain and suffering damages. The deductible is currently $38,818.97. However only 10% of those surveyed felt that the deductible is over $10,000.00. That means that where an injured party is awarded $50,000.00 for pain and suffering then the at fault insurer will only have to pay $11,181.03.

Only 25% of respondents feel there should be a deductible for pain and suffering damages.

The deductible for pain and suffering damages increases by the CPI rate annually, further eroding damages payable to innocent victims. Contrast that to rate payable by the insurer for income benefits (maximum $400.00 weekly) which has stayed stable since 1990, unless optional coverage is purchased.

“Our third annual survey shows that consumers in Ontario are not sufficiently informed about auto insurance including the availability of enhanced medical and income benefits and the erosion of damages when they are involved in an accident. There needs to be better education so consumers can make more informed decisions about their insurance and avoid becoming a victim twice – at the time of the accident and then realizing how their benefits do not sufficiently deal with their needs,” says Rob Deutschmann.
For those respondents that have been involved in a “close call” while driving, 87% identified that there was another vehicle involved and 11% with a bicycle or pedestrian. 45% identified speed as the biggest cause while 38% identified distracted driving and 25% identified improper turns.

The independent survey, conducted in September 2019, was administered by Metroline Research Group on behalf of Deutschmann Law. Over 800 Ontario licensed drivers between the age of 18 -74 participated. All were identified as decision-makers regarding their auto insurance policy.

ORA Response to FSRA Priorities

On behalf of the Ontario Rehab Alliance I am pleased to have an opportunity to respond to FSRA’s published Priorities and Budget.

Six Months In

The ORA commends FSRA for the Stakeholder Engagement efforts it’s made since its inception.

  • Striking the ad hoc Industry Advisory Group (IAG) of Health Service Providers to provide input to Fee Rule decision making. As a participant, the ORA was impressed with the degree of transparency, information sharing and interest in learning more about the HSP sector.
  • Establishing the Stakeholder Advisory (SAC) Committee for HSPs. We have several comments with respect to this:
    • Timeframes within which the SAC has been asked to frame comments have been very constrained, making it difficult for association representatives to properly accommodate their own governance processes (consulting with members and Board’s). More time between meetings with FSRA management and its Board would also enhance the capacity of SAC members to discuss and develop clarity on points of convergence and divergence and therefore offer FSRA enriched feedback.
    • SAC members and their deliberations would benefit from access to more data about the sector, such as proportion of HSPs with Regulated Health Professional (RHP) ownership, breakdown by RHP and other relevant factors.

The ORA has kept its members up to date on the transition from FSCO, however many HSPs who do not belong to this or other active associations, are unaware of the transition to a new regulator.

We also commend FSRA for early efforts in Burden Reduction.

  • The Draft version of the 2020 Annual Information Return shared with association representatives will be considerably less burdensome to complete.

2019/2020 Priorities

Supporting Auto Insurance Reform

The ORA was pleased to participate in Auto Insurance Reform consultations this summer and early fall. We are keenly interested to learn more about the intended policy directions government is heading in and stay involved on issues of greatest significance to Health Service Providers, such as:

  • Increased optionality and the potential impact on mandatory accident benefit levels and consumer risk of being inadequately insured if seriously injured
  • Reducing HSP fees which would reduce access to treatment as HSPs will continue to leave the sector
  • Compromising consumer choice by expansion of preferred provider arrangements
  • Accountability mechanisms to fair and effective insurer claims management practices, particularly as FSRA moves towards a principles-based approach

In addition to the legislatively established Auto Insurance system, consumers, claimants and HSPs are also impacted by a parallel reality of ‘ghost’ regulations created by patterns of insurer practices that can create obstacles to access for consumers/claimants and considerable costs for HSPs. For instance, our members report an increase in the frequency of non-payment for approved and delivered services; the reason given by insurers is the exhaustion of med/rehab benefits. Insurers are mandated to manage and dispense these funds, yet they are not held accountable for not doing so, and HSPs have no regulatory means by which to hold them accountable.

Similarly, the impact and importance of LAT decisions must be taken into consideration. Though not intended to be precedent-setting, LAT decisions in favour of any one insurer are quickly acted upon by others. Conversely, LAT decisions in favor of HSP (e.g.  psychotherapist rates) are not generally adopted by insurers.

