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Proposed Amendments to Accident Benefits

Ontario’s 2015 budget proposes many changes that will drastically cut statutory accident benefits. You had better be prepared to purchase optional benefits because the basic coverage is not going to be very beneficial if you are involved in a serious accident.

Here are the proposed changes:

1. Medical/rehab benefits will be $65,000 (from $50,000) but will include attendant care. There will be an option to purchase increased coverage to up to $1 million;

2. Medical/rehab benefits that are currently available for 10 years will be reduced to 5 years for all claimants except for children and catastrophic impairments;

3. For catastrophic claims, the $1 million medical/rehab benefit will include attendant care. There will be the option to purchase an additional $1 million for a total $2 million coverage;

4. The non-earner benefit will be available right away with the six month waiting period removed but it will only be available for two years after the accident;

5. Goods and services that are not specifically listed in the Statutory Accident Benefits