Medical-Rehabilitation & Attendant Care - Summary of Cuts to Accident Benefits

Click here to email your MPP today about these cuts!

• Rehabilitation (“rehab”) benefits cover a range of medically necessary goods and services that aren’t funded in the public system such as physiotherapy, speech therapy, psychology, medications, accessibility renovations, nursing, wheelchairs, artificial limbs, etc.
• Attendant care (“AC”) benefits cover the services of personal support workers to assist with bathing, dressing, toileting, etc.
• All goods and services are always subject to the insurer’s determination of what is “reasonable and necessary”, so insurers can deny any request for rehab or AC services even if funds are available
• There are approximately 65,000 people injured in motor vehicle accidents in Ontario each year: minor injuries account for about 80% of all injuries, serious injuries account for about 19%, and catastrophic injuries account for just 1%; insurers have strong controls over which individuals get classified into which severity category

1996	2010	2014	Budget 2015
Rehab for Minor and Serious Injuries: $100,000 plus the cost of assessments; minor injuries were subject to care pathways AC for Serious Injuries: $72,000 Rehab for Catastrophic Injuries: $1,000,000 plus the cost of assessments Attendant Care for Catastrophic Injuries: $1,000,000	Rehab for Minor Injuries: $2,200 with an option for an additional $1,300; in-home assessments eliminated Rehab for Serious Injuries*: $50,000 including the cost of assessments (approximately a 65% cut in benefits) AC for Serious Injuries: $36,000 (a 50% cut) Rehab for Catastrophic Injuries: $1,000,000 including the cost of assessments (approximately a 20% cut in benefits) Attendant Care for Catastrophic Injuries: $1,000,000	Rehab for Minor Injuries: No further changes to limits but additional documentation required Rehab for Serious Injuries*: No further change to limits AC for Serious Injuries: $36,000 for outside caregivers; family member caregivers must demonstrate direct economic loss Rehab for Catastrophic Injuries: No further change to limits Attendant Care for Catastrophic Injuries: $1,000,000 for outside caregivers; family member caregivers must demonstrate direct economic loss	Rehab for Minor Injuries: Awaiting a report with recommendations Rehab and AC for Serious Injuries**: $65,000 combined (a $21,000 or additional 25% cut) Rehab and AC for Catastrophic Injuries**: $1,000,000 combined (a $1,000,000 or additional 50% cut) Budget also suggests changing the criteria for “catastrophic”

 
* Optional Benefits
In 2010, the government introduced “optional benefits” to allow buyers of auto insurance to buy better coverage.  Our members’ experience with agents and brokers is that this is rarely discussed when policy renewals come up and most brokers are unable to speak to what med-rehab and attendant care benefits cover.  Data from FSCO released a couple years ago confirmed that less than 2% of policy holders bought optional coverage.  This is in stark contrast to optional liability coverage which agents and brokers always encourage policy holders to increase from the mandated $200,000 to $1,000,000 or $2,000,000 (liability coverage pays for the rehabilitation and expenses of someone a policy holder injures in an accident, whereas accident benefits pay for one’s own rehabilitation and expenses when injured).  It is unconscionable that drivers in Ontario are encouraged to ensure they cover someone else’s health care needs to the tune of $2,000,000 in coverage, yet are told that they need less than $50,000 to cover their own health care needs.
 
** Combining Rehab and AC Benefits
The 2015 budget suggests combining rehabilitation and attendant care benefits into one fund, meaning the most seriously of injured people (e.g., those who are paralyzed, people with amputated legs or arms, individuals with severe brain damage, etc.) will be required to choose between getting help to maintain their personal hygiene (bathing, toileting, dressing, etc.) or getting rehabilitation to improve their functional abilities.  This represents one of the most distasteful slashes to the dignity of those with disabilities in the province of Ontario, and because of the small percentage of people who fall into these categories, the savings to insurance companies will be negligible.
 
SUMMARY OF IMPACT ON DISABLED ONTARIANS
Prior to the 2015 Budget announcement, Ontario had already devolved to having the worst rehab insurance coverage in the country on a weighted average basis (80% of injuries access up to $3,500, 19% access up to $50,000 and 1% up to $1,000,000 = weighted average of up to $22,300 in available rehab benefits, if the insurer approves the funding).  With the 2015 Budget announcement, this figure drops to an appalling $15,400.  In 6 years, the Ontario government has reduced rehab funding in the auto sector from a weighted average of $50,000 to $15,000 – and this in the context of publicly funded outpatient and home care rehab services being drastically reduced or eliminated in most jurisdictions across the province.

Numerous other changes have been made to the Accident Benefits package in the past 6 years, all designed to constantly boost insurers’ profitability and all on the backs of injured and vulnerable Ontarians.  The important balance between insurer profitability, premium levels and consumer protection was pushed to the brink in 2010 and will be completely destroyed with the 2015 Budget announcement.  Our government passes seatbelt, helmet and smoking laws to keep people safe.   And one of our most deeply held Canadian values is to provide a safety net for the most vulnerable among us.  The Ontario government needs to show that it cares as much about its citizens as it does about insurer profitability.  Disabled Ontarians and their families are too busy trying to get through basic daily activities with some dignity and hope; they can’t lobby the way the insurance industry can.  You, our MPP, need to be their voice. 

Please stop these proposed changes, review insurer profitability, and let the impact of all the other cuts take place before enacting any new regulations that further disadvantage injured Ontarians.

Source: http://www.ontariorehaballiance.com/page/insurancechanges