The Provincial Government invited suggestions for possible changes to the automobile insurance system from interested parties in a Consultation Paper dated September 2001. The government solicited responses to 25 questions which were concerned with both tort claims and accident benefits issues.
Thomson Rogers, in preparing our submission to the government, attempted to get input from a variety of professionals involved in assisting accident victims in recovery, rehabilitation and accessing compensation. Unfortunately, with the very limited time allowed by the government to respond, it was impossible to incorporate many of the excellent suggestions these health care professionals had for improving the system for the benefit of injured parties. We hope to facilitate continued dialogue among health care professionals in order to persuade the government that changes to the current system are necessary to keep it fair, balanced and cost-effective.
We highlight some of the more significant suggestions made in our submission to the government.
- One of the more important issues to address is the definition of “catastrophic”. The shortcomings of the current definition are generally well-appreciated by those involved in caring for accident victims. They include the fact that: children are not well-served by the current definition; many seriously injured adults, not qualifying as “catastrophic”, are deprived of needed medical and rehabilitation benefits beyond the time and monetary limitations contained in the regulations; and, the Glasgow Coma Scale is not necessarily a good measure of outcome. There are other shortcomings, the particulars of which will not be addressed in this article.
We have suggested that the definition of “catastrophic” be changed to remedy these problems. Claims against at-fault drivers for pain and suffering cannot be advanced unless the verbal threshold is met. The threshold provides that, apart from scarring and fatal accidents, a claim can be brought only if the person suffers a permanent serious injury to an important physical, mental or psychological function. The words “permanent and serious” have already been judicially considered, providing some guidance on the meaning of the phrase. Our suggestion is that the definition of catastrophic be the same as or similar to this threshold.
- Other recommendations, aimed at creating more efficiencies in the accident benefits claims process have also been suggested. Recognizing that delaying access to needed treatment can adversely affect the accident victim’s recovery and rehabilitation, we have tried to make suggestions that will expedite the process of obtaining benefits and, at the same time, reduce cost. As an example, the DAC process is time-consuming and expensive. Streamlining and limiting that process will result in considerable savings to the system. Reducing or eliminating insurer medical examinations will also result in substantial cost savings.
- Many health care professionals have long called for changes to the Form 1, dealing with attendant care needs of accident victims. Changes are required to make the Form 1 reflect the “reality” experienced by those who need and try to access assistance caused by injury-related limitations. As well, Form 1 does not adequately reflect the needs of children, an important, but largely forgotten, group of victims.
- It has been suggested by some that the need for some services provided by health care professionals is questionable and is causing a financial drain on the system. Yet, it is apparent that a very substantial amount of money expended by insurers go toward assessments (DACs and Insurer Examinations). Changes are needed to direct less money to assessments, which do not advance recovery, and more money to therapy. There should be a presumption that treatment recommended by treating health care providers (as opposed to experts hired by a lawyer or insurer) is both reasonable and necessary and ought to be implemented in a timely way. Undue delay in financing this treatment should be met with penalties severe enough to deter such behaviour.
At this stage we do not know what changes are being contemplated by the government. The insurance industry, through the Insurance Bureau of Canada, has made submissions. While it is important to recognize that insurers must stay commercially viable, the IBC recommendations, we suggest, do not adequately balance the profit motive of the insurance industry with the needs of accident victims. In the interests of weeding out questionable or frivolous claims, many meritorious claims can be affected. Therefore, the input from health care professionals regarding improvements to the current automobile insurance system is needed to ensure that current and future accident victims have representation. We hope to consult with many of you and we encourage you to make submissions to the government now.