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Difficulties in the land of Accident Benefits

Recently, Ontario’s Standing Committee on General Government held public hearings on Ontario’s auto insurance industry practices in Queen’s Park. This committee doesn’t have the power to make changes, but it has the power to recommend them.

The Committee heard from the Insurance Industry, health professionals, personal injury lawyers, Financial Services Commission of Ontario (FSCO) and the Auto Insurance Anti-Fraud Task Force

Personal Injury Lawyers in Ontario can certainly speak to a number of growing concerns when it comes to auto insurance. Especially since the September 1, 2010 reforms.

Accident victims have to contend with the Minor Injury Guideline and a maximum of $3500 of medical/rehabilitation benefits.

Insurance adjusters must provide a medical reason for denying a treatment plan. But why are they being allowed to make medical decisions?

The accident victims who are denied treatment, whose rehabilitation is put on hold are at a serious disadvantage.

It certainly seems as if more and more treatment plans are being denied. And with the MIG in existence, it is harder for people who are placed in that category to achieve full recovery if they require further treatment after the $3500 has run out.

Applying for mediation is they way to appeal an insurer’s decision, however there are over 30,000 applications waiting to be processed and mediated at FSCO. That is very telling.  It is estimated that an additional 3000 applications are being submitted each month.

And what might these applications be for? Denials of benefits – medical benefits, weekly benefits, attendant care benefits, housekeeping benefits….benefits accident victims require to recover and rehabilitate.

Legislation requires that FSCO mediations are to be completed within 60 days of the filing of an application. The reality now is that mediations are taking place 10 to 12 months later, or even longer.

So what did the Insurance Bureau of Canada (IBC) have to say to the Committee?

According to an article posted on CanadianUnderwriter.ca   IBC’s VP for Ontario, Ralph Palumbo said “While the September 2010 reforms were a needed first step in reducing the pressure on no fault injury costs, claims costs are still out of control..”

Mr. Palumbo listed the following reasons for high costs:

1.Mediation Backlogs

2. Increase in Catastrophic Injury Claims

3. Increase in Bodily Injury Costs

4. Persistence of Auto Insurance Fraud

 

With respect to catastrophic injury claims, Palumbo noted that hospitalizations from car accidents decreased by 12% while the number of CAT claims increased.

He further noted that  on the tort side of things, bodily injury claims are increasing drastically. Both the frequency and cost of these claims has been rising. BI claims represent more than $2 billion in annual costs.

Palumbo had this to say: “BI is on the same track accident benefits were before the 2010 reforms and more needs to be done to assess the causes and what can be done to alter this concerning trend.”


Aaron Waxman & Associates is a Toronto Personal Injury Law Firm dedicated to serving the needs of their clients.

 

 

 

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This entry was posted on Sunday, June 10th, 2012 at 10:33 pm and is filed under Aaron Waxman & Associates, Automobile Insurance Claims, Car Accident Lawyers, Car Accidents, Insurance News, Personal Injury Lawyers, Personal Injury Lawyers North York. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

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