Injured insureds in Ontario worse off after auto insurance reforms, alliance of health care providers says

Dr. Carlan Stants

As a Chiropractic Specialist involved in both the treatment and assessment of individuals injured in motor vehicle accidents, I can say with confidence that the current system is not working. I routinely see individuals with "minor injuries" receiving insufficent treatment under the current Minor Injury Guidelines and treatment that is inconsistent with the histopathology of healing. As to the issue of fees, the fees per hour are in fact less than the recommended professional fee schedules for almost all the regulated health professional associations. One cannot compare patients that are seen in regular clinical practice with those seen as a result of a motor vehicle accident. In regular clinical practice, the injury site is usually localized to one area only in contrast to motor vehicle accidents which is typically 2 or more. Additionally, the amount of paper work involved in handling the motor vehicle accident is significantly more than in a personal injury case. As a past member of the Superintendent's Committee on Auto Insurance Reform and a Past Chair of the Coalition of Health Professional associations, it was not the health professions that were promoting the extensive requirements for documentation - it was the insurance industry. Notwithstanding all of this, the system still needs reforms to create a more balanced process that contains cost-containment measures for insurers yet allows legitimate accident victims to receive appropriate benefits and access to legal counsel while severely penalizing those individuals who would seek to abuse the system whether they be an insurer, health professional, legal representative or claimant.

Posted September 29, 2011 04:51 PM

michele

How come "joe off the street" can be charged $60/hour at a physiotherapy facility - but if it's an MVA - they can charge $96.07/hour because the professional fee guidelines say so. How come a chiropractor will normally charge $35.00 but then if its an MVA - they can $108.65. That's where the money is being spent. If they charged their regular fees - then perhaps the $3500 would be utilized in a more efficient manner. I don't believe that every claim is a MIG - but there are times where it is warranted. (more so than not). I personally believe that adjusters have a responsibility to educate the client on the MIG. Sending out a package with a letter is not educating them. Adjusters also need to educate service providers. I work in a rural area - and to be honest - the MIG is working... but I'm helping to make it work. It's the legal firms that want assessment after assessment.... we are spending just as much money on IE's to keep the client in the MIG as we were before the auto insurance reform began. I think that legal firms and assessment providers (who submit OCF-18's for FAE's 2 days after an accident) should be investigated more and be more accountable for their submissions. The question is - to whom? Adjusters should be able to report these types of abuse to an insurance task force that have the resources to investigate these types of legal firms/service providers - to make them more accountable. Colleges of chiropractors/physiotherapists, etc. need to be working WITH us - not against us to make this work.

Posted September 23, 2011 09:04 AM

harry

I am an independent adjuster and have dealt with thousands of AB claims over the years and I can tell you that I saw rampant abuse of the system by service providers and assessment companies. That is not to say that the insurance companies were blameless, they hired incompetent staff who did not seem to care about abuse, only processing the paperwork. A psychologist that I know who did a lot of Section 24 assessments told me that service providers are now suffering economically because the chiropractors got greedy and tried to make $10,000 on every whiplash case. In other words they killed the golden goose. A lawyer who defends insurance companies told me that she expects a lot of work in the near future because the insurers are making a lot of cases MIG which clearly are not MIG. She thinks that claims for special awrads and bad faith against insurers will be on the upswing.

Posted September 21, 2011 07:13 AM