Developing Fraud & Abuse Strategy

Data shared at the Ministry of Finance’s Cost Reduction Working Group this fall shows that while the average Accident Benefits Claim cost has been decreasing the past few years, costs related to property damage are increasing. We therefore suggest that fraud and abuse strategies focus the areas of rising costs, such as:

  • Towing and storage
  • Repairs and rentals

The ORA would like to see the elimination of the double standard that continues to question costs associated with human body repair while the corresponding costs on the auto body side are not similarly examined.

Reviewing HSP Regulation

HSP Licensing through FSCO, when implemented in 2014, was to be a cornerstone of fraud reduction efforts on the accident benefits med-rehab side, yet efficacy to date has not been fully established.

We strongly encourage FSRA to establish one or more task specific (as opposed to standing) technical committees to assist with various aspects of the review such as: degrees of regulatory oversight for various classes of HSP, governance distillation and distribution to HSPs, transition and transformation of HCAI, etc..

2020/21 Priorities

4.1           Empower & Protect Insurance Consumers

With respect to auto insurance, we urge FSRA to consider that consumers at point-of-policy- purchase become claimants when they are injured. Empowering consumers if translated to mean increased optionality of Accident Benefits must then also mean educating them sufficiently on the possibility of injury and associated costs so that they are sufficiently protected if injured. The costs of not doing so will be evident in the hallways of hospitals and the demands on strained health and social services.

4.3          Develop a Comprehensive Auto Insurance and Data Analytics Strategy

We support the transition of HCAI to the regulator and its transformation to a system better designed to support users, the regulator, and policy makers.

We urge FSRA to strike one or more stakeholder technical committees to establish useful, functional outcome measures and metrics to shape data gathering activities, tools and analytics to support a principles-based approach to regulation and service delivery standards.

4.2 Support and Implement Auto Reform

See comments under 2019/20 Priorities, above.

2020/21 Budget

HSP licensing fees should be held at the current levels until burden reduction strategies for the HSP regulatory regime have been fully developed and implemented, so that associated costs for a presumably leaner and lighter regulatory regime can be properly established.

Other Comments

The Ontario Rehab Alliance wishes to play a key role in assisting the government to reduce hallway medicine. Our members are primarily small and medium sized businesses located throughout the province, with a focus on the treatment of serious injuries. Our work across the healthcare continuum gives us a wide-angle lens and a capacity to drill down into an understanding of the role that accessible and appropriate rehabilitation services play in keeping Ontarians and their healthcare systems at optimally functional levels.

Laurie Davis, Executive Director

Fall Economic Statement Falls Back & Good News re FSRA’s SAC

Dear members,

The Ford Government’s Fall Economic Statement makes clear intentions to continue its Auto Insurance Reform agenda by potentially altering mandatory coverages. While last spring’s Budget suggested there wouldn’t be tinkering with current AB levels it now seems tinkering may be the form of “increased choice” as we heard discussed in consultations over the past months.  The previous government slashed away at AB limits and we’d hope these days were behind us. As hope is not enough, we will continue to advocate to ensure that greater flexibility of coverage doesn’t compromise the needs of the seriously injured. I’ve extracted from the full statement [link] http://budget.ontario.ca/2019/fallstatement/chapter-1a.html#section-15 the key points for Health Service Providers, below. Italics are mine. Action to reduce system costs that drive up auto insurance premiums for drivers, includes:

  • Increasing consumer choice by allowing drivers to decide for themselves what coverage they need;
  • Enhancing competition by supporting innovation and reducing barriers for new and existing companies to compete in Ontario; and
  • Fighting fraud and taking costs out of the system by working with the Financial Services Regulatory Authority of Ontario (FSRA) to prevent bad actors in the system, replace inefficient processes and reduce fees

The good news is that we continue to be invited to consult. I am very pleased to have been selected to join FSRA’s Health Service Providers Stakeholder Advisory Committee. We meet with FRSA Management this coming Tuesday.Back at the ORA ranch we are working on HSP rates data and strategy and I will be reaching out shortly to the members who will be supporting our work on non-regulated rates.

Laurie Davis, Executive Director

ORA Response to Care Not Cash Consultation

Read PDF Version: ORA Submisison re Care Not Cash

Care, Not Cash Default Consultation
Submitted by the Ontario Rehab Alliance

September 16, 2019
Contact: Laurie Davis, Executive Director- [email protected]

About the ORA: The ORA represents primarily small to medium sized healthcare businesses that collectively employ upwards of 4000 healthcare providers including Regulated Health Professionals from all disciplines, social workers, personal support and rehabilitation support workers. We are the primary providers of rehabilitation to Ontarians seriously injured in automobile accidents. Most of our members work throughout the healthcare system, giving us a wide-angle view. We are the only association focused primarily on the interests and issues of health providers in the auto sector.

