IF IT SOUNDS TOO GOOD TO BE TRUE

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IF IT SOUNDS TOO GOOD TO BE TRUE

I am talking about the changes Doug Ford promised to auto insurance when he delivered his recent budget which he dubbed “Caring not Cash”.

If it sounds too good to be true, it probably is. I am talking about the changes Doug Ford promised to auto insurance when he delivered his recent budget which he dubbed “Caring not Cash”. He was talking about changes to policies of first party automobile insurance. This is the part of insurance which has typically been called “No Fault Insurance” which means that anyone injured in any accident can access benefits through their own insurer. These benefits include access to medical rehabilitation benefits and other benefits such as the income replacement benefit or the non-earner benefit.

Over the last two decades what is available to policy holders from their own insurer if they are hurt in an accident has been gradually eroded and reduced supposedly to limit the exposure of the insurers to these costs to help them keep insurance premiums affordable for customers. From a policy perspective some of these changes have seemed to make logical sense: there have to be reasonable limits on how much money insurers have to pay for treatment costs if someone is hurt in an accident as it is important for so many people to have affordable premiums as driving is a necessity of life i.e. to get to work etc. But practically how these changes are implemented have to make sense: persons injured in accidents do need to be able to access a reasonable level of treatment so that they can make a good recovery if they are unfortunately injured in an accident AND I am sure most people would agree insurance premiums have NOT gone down despite the drastic changes made to entitlement of injured persons to benefits.

If people cannot access enough treatment to make a good recovery the costs of them not recovering from their accident injuries will not only be born by them and their families but also by society. For example the more costs that aren’t paid by the automobile insurers the more health care costs are transferred to the government funded health care agencies. If persons injured in car accidents aren’t being paid income replacement benefits they end upon disability through CPP or ODSP.

IF IT SOUNDS TOO GOOD TO BE TRUE

At the present time persons injured in an accident are having difficulty accessing the extremely limited benefits available to them through their automobile insurer even if they have the assistance of a lawyer. After the one year mark the insurer currently has an option to resolve the claim on a full and final basis for a lump sum settlement. This can be a good option as it allows someone to have control over their treatment, they can pay for what they need and use treatment providers of their choice. Most importantly they no longer have to attend insurer exams. Under the current regime any time a treatment plan is submitted for a claimant the insurer can have the plan assessed by a doctor of their choice to see if the treatment is reasonable and necessary. This involves an enormous time commitment on behalf of our clients as they must attend these assessments which are often outside of the Region of Waterloo. Not surprisingly as these doctors are chosen and paid for by the insurer frequently the result of these assessments is a report supporting the denial of a treatment plan. Needless to say there is no shortage of doctors who are prepared to be hired by the insurers to do these assessments at a cost of approximately $2,000 per assessment.

Doug Ford is suggesting that adopting a Caring Not Cash policy would be in the interests of policy holders. This would allow them to deal directly with their insurer without having treatment monies going to pay lawyers. From a practical perspective it would result in the removal of lawyers from the dispute resolution process for clients who are injured in accidents. At this time many clients injured in accidents cannot access lawyers to represent them and assist them in accessing treatment and they are finding the result is the insurer allowing them to use up the amount allocated to them under the Minor Injury Guideline and then closing their file.

If lawyers are removed from this process it is difficult to understand where the “caring” part of the equation will come from - lawyers are involved in the process now because insurers won’t fund treatment that claimants believe they need to get better although they have no problem funding ending insurer assessments to obtain reports saying treatment claimants want and need is not reasonable and necessary. So if it sounds to good be true, it probably is, as it is a little naive to believe that the involvement of lawyers is an obstacle to insurers caring about their clients since most of my clients are calling in the first place because the insurers wont fund the treatment they need to get better. Of course, this will go hand in hand with everyone getting their treatment from “insured preferred treatment providers”. These treatment providers will work to reduce the number of disputes by submitting less and more limited treatment plans and discharging claimants before they have reached maximum medical recovery, because this is what the insurers will pay them to do.....and this will supposedly lead to lower insurance premiums? (If it does, at what cost to consumers? I am having a hard time understanding how people can access less in terms of treatment and benefits).

Lisa Morell Kelly - Lisa@morellkelly.com

Morell Kelly Professional Corporation