Canadian Underwriter

Insurance companies turning down increasing number of requests for assessment and treatment of auto injuries: health care providers

January 31, 2012   by

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Insurance companies in Ontario are now turning down an increasing percentage of requests for the assessment and treatment of serious (non-minor) injuries sustained by motor vehicle accident victims, according to a survey of Ontario rehabilitation providers.

The Alliance of Community Medical and Rehabilitation Providers commissioned the survey, according to a press release on Jan. 19, although as of press time it was not known when the survey was conducted. The Alliance represents approximately 80 companies and about 3,500 health care providers, including physiotherapists, occupational therapists, speech language pathologists, chiropractors, psychologists, rehabilitation therapists, social workers, personal support workers and case managers.

The survey of 1,143 rehabilitation providers found that 42 per cent of requests for treatment are now being rejected — up from only 11 per cent prior to the government’s changes to the insurance system in September 2010.

“That’s a 282 per cent jump,” the Alliance said in the release.

According to the Alliance, the survey results further demonstrate that insurers are attempting to slot as many claimants into the ‘minor injury’ classification as possible.

“Insurers are now automatically classifying many cases as ‘minor injury,’ even though the health care providers have identified the injuries as serious,” the group says in its analysis of the results. “Survey respondents say more than half of their patients who have been slotted into the ‘minor injury’ category will run out of benefits before they recover.”

Insurers say they are “appalled” the Alliance is pointing he finger of blame at them. The Insurance Bureau of Canada (IBC) said the results of the Alliance’s survey are better understood in the context of the province’s efforts to reduce the number of fraudulent auto insurance claims.

“As Ontario’s auditor general pointed out in his annual report at the end of 2011, there has been an alarming 150 per cent increase in claims costs when the number of injury claims only increased 30 per cent in the same time period (2005-2010),” said IBC’s vice president for Ontario Ralph Palumbo. “Is it reasonable that, as stated in the report, accidents are down while claims have increased? It just doesn’t add up.

“The average injury claim in Ontario is about $56,000 — five times more than the average claims in other provinces. Too many people are using the auto insurance system as a profit-making opportunity. There is a sophisticated network of service providers who use the auto insurance system for their own self-interest.”

In its statement, the Alliance said it had tried to obtain information about insurers’ denial rates from Health Claims for Auto Insurance (HCAI), which is an electronic system for transmitting auto insurance claim forms between insurers and health care facilities in Ontario. Unable to acquire the data from HCAI, the Alliance said it elected to survey its members instead.

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