Our member companies operate in home, community and clinic settings. As health professionals we have a strong duty of care to our clients, as business owners we have a responsibility to keep the business viable for ourselves, our staff, and the clients who depend on us.

On behalf of its members, the ORA advocates for motor vehicle accident victims, adequate insurance benefits, and fair treatment of those injured. We help members to navigate the claims system with timely information bulletins on new requirements and issues, and with resources to support daily operations.

4.4. Consultation Questions
Note: The ORA has focused its response of the consultation questions where we have expertise to contribute. We have responded to the others with ‘no comment’.

Current State: Cash Settlements

1. What do you believe are the main reasons injured persons and insurers engage in cash settlements for auto insurance claims?

It would be most interesting to see data, if such exists, on this topic. Without access to data, we can only speculate based on our observations as healthcare providers. As such, we believe that the primary reason is frustration and disappointment with insurers’ accident benefits (AB) claims management practices.

For many claimants, AB administration is experienced as “prove-you-are-not-a-malingerer-orfraudster- and-keep-on-proving-that”. The rate of treatment plan denials, dispute and the high incidence of insurer-initiated IMEs supports this narrative. Rather than feel supported by their insurer, claimants and their families too often feel as if they must fight for the treatment and support that they believed they were insured for. The fraught relationship with their insurer, and the struggle to get treatment and other benefits, becomes an additional burden and energy drain, further compromising their recovery. Cash settlements free them from this unhelpful and unhappy dynamic.

Simply put, denials in this climate gives rise to disputes which leads to cash settlements.

2. If you are responding on behalf of industry, over the last ten years, what is the average: a) value of cash settlements by injury type? b) amount spent per settlement on non-medical care? (e.g., legal expenses, wage loss, independent examinations)

We are very interested in seeing the data collected through this consultation question.

Implementation Details: Care, not Cash Default

3. What could be done to facilitate earlier resolution of disputes regarding the delivery of care (including benefit entitlement, treatment decisions and assessments / insurer examinations)?

There are many avenues to explore to avoid disputes and facilitate earlier resolution, such as:

– Reduce the number and frequency of treatment denials;

– Institute insurer accountability for fair and reasonable adjudication of claims; require more extensive and fact-based rationale than merely ‘not reasonable and necessary’ when overruling (by denial) a clinician’s recommendation.

Imagine what an MVA-style system would look in the OHIP system: GPs orders for lab work, diagnostic imaging or specialist referrals are subject to adjudication and routinely denied by back-office OHIP administrators. It would be clear to any and all that this is not the way to get people better.

– Institute an initial dispute-free ‘zone’ or phase which applies to all claims at outset, eliminating the need to determine or dispute whether MIG or non-MIG; credit trained and licensed health service providers with the capacity (reinforced by their Colleges’ standards) to put the injured person’s interests first.

– Improve the OCF-18 so that it provides for better information on which adjusters can base their decisions

Improvements to IME/3rd Party Assessments
Improvements to this aspect of the regime will go a long way to facilitate earlier resolution of disputes regarding the delivery of care. The ORA was pleased to be part of the working group consultation focused on this aspect of system improvement. We will not replicate all of that commentary here, but key recommendations include:

Institute minimum standards for IE assessors

Standardize the following:
– triggers for referral to IE
– referral questions
– what type of discipline to refer to for which questions
– the explanation of the assessment to the claimant
– the practice summary of the assessor
– the consent form
– the overall summary of the results (e.g. a 1-2 pager)
– NOT the clinical assessment report that supports it, although you could have some key headings that could be applicable for all disciplines

Establish a working task group to address the above with insurers, legal and healthcare providers represented.

