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Social Justice: Superintendent cloaks policy issue as science on catastrophic impairment

September 13, 2012

Social Justice: Superintendent cloaks policy issue as science on catastrophic impairment


Monday, September 10, 2012 | Written by Alan Shanoff | Law Times


http://www.lawtimesnews.com/201209109304/Commentary/Superintendent-cloaks-policy-issue-as-science-on-catastrophic-impairment


The superintendent’s report on the definition of catastrophic impairment in the statutory accident benefits schedule may seem like a dry topic, but for those suffering injuries in motor vehicle accidents, the difference between having a catastrophic impairment designation and not getting one can be a life-altering distinction.


Of all of the proposals in the superintendent’s report, none is more controversial than the one rejecting the combination of physical and psychiatric impairments to determine catastrophic impairment. The origin of this proposal lies with the final report of the catastrophic impairment expert panel from April 2011.


The panel conceded in its final report that it “did not have the resources to conduct a comprehensive review of the literature to determine whether valid and reliable methods of combining physical and psychological impairment exist.” Thus, it wasn’t surprising that it “did not find sufficient evidence that combined impairment ratings are more clinically meaningful than using separate criteria.”


We’ve come full circle with the superintendent now concluding that “there is no scientific evidence to suggest that combining impairments is a simple additive process.”


It’s also not a surprising conclusion given the constituency of the expert panel. As stated on July 9 by Dr. Harold Becker in his submission to the standing committee on finance and economic affairs, the majority of the expert panel members weren’t experts in catastrophic impairment and the two physiatrists are friendly to insurers.


Becker believes the “failure to acknowledge the coexistence of traumatic brain injury and associated psychiatric impairment . . . is seriously flawed and demonstrates a serious bias against both brain-injured claimants and claimants who develop associated psychiatric reactions resultant from traumatic brain injury.”


Becker’s views deserve the utmost of deference. He was responsible for leading the advisory panel that wrote the catastrophic impairment assessment guidelines for designated assessment centres in 2001. He then served as the medical representative on the advisory panel that wrote the previous report on the definition of catastrophic impairment.


Is there an epidemic of claimants? Hardly. According to the 2011 annual report of the office of the auditor general of Ontario, about one per cent of all accident victims are determined to be catastrophically impaired. That’s less than 700 people a year.


But perhaps there’s a potential flood of additional claimants who would satisfy the definition if we allowed the combination of physical and psychological impairments? That’s not the case.


The current definition of catastrophic impairment has been interpreted to permit the combination of physical and psychological impairments and in last December’s decision in Kusnierz v. Economical Mutual Insurance Co., the Ontario Court of Appeal referred to a concession made by the insurer that “there are only a very few cases where there are permanent physical impairment and permanent psychiatric impairments that are not catastrophic if assessed separately but are catastrophic if assessed together.”


So permit me to be puzzled about the pressing need to disallow combined impairment ratings. It’s also noteworthy that any decision to disallow combined impairment ratings shouldn’t be based on scientific evidence or the lack thereof.


This isn’t a scientific or medical question. It’s a question of policy. The Court of Appeal said it succinctly in Kusnierz when it said the purpose of the catastrophic impairment definition is to ensure that “those with the greatest need for health care are able to recover the expenses of that health care.” If so, why is it necessary to disallow combined impairment ratings?


The composition of the expert panel was problematic at the outset. It made a recommendation without conducting a comprehensive review. The superintendent has followed that recommendation and in turn made an ill-informed recommendation that cloaks a policy issue as a scientific one to the Ontario government. It’s now up to the government to do the right thing and reject it.

a woman is sitting at a table counting money .

Ontarians Have Overpaid for Their Auto Insurance by over 3 Billion Dollars

May 11, 2015
We are paying something for nothing. The mandatory accident benefits policy in Ontario provides minimal coverage for the vast number of people injured in car accidents . Presently, over 90% of victims are restricted to payment of a maximum of $3,500.00. They are forced by law to pay hundreds if not thousands of dollar PER YEAR for this coverage. Ask yourself. Would you voluntarily pay $1,000.00 per year of $3,500.00 worth of life insurance? Of course not. But the Government of Ontario forces you to pay for this very poor product. It’s time to speak to your Member of Provincial Parliament. See the full facts here. http://truthaboutinsurance.ca/drs-lazar-prisman-report/

Ontario Budget a Disaster for Anyone Injured in or by a Motor Vehicle

May 11, 2015
The Ontario Trial Lawyers Association has prepared a series of blogs identifying current issues with the recent budget and how it impacts people injured by Motor vehicles. Please read the full blog here. http://otlablog.com/hidden-costs-of-the-provincial-budget/ Part One of a Three-Part Series on the 2015 Ontario Budget Last month, the Ontario Liberal government revealed its latest budget entitled “Building Ontario Up” but what it does to our auto insurance benefits is actually the opposite by significantly slashing benefits available to accident victims. This follows promises that tout more affordable insurance but do not disclose the true cost to those who find themselves in need of the coverage now, and those who will unfortunately need the protection in the future. The rationale of the Liberal government is that the reduced benefits will lower claim costs which will then be passed on to the consumer in the form of savings on premiums. A promise to reduce rates by 15% was made about two years ago but in reality, and by their own admission, has not been realized. It is estimated that since 2013 rates have decreased by only about 7%, and many of us still have not seen that reduction. On the other hand, the cuts to benefits will be effective immediately once the budget is passed. The reduced premiums come at the cost of a 50% slash to (or total elimination of) many benefits that were once part of mandatory insurance coverage prior to the 2010 reforms. The erosion of available benefits is disproportionate to any rate decrease and is unfair to consumers. According to the Liberal budget, “…costs in Ontario’s auto insurance system remain too high,” While a reduction in claim costs is welcomed by consumers and stakeholders alike, it can be achieved through other means. For example, as discussed on the OTLA blog following the release of Justice Cunningham’s review of the Dispute Resolution System late last year, insurers spent thousands of dollars on Independent Medical Assessments which account for roughly 25% of total health claims expenses. Despite this, the Liberal government made the choice to save costs by reducing available benefits rather than regulating insurer practices. The insurance industry has been crying poor through persistent lobbying (that also comes at a great cost), while profits have been on the rise since the initial cuts began in 2010. The latest benefit cuts will surely continue to boost these margins. Data released by the General Insurance Statistical Agency (GISA) suggests a dramatic reduction in Accident Benefit claims from $3.8 billion in 2009 to a low of $1.9 billion in 2012. While claims over the past year were projected to rise to $2.2 billion they are still down overall. This has allowed insurers to reap massive profits at the expense of those who need it most: accident victims. Profits remain high, payments to claimants remain low, and benefits are further restricted with trivial savings that may never end up in the consumer’s pocket. What additional cuts can we expect from this budget? The budget combines the medical and rehabilitation benefit which currently offers $50,000 of coverage and the attendant care benefit which currently offers $36,000 of coverage into one cumulative coverage limit of $65,000 – a reduction of more than $20,000. In the case of the catastrophically injured, attendant care and medical and rehabilitation benefits have been reduced from $2 million to a combined total of $1 million. This begs the question: is a 50% reduction in benefits worth a 7% reduction in premiums to some consumers in Ontario? The real kicker is that Ontario NDP leader Andrea Horwath – whose party propped up the Liberal minority in exchange for the 15% reduction to auto premiums – has publicly opposed the proposed changes stating, “…if you are talking to the insurance industry, they are going to try to paint it in a way that looks like they are really struggling. I don’t think anyone in this room believes that for a minute and I certainly don’t.” She went on further to say that “…in 2010 the (Liberal) government made changes to the policies around insurance and all that did, instead of creating an opportunity for reductions, is it created an opportunity for insurance companies to pocket more money.” So what has the Liberal government and the insurance industry offered the public in exchange for the slashing of benefits? A mandatory discount for winter tires. Think about that the next time you’re shopping for a set of Michelins. This blog post was contributed by Michael Giordano, Junior Partner and Monty Dhaliwal, Associate Lawyer of Sal Guzzo LL. B.

Ontario auto insurance: How much worse can things get for victims?

May 23, 2014
Ontario auto insurance: How much worse can things get for victims? Changes in 2010 created windfall profits for insurers by slashing coverage for the vast majority. We need to restore fairness and impose a moratorium on further reductions in coverage! In September 2010, the Ontario government introduced sweeping changes to auto insurance in response to pressure from the insurance industry to contain injury costs despite the industry’s long-standing failure to address systemic fraud in the system. The MIG: Minor Injury Guideline for victims The main feature of the so-called reforms was the MIG – the Minor Injury Guideline. What did it mean? Coverage for the vast majority of policyholders was slashed from $100,000 for medical and rehabilitation treatment to the paltry level of $3,500 maximum for medical and rehab needs following an accident. The MIG currently captures up to 75 per cent of all accident victims in Ontario, often without regard for the seriousness of the injuries involved. OTLA members report that many clients in the MIG typically exhaust their maximum benefit of $3,500 very quickly, leaving them without access to needed treatment. Clients are often forced in the Minor Injury category despite having injuries that could not reasonably be considered as “minor” e.g. serious fractures and brain injuries. The MIG: Major Income Generator for insurance companies It’s really no surprise what happens when premiums are increased and insurance payments are dramatically reduced for most injured accidents victims. In fact, the “good news” for insurance companies started to become apparent almost immediately. Here’s what one insurance CEO quipped, perhaps a bit too candidly, mere months after the changes: “We are starting to see the benefits of the 2010 auto reforms in Ontario, which is combining with our recent focus on proactive broker management and underwriting discipline to generate stronger results.” The early trend that this CEO was talking about here materialized and, by the end of 2012, total auto insurance claims were down more than 20 per cent or a reduction of $4 billion. The tally for auto insurers was more than $3 billion in profits in the first two years following the 2010 changes. Early indications for 2013 indicate that auto insurance companies in Ontario continue to enjoy strong results to this day. It should come as little surprise to anyone that insurance companies are doing extremely well under this model: then again, you can’t lose when you’re charging more and paying out a lot less. Ontario, now the worst coverage in the country As a result of the September 2010 changes, Ontario emerged as the only jurisdiction in the country with a special category of insurance for so-called “minor” injuries. And, significantly, Ontario has the lowest level of compensation for this category of injury. Even the insurance industry’s own data supports this contention with average claims payouts down dramatically from previous levels and more claimants than ever being captured by the MIG. But how much worse can things get for victims? Once again, columnist Alan Shanoff has documented the steady slide in coverage over the past few years in Ontario. Read his comments here. He ends his article this way: “One thing is certain. The current system can’t get much worse for accident victims. Victims need timely, adequate accident benefits even more than they need premium cuts.” Help make things better for victims! As a candidate, here’s how you can help ensure that the system doesn’t get any worse for victims: Demand that your party impose a moratorium on further auto insurance coverage reductions It’s time for our politicians to stop worrying about how to allow insurance companies to make more money, and start concerning themselves with how to restore fairness in our automobile insurance system.
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