The lawyers at Aaron Waxman & Associates are experienced with Disability, Personal Injury and Employment claims.
For car accident victims, rehabilitation and treatment are necessary components of recovery.
Ontarians injured in car accidents are finding out that the treatment being prescribed by their doctors is not being covered by their insurance company. This seems to be a more common occurrence post September 1, 2010, when the Ontario government introduced changes to the Statutory Accident Benefits Schedule in an attempt to deal with insurance fraud and rising premiums.
At one of the leading brain injury clinics in Ontario, Dr. Donna Ouchterlony, of the St. Michael’s Head Injury Clinic is finding that insurance companies are declining more and more treatment plans.
Even harder to believe is that it is the insurer adjusters themselves that are making the decisions. Dr. Ouchterlony says this has had a “profound impact” on patients in need of treatment.
What is concerning is an insurance adjuster with very little training can make the decision to deny a treatment plan and although they have to give a medical reason for the denial, they themselves do not have medical training.
There are suggestions that as many as 40% of treatment plans are being denied.
For specialists who treat brain injured patients in particular, or where a team of specialists work together to set up a treatment plan, to have that plan denied is extremely frustrating to both the accident victim and the treatment providers. The client is put into a position where they have no funding for medically necessary treatment. With traumatic brain injuries in particular, it is crucial that an accident victim receives treatment within the first 6 months after the injury.
One of the biggest changes to the SABS of course was the creation of the MIG, the $3500 category. Once someone has been placed in this category and has used up the $3,500 for medical and rehabilitation treatment, where will the funding come from?
The new changes reduced the $100,000 category for medical and rehabilitation benefits to $50,000.
The bottom line is treatment and rehabilitation are expensive and most patients can go through benefits very quickly, especially those with serious injuries who are not declared catastrophic (if deemed catastrophic, the medical/rehabilitation limit is $1 Million).
But, the Insurance Bureau of Canada insists that treatment providers are recommended unnecessary treatments. Because of fraudulent claims, all claims are being closely examined and the battle ensures between insurers and their insureds.
Ontario’s Auditor General Report, released in December 2011, revealed that fraudulent claims are responsible for driving up premiums in Ontario and are costing the province $1.3 Billion. Ontarians pay the highest amount for car insurance, in part because the average accident benefits claim is five times higher than any other province.
Aaron Waxman and Associates is a Toronto Personal Injury Law Firm that specializes in car accident claims.
* This blog is for informational purposes only and is not meant to substitute legal advice. Please read our disclaimer for further information.
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* Office in Toronto and able to represent people in the province of Ontario