Winter is Coming: News from the Front
   

Dear members/colleagues,

It has been an eventful advocacy and issues-arising time in our sector. Having promised to keep you posted on developments, I’ve prepared this one-stop-shop update on all the various fires we’re fighting and some smoke we see on the horizon.  I’ll start with the most recent….

Auditor General’s Report on FSRA’s Regulation of Auto Insurance  – Released November 30

The above link will take you to the full report. The general themes in the report line up with David Marshall’s report(s) and hint at auto insurance changes likely waiting in the wings. There’s a lot here of interest to us. On an initial read the following recommendations to FSRA jump out. Underline and italics are mine.

More MIG?

• Implement up-to-date programs of care for injuries such as sprains, strains and whiplash to standardize treatment provided after an accident and the costs of such treatment, beyond just those of minor injuries; An expansion of the MIG approach to more serious injuries? Yikes.

• Assess the cost of a centralized medical assessment process requiring both insurers and consumers to use the process to reduce medical assessments and disputes related to those assessments; Are the Designated Assessment Centres (DECs) coming back from the dead?

• Develop an accreditation regime for automobile repair shops; This is long overdue. At least there would be a better balance of regulatory oversight between the attention paid to those who fix car bodies and those that fix human bodies.

•  Act on previous reform recommendations that can most reduce costs and premiums, strengthen industry oversight and increase consumer protection. This recommendation refers to Appendix 9 wherein we see Mr. Marshall frequently referenced

• Return to on-site inspections of HSPs as soon as operationally possible;
  • Require HSPs to provide evidence (such as through attestation) that they have corrected all issues identified during an inspection and conduct follow-up examinations or desk reviews to confirm this on a risk basis.
  • I note the convergence of this recommendation with FSRA’s recent HSP Supervision Plan which suggests a focus on those:
    • that conduct IEs examinations to assist an insurer’s determination of an insured person is or continues to be entitled to a benefit
    • that have never been examined by FSRA
    • that have a sanctioned practitioner listed on their HCAI roster

• Expand information-sharing with the LAT to request information about automobile accident disputes, including which companies were involved and how long cases took to resolve
  • follow up the market conduct of insurance companies that have a disproportionately high number of LAT disputes relative to their market size, or a high volume of specific types of disputes, and identify necessary action items for the companies to take to reduce the occurrence of such cases going forward and study the reasons for the most frequent types of disputes. Be still my beating heart! Winter may be coming but spring could be around the corner.

Travel Time
   

Dear colleagues,

Most of you have likely heard that there have been two recent LAT decisions supporting insurers’ denials of travel time. Two things for us to keep in mind as providers, though they are both very much in the ‘cold comfort’ category are:

• LAT decisions are case-specific. They do not make case law that influences other cases. Though such decisions may inspire further insurer denials of travel time they don’t make the success of each denial a certainty.
• There is nothing in the SABS to prevent insurers for paying for travel time, or mileage for that matter. Some adjusters may pay for one or the other – and in very rare cases, both, when offered a compelling reason to do so. For instance, if it has been clearly established why the client requires in-home services and that there is no appropriate therapist/provider in closer proximity to the client, and the provider makes clear they are unable to absorb the cost of unpaid travel time then to deny travel is to deny service and might be seen as bad faith.

We are putting our heads together here at ORA Headquarters to develop further strategy. Stay tuned for developments and send your thoughts our way in the meantime.