A Quick Summary of the Changes
Accident benefits for non-catastrophic injury claims will undergo some major changes, including:
• Caregiver Benefits – The $250 per week, plus $50 per additional person in need of care will be eliminated
• Medical and Rehabilitation Benefits – These benefits are being reduced to $50,000 from $100,000
• Attendant Care Benefits – These benefits will be reduced to $36,000 from $72,000 per annum
• Housekeeping Benefits – The $100 per week housekeeping benefit will be eliminated
Accident benefits for catastrophic injury claims will undergo some major changes, including:
• Treatment assessment costs will be deducted out of the specific benefit limit
• There will be no ability to apply for Catastrophic designation (whole person impairment test or the marked/extreme mental or behavioural test) in the first two years post-accident, except in cases where a brain injury is present
• There will incur a definition for “incurred” which will require the insured person to pay for the expense, and the service provider to be a professional provider, except in cases of family members whom are able to prove loss of income
• Assessment costs are limited to $2,000
Other changes to accident victims will include:
Income Replacement Benefits
1. The maximum of $400 per week remains; however, the calculation of the weekly amount is changed to 70% of the insured’s gross income (was previously 80% of the insured’s net income)
2. The cost of accounting reports to substantiate a claim for weekly accident benefits is capped at $2,500
Commentary: These changes are welcome as they are more easily understood by insureds. Less cost will also be spent in having these benefits calculated by accountants.
Processing and Costs Associated with Accident Benefit Assessments:
1. Assessment Costs as a separate category of accident benefits will be eliminated. This will result in all fees and expenses for conducting assessments, examinations as well as preparing reports, being paid out of the medical and rehabilitation limits of the insured.
2. Assessment or examination costs, including insurer examination costs are limited to $2,000.
3. An Insurer will no longer be required to pay for any future care plan, life care plan or similar plan.
4. Rebuttal examinations have been completely eliminated.
5. Only Occupational Therapists and Nurses who have been trained on the use of the Form 1 will be entitled to complete Attendant Care assessments.
6. In-home assessments are eliminated in cases of a “minor injury”. Minor Injury is a newly defined term under the Statutory Accident Benefits Schedule.
7. Adjusters are being given some discretion to deny benefits, assessments or treatment plans without requiring an insurer examination.
8. Adjusters will be given 10 business days to review and respond to assessment requests submitted on behalf of the insured.
Commentary: While insurer examination costs including accounting reports will not be deducted from an insurer’s medical and rehabilitation benefits, an insurer will be responsible for the cost of their own assessment and examination reports which will mean less money available to them for treatment. This will undoubtedly exhaust the insured’s medical and rehabilitation limits which are being reduced from $100,000 to $50,000.
1. An injured victim who suffers “minor injuries” in car accidents which is being defined as a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae would receive a maximum of $3,500 worth of treatment and assessments.
2. The minor injury limit of $3,500 for medical and rehabilitation benefits does not apply to an insured person if their health care practitioner provides compelling evidence that the insured person has a pre-existing medical condition that will prevent the insured person from achieving maximal recovery from their injury, if the insured person is subject to the Minor Injury Guideline’s limited goods & services.
3. An injured victim suffering from “minor injuries” will not qualify for attendant care benefits.
4. An injured victim will not be afforded any payment towards an in-home assessment.
Commentary: Accident injured victims which unfortunately get caught within the “minor injuries” definition of this new legislation will have extremely limited access to health care benefits. However, it is important to remember that where these “minor injuries” meet the permanent and serious definition under the Insurance Act, the additional medical and rehabilitation costs can still be claimed against the at-fault parties for the automobile accident in any future lawsuit.
1. The interest rate chargeable on overdue accident benefit payments by insurers will be reduced to 1% per month compounded monthly.
Commentary: This change reduces the penalty insurers are required to pay for late payment of benefits. The current legislation requires an insurer pay 2% per month compounded monthly.