Lack of knowledge could lead to inadequate coverage: Healthcare providers

A lack of consumer knowledge makes decreasing mandatory medical and rehabilitation benefits in order to lower insurance premiums a dangerous proposition for Ontario drivers, according to the Alliance of Community Medical and Rehabilitation Providers (ACMRP).

“There is obviously an educational gap,” clinic owner and ACMRP spokesperson Nick Gurevich said in an interview conducted before proposed changes to Ontario’s auto insurance system were announced on November 2. “Folks don’t take the time to research the product the way they should given what’s at stake.”

Gurevich was drawing his conclusions from the results of a Harris/Decima poll conducted on the ACMRP’s behalf: the poll found most motorists have very little understanding of the scope and source of the benefits they claim to value so highly.

In the poll, the alliance questions whether the government’s “moral responsibility” regarding auto insurance is to ensure adequate benefits or affordability, which resulted in a 58%-32% split in favor of adequate benefits (10% were undecided). The ACMRP claims that this proves that Ontario motorists are as concerned about having adequate benefits as they are about affordable premiums.

Among other findings:  91% of Ontario motorists consider the cost of insurance to be very or somewhat important, while 88% consider adequate benefits to be very or somewhat important. Additionally, 92% consider having adequate liability coverage in case they are sued to be very or somewhat important, and 88% rate the repair of their vehicle as being very or somewhat important.

Despite these figures, Ontarians said they spend less or the same amount of time shopping for auto insurance as they do shopping for computers and televisions. Furthermore, an overwhelming majority of respondents believed that seven benefits currently offered under their auto insurance policies are in fact covered by OHIP. None of this stopped 70% of those surveyed to describe themselves as “educated consumers”.

The ACRMP was founded by clinics and medical service providers as a reaction against a FSCO recommendation to lower mandatory medical and rehabilitation benefits to $25,000 from their current $100,000 mark, a move supported by the Insurance Bureau of Canada (IBC). Minister Duncan’s proposal would lower the benefits to $50,000, and was criticized by Gurevich and applauded by the IBC when announced.

The IBC greeted the ACMRP survey results with skepticism, pointing out that no definition of what constitutes “adequate benefits” was ever given. Furthermore, IBC vice president, policy, Barbara Sulzenko-Laurie said that the choice respondents were forced to make when answering the question is not one they face in real life. “There isn’t an either or,” Sulzenko-Laurie said. “You can provide adequate protection and affordability at the same time and we’ve seen that across the country. The fact that rates in Ontario are 25% higher than the next most expensive province doesn’t mean that benefits are inadequate in that province, which is Alberta, where people recover from their injuries as well, if not better, than in Ontario.”

Sulzenko-Laurie advocated a lower cap for mandatory benefits as a way to control a system that is currently rife with abuse. “There is a lushness with respect to the way in which medical benefits, ancillary benefits like housekeeping, attendant care, dependant care and so on, are authorized by the system,” she said. “When you get a minor injury and there is potential for up to $100,000 that can be spent for healthcare and related resources for that injury, that $100,000 becomes a target.”

Gurevich does not deny that unscrupulous health care providers do exist. “We’ve tried to reach out to the IBC before and tell the: this is as much a problem to us as it is to you,” says Gurevich. “Unfortunately, we get painted in this negative light while it’s actually a small minority that is gaming the system.” To help decrease the abuses described by Sulzenko-Laurie, Gurevich proposes that clinics and rehab providers adopt a voluntary code of best practices containing common guidelines, a “stamp of approval” that could be useful to insurers. Additionally, Gurevich expressed a willingness to draw the IBC’s attention to any clinics engaging in unlawful practices, and believes the various associations and organizations that govern the health care professionals working with auto accident victims need to be made more aware of the unethical acts committed by some of their members so that disciplinary action could be taken.

Gurevich is also not automatically opposed to caps. “Our position is that we want to maintain the current cap at $100,000 for the seriously injured, and define seriously injured as anyone who has an injury that’s more severe than a strain, sprain, whiplash or uncomplicated fractures,” Gurevich says.  “For all the folks with those minor injuries, establish different caps depending on what type of minor injury they have,” he continues, explaining that it is logical for a relatively minor injury like whiplash to have a lower cap that a more severe one such as an uncomplicated fracture.

Gurevich is also skeptical that consumers will choose to buy additional coverage to supplement the new reduced mandatory amount. “No one buys [extra coverage] today,” Gurevich said, noting he does not expect that to change in the future and that a lack of knowledge about the true costs of rehabilitation and health care has the potential to leave many Ontario motorists without adequate protection if they are ever seriously injured in an automobile accident.

“How do you educate people about how much coverage they need?” Gurevich asks, “how do you educate people about how much a wheelchair can cost, how much a ramp can cost, how much a lift can cost, how much therapies cost? To me, at least, that’s an impossible task to ever properly execute.”

This story was originally published by Canadian Insurance Top Broker.