Enhance the ability of adjusters to confidently provide treatment approval, when appropriate, without the need for a 3rd party-initiated assessment (e.g. training, more standardization) by:

– Standardization, as above (especially the triggers for referral and questions)

– Training for adjusters to include:

– Roles and overlap of regulated and unregulated healthcare      providers/clinicians

– Sample injury and treatment scenarios with associated costs, (including
home and vehicle modification, prosthetics and equipment needs)
spending trajectory, for complex (serious and CAT) injuries

– Start double blinding the assessment referral or some alternate model that enhances the integrity of the system

Non- IME Related Suggestions
– More experienced adjusters for those outside of the MIG and especially for CAT
– Designated adjusters with high level of knowledge, Accident Benefits experience and skills who may act as internal resources for other adjusters for non-MIG claims
– Increased communication with treatment providers; adjusters should be required to discuss concerns with treating provider prior to triggering an IE.
– Reestablish case management for more complex cases (non-cat, non-MIG)
– Establish an affordable and accessible process to expedite treatment disputes, pre-LAT, such as using a panel of experts.

4. What types of extenuating circumstances for the exception to the Care, Not Cash default should be considered? Please include an explanation of the rationale and supporting evidence. With suggestions, please consider how to ensure clarity for consumers and insurers as to avoid unnecessary disputes.

The consultation paper proposes several exceptions to the Care, Not Cash default. We comment and elaborate on these, below.

Catastrophic Injuries
We support this exemption with these implementation recommendations:

The trigger to open the door to settlement should be upon submission of an OCF-19. This will minimize disputes surrounding CAT designation and shorten the gap between exhaustion of non-CAT AB and CAT designation.

Cash settlement not to be available until minimum 3 years post-accident to ensure sufficient time for injured persons to get traction and understanding of their rehabilitation needs and longer-term goal.

When cash is provided for future care for children and adults without capacity and requiring substitute decision makers, this should be done through structured settlements to ensure funds will be available over their lifetime.

Costs to repair vehicles, income replacement benefits etc.
We support these being exempted.

Optional benefit to negotiate a cash settlement has been purchased

Many of the concerns we’ve articulated in our response to the consultation on the implementation of the $2 million CAT benefit level and the proposed buy-down option, apply
here:
– Historically, few consumers buy-up accident benefits and this will play out in reverse if this option lowers price, resulting in the cheapest rather than the wisest policy.
– Most drivers do not consider it likely that they will be in an accident that leaves someone seriously, let alone catastrophically injured. They don’t know they need it until they do.
– Insurance brokers and agents do not themselves understand the cost of serious and catastrophic injuries and are therefore not able to properly dissuade those deciding to “buy down”
– Implementation will need to mitigate all the above in order to ensure that Care, Not Cash does properly function as ‘default’

Extenuating circumstances
We agree that relocation by an injured person out of the jurisdiction is a reasonable exclusion. This could be expanded to include situations where funds are required to assist relocating a family member to provide help to the injured person.

Other
Reimbursement for claimants when they have paid for reasonable and necessary treatment because the treatment required.

5. What would be the best approach and timing for the transition to the Care, Not Cash default to ensure consumers have sufficient time and opportunities to make informed choices (e.g., tie implementation to auto policy renewal dates, make it effective immediately for all claims, or make it effective for accidents that occur on or after a certain date)?

Though the numbers of consumers who have a good understanding of the AB aspects of their policy is very small, the most consumer-centric approach is that of aligning the effective date with policy renewal dates.

6. In implementing Care, Not Cash, what are the concerns, challenges, and mitigation considerations that must be contemplated (e.g., insurers’ claims management operations, health service providers’ operations, consumer experience, etc.)? Please be as specific as possible based on your role in the insurance system.

Unintended Consequences

Without proper safeguards and consumer/claimant protection mechanisms in place a ‘Care Not Cash’ system could well become one in which insurers are incented to deny so that the injured get neither care nor cash. The balance of power in this sector is currently skewed in favour of insurers who have much deeper pockets than claimants or healthcare providers. When an
insurer denies a treatment plan now claimants may be able to retain lawyers that may sometimes appeal the denial through the LAT. If the proposed Care, Not Cash was implemented lawyers will not be able to represent victims. This means that injured victims, many of which may be dealing with post-accident cognitive and communication impairments, will have to take themselves to the LAT and face a technical process, making legal arguments with respect to a complicated regulation against actual lawyers acting on behalf of insurers. This is simply unfair and cruel.

Consumer Protection

We are very much in support of regime change that focuses on improving access to care and getting people better. However, we are concerned that implementation may compromise protection of claimants’ interests if not done mindfully. Much depends on the extent to which implementation is accompanied by other changes that will positively impact the claims
management experience of claimants. In the current culture of ‘deny, delay & dispute’ which seems to characterize too many insurers’ claims handling practices, the injured rely on legal representation. Unless there are strong measures established to incent insurers to expedite claims, constrain denials, and uphold due process, claimants will be left in the lurch.

Lawyers will not be able to take on AB cases in a ‘cashless’ scenario. Claimants will not be able to retain lawyers, but insurers will. Mechanisms must be put in place to enable recourse to legal representation and/or establishment of impartial dispute process which does not favour the
party with legal representation.

A funded mechanism should be established to enable claimants to secure independent legal representation to review proposed cash and/or structured settlements. In those situations where claimants have received consecutive denials for treatments and are also unable to access cash settlements (the ‘neither care nor cash’ scenario), they should have access to independent legal representation funded through their auto insurance. This a vital
requirement to ensure consumer protection and equity. Otherwise, only those claimants with private means to hire lawyers will be able to effectively challenge unfair practices on the part of their insurers.

Possible expansion of preferred provider relationships and the development of a policy option that would lower premiums if consumers agree to use preferred providers when purchasing their policies, have been floated as potential system changes. We believe such considerations could have profound impacts on consumer protection and treatment outcomes and therefore requires distinct consultation and thoughtful discussion.

Implementation Details: Optional Benefit (cash settlements)

7. What terms, conditions, limits, or other factors should the government consider in designing a cash settlement optional benefit?

As discussed previously, we wonder about the viability of this proposal, as much as we appreciate the intent to increase the degree of consumer choice available. Though take-up of optional AB has always been extremely low, this is likely due to there being additional costs associated with them, in addition to their complexity. Ontario’s auto insurance sector has had
no experience with optional benefits which lead to lower costs, but our association would be concerned by the possibility of significant erosion of the Care, Not Cash default if the pricing is such that premiums are lowered by choosing this option.

Supporting Implementation: Consumer Education and Awareness

8. How should the insurance industry (insurers, agents, brokers) support consumer awareness and informed decision making with respect to a Care, Not Cash default and the cash settlement optional benefit?

All stakeholders in this sector agree that aside from the cost of premiums Ontario consumers have a very low awareness of what, exactly, auto insurance is for and how it works. If this government’s auto reforms result in improved consumer education and awareness that will be a tremendous accomplishment. We will reiterate here much of what we offered in our response to the $2 mil CAT consultation.

For the most part, the consumers we meet in the course of our work are already seriously or catastrophically injured. Rarely, did they have any understanding of the potential for such injuries before they occurred.

Insurers (brokers, adjusters) must be better informed so that they can then inform consumers. In our industry, it is the common experience that we, as consumers, have to educate – and almost persuade – our brokers and insurance agents in order to buy up the optional benefits we need. When we inquire of family and friends who we have encouraged to also buy-up they
report similar experiences. Consequently, we believe that insurers will have to make a very significant effort to move the awareness dial.

Our association has developed resources to support broker and insurer education which we’d be happy to develop more fully and share more widely. We also provide some general information to the public and our clients:

Accident benefits and serious and catastrophic injuries are complex matters. In fairness, it may be asking too much of most insurers to do this well. The costs of healthcare are not well understood by most Canadians. OHIP is managed in such a way that most have no idea what their healthcare costs; only in the auto insurance sector are some of these costs visible. Without
any context for understanding or comparing MVA healthcare and rehab costs insurers and consumers alike will be prone to seeing the real costs as inflated.

Addressing this issue in the MVA sector should come second to addressing it more widely and helping Ontarians better understand the costs of healthcare through a similar degree of transparency with the costs of OHIP, WSIB, etc.

9. What other opportunities exist to ensure consumer awareness / education?

The ORA believes that government, most likely FSRA as regulator, has a role to play in consumer awareness. Because auto insurance is mandatory, Ontarians should have easy access to the basic information they need without it being tied to product sales.

Additional Comments

10. Please share any additional comments, suggestions or information to inform the proposed Care, Not Cash default.

We urge caution in designing a system intended to mimic that of WSIB. There are very significant differences in the mandate and scope of the two regimes. These include, but are not limited, to:

– WSIB’s focus is much narrower: return to work; the MVA system has the broader mandate of return-to-life
– Only working age adults are covered by WSIB
– There are no funding caps in the WSIB system
– Individuals do not purchase WSIB insurance, nor is there a choice of carrier