Accident benefits in Ontario: When $50,000.00 is Not $50,000.00
November 23, 2009
The proposed changes by the Liberal government to the minimum accident benefits in Ontario automobile insurance coverage sets out $50,000.00 for medical and rehabilitation expenses. $50,000.00 might sound to some people like a lot of coverage. It really isn't - for a number of reasons.
First, the medical and rehabilitation portion of your accident benefits in Ontario includes the costs of assessments that are done by both your own caregivers and by the auto insurer's hired medical "experts". Think about it for a minute. You are in a car accident. You suffer what you are told are "soft tissue" injuries to your neck and back. There may be a bulging or herniated disc. Now, even the insurance companies will typically admit that in a moderate "whiplash" injury the normal recovery requires 6 months to a year of physio, massage and medication treatments. Assume your doctor prescribes physio and massage and some prescription medications. A few thousand dollars are gone in the first few weeks. More money is spent in the next few months. But six months later your doctor doesn't think your recovery is progressing as he or she would like. You are not experiencing the "typical" or "normal" recovery. So your family doctor refers you to a specialist - maybe a physiatrist. At the same time your physio and massage treatments have run out from the first couple treatment plans and assessments are done to determine what treatment is now best for your maximal recovery. The physiotherapist does an assessment and treatment plan. Your massage therapist does an assessment and treatment plan. The physiatrist does assessment and treatment plan. All three now present bills to your insurer for their assessments. Your auto insurer doesn't agree to pay for these suggested treatments and decides it wants some assessments of its own. It hires a physiotherapist, a massage therapist, a physiatrist and an orthopaedic surgeon to do assessments. This is fairly typical. The first three mirror the expertise of your own caregivers. The last person, the orthopaedic surgeon, will give an opinion that from an orthopaedic perspective. They do their assessments and, as expected, say that the treatments proposed are not reasonable or necessary and therefore the insurer denies all treatment. This leads to your own caregivers doing rebuttal reports. In addition, you get your own orthopaedic assessment done. The insurer still denies and you are forced to fight this through the Financial Services Commission of Ontario starting first with mediation. Now you have to wait months simply to get to mediation. During that time you do not have the money to pay for the proposed treatments. Your condition does not improve - it worsens - because you are not getting the treatment you need. But here is where $50,000.00 does not mean $50,000.00. You have used up $15,000.00 - $20,000.00 of your benefits paying for the assessments that have been done.
You have just used up 40 percent of your medical and rehabilitation accident benefits without getting any of that needed treatment. This is a very typical progression. So the insurance company uses your benefits to pay for its own experts to say there is nothing wrong with you. It often gets worse than this. Perhaps you have some tingling in your fingers or your feet. This might lead to a neurologist referral. Add in an occupational therapist assessment and the related assessment fees and you may well have used well over 50 percent of your medical and rehabilitation benefits without getting any treatment.
Just another example of the Ontario government making changes to the Accident Benefits in Ontario to bolster profits in auto insurers without regard for its' citizens.
If you are injured in an accident there are organizations there to help. You might want to visit Injury Alliance at http://www.injuryalliance.com/ or go to the Ontario Trial Lawyer's Association at http://www.otla.com/ .
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