The Right to Sue for Health Care Expenses and the $15,000 Deductible

Under the current auto insurance law, an injured person is not entitled to sue the person(s) at fault for the accident, unless they have suffered a catastrophic injury. The draft legislation proposes to allow all injured persons to sue for health care expenses, where they have suffered a permanent and serious injury. Allowing a person to sue for health care expenses is an important change and should be supported. It addresses a significant deficiency in the existing legislation for non-catastrophically injured persons. Currently, non-catastrophically injured persons have limited access to health care expenses from their nofault policy and at the same time are prevented from claiming any shortfall from a wrongdoer.

However, the draft auto insurance reform also includes a proposal to apply a $15,000 deductible against health care expense claims. Therefore, all innocent accident victims who can sue for their legitimate health care expenses, will not be permitted to collect the first $15,000 of their claims.

Applying a $15,000 deductible to health care claims is patently unfair and unjustifiable. The auto insurance regime in Ontario already places a number of restrictions on the right to sue for health care expenses:

1. The accident victim must suffer a permanent and serious injury;
2. The Health Care expense must be accepted by a Court as both reasonable and necessary; and
3. The accident victim will likely have exhausted $100,000 in medical/rehabilitation benefits available from his/her no-fault insurer before seeking reimbursement through the Court.

There is no justification for depriving accident victims of $15,000 for medical and rehabilitation services that they clearly require. In most cases, victims with permanent and serious injuries are disabled from work. How will they pay the first $15,000 of their medical expenses?

Accident victims have often had their world turned upside down – they are not working, their home life is in disarray, their future is uncertain – economic pressures can be great. The proposed deductible will only add greater pressure.

No deductible should be applied against health care costs. They are legitimate, out-of-pocket expenses that are only claimed in serious cases of permanent injury.