The wholesale approach to cutting costs is hurting not just those seeking insurance benefits, but those delivering health care, says the head of the Ontario Rehab Alliance.
“With the government’s commitment around the 15 per cent reduction in premiums, it is our concern that it has led to a kind of wholesale approach to cutting costs and cutting accident benefits,” said Laurie Davis, the executive director of ORA. “I mean, accident benefits are just a small piece of the total cost of running the auto insurance system, and we believe they’ve been the undue focus of cost-cutting measures, and each measure has thoroughly weakened the coverage of each person who is injured.
“We call it the dragnet fishing approach. You’re not just fishing for the one fraudulent species.”
For Davis, it is a telling statement that insurance companies will gladly pay mileage for those investigating accident health claims, but not to those who are involved in the healing process, like occupational therapists.
“Insurers pay mileage, or rent cars, or give gas cards to their employees and investigators – and pay for insurance-ordered independent examiners to attend,” Davis told Insurance Business. “We have all these mileage-related expenses that are supporting, what you could say, the ‘denial’ of treatment – so to take away mileage that supports the ‘delivery’ of treatment is, to us, just another blow against the people who are injured, who felt they were insured, and now find themselves without access to treatment.”
The disconnect between the public and the realities of the true cost of rehabilitative health care is a failure on the part of the insurance industry and brokers, says Davis. (continued.)
#pb#
“Take people buying auto insurance: the irony I find is your car is better insured than your person,” she says. “If people knew that, when they and their families were getting into their car – it is the equivalent of driving without a seatbelt.”
And the only way to improve the situation is through education, says Davis.
“Just as we think there is a great deal of education that needs to take place at the regulatory level, similarly, we believe there is a need for education at the broker level,” she says. “The current benefit threshold of $50,000 if you’re seriously injured is quite often insufficient. Not always, but often enough so that people to fully rehabilitate and return to their pre-accident lives.
“Before 2010 that amount was cut from $100,000 in half, and the minor injury guideline was put in place. Many people find themselves relegated to the minor injury category.”
Although Davis supports the minor injury guideline, she admits that ORA doesn’t always love how it is administered.
“At the front end level, we believe all Ontarians should be educated about what is covered under the basic, mandatory policy, and understand the limitations of that policy so as to make an informed choice about buying up additional benefits – and hope that they don’t experience any barriers to accessing those benefits,” says Davis. “It is currently only about 1.4 per cent of those of us covered by auto insurance who buy those extra benefits, and we think at the Ontario Rehab Alliance we know most of them. They are the people who work in the field and understand the realities.
“But that is a very small number when we know how many people will be injured will need more. But the current pressure on lowering premiums has put cost at the forefront of everything. We believe the current system and the changes that have been made in 2010 have made an enormous difference in claims’ costs for insurers, and we’re just beginning to see that data now.” (continued.)
#pb#
The pressure being placed upon providers – like occupational therapist Teresa Riverso (see ‘Therapists feel the bite from Bill 15’) – will have a ripple effect throughout the health care sector, says Davis.
“What we’re seeing is some of the most experienced providers – like Teresa and others, who have been working in the sector upwards of 15 and 20 years – they are making the decision to discontinue their work in this sector; and we think it will impoverish the sector,” she says. “It will mean some of those skillsets are not available and in some cases, more importantly, outside of the GTA, we have people who are injured in rural and remote areas. In order to minimize the impact on that $50,000, in order to treat them, the less direct service they’ll get.”
