Recent changes to the standard Ontario auto insurance policy characterized as “mean spirited” by the New Democratic Party's consumer services critic have brought a swift response from the
Insurance Bureau of Canada.
“Attendant care coverage is not limited to those catastrophically injured in an accident as stated by the MPP,” said the IBC’s Ralph Palumbo, vice-president for Ontario, in answer to NDP critic for consumer services Jagmeet Singh’s comment that changes to the Statutory Accident Benefits Schedule “restricts the amount of attendant benefits that can be claimed by family members who are caring for someone who has been injured in an automobile accident.”
Ontario Regulation 347/13 makes four changes to the Statutory Accident Benefits Schedule (SABS), also known as Ontario Regulation 34/10.
Singh told the legislature last week that “this attendant care benefit is only available to the most vulnerable people in our society: those who are catastrophically injured.”
But attendant care benefit is actually available for both catastrophic and non-catastrophic injuries that do not fall under the minor injury guideline (MIG), Palumbo told Insurance Business in a written statement this morning.
“The SABS provides for Attendant Care benefits of up to $3,000 per month for non-catastrophic injuries as well as up to $6000 per month for catastrophic injuries,” stated Palumbo. “The total amount for non-CAT is $36,000 and policyholders have the option to buy additional coverage up to $72,000 for the total for catastrophic claims is $1,000,000, there is also the option to buy up. Attendant care is not available for those with minor injuries.” (continued.)
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On December 17 of last year, the minority Liberal government filed Ontario Regulation 347/13, which was published in the Ontario Gazette on January 4 and took effect February 1.
The change that Singh referred to clarifies the amount that can be claimed, by an “attendant care provider” who is not providing care “in the course of the employment, occupation or profession in which the attendant care provider would ordinarily have been engaged for remuneration, but for the accident.”
That amount cannot exceed “the amount of the economic loss sustained by the attendant care provider during the period while, and as a direct result of, providing the attendant care.”
This change, Singh claimed, “means that people who have already left their jobs, who are already caring for their loved ones, would no longer have the protection or the compensation that they would have been entitled to.”
As a result, Singh added, this could result in more disputed claims, which is “quite ironic, because the government has just introduced a bill which seeks to speed up the dispute resolution system but has actually created another complex problem in the system.” (continued.)
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Palumbo points out that the entitlement to the claimant remains unchanged, as well as for claims for attendant care processed prior to February 1.
“The new reform that came into effect on February 1, 2014 limits a friend or family member who provides attendant care to an injured auto claimant to be compensated for that service to the extent of the economic loss that they incur to provide that care,” stated Palumbo. “This does not change the entitlement of the claimant. The funds available for attendant care services remain the same should the services be provided by a professional health support worker. The reform would also not impact a family member or friend of a claimant who is currently providing care to an injured party.”
Of the other changes to SABS, one pertains to an exception, to the $3,500 maximum, that can be claimed by someone who falls into the minor injury guideline (MIG).
A third change pertains to pre-existing conditions, in cases where claimants have injuries that would otherwise fall under the MIG. Section 38 outlines the requirements for treatment and assessment plans.
The fourth change applies to accident victims who could meet the criteria for two - or all three - of income replacement, non-earner or caregiver benefits. In those cases, applicants must elect one of the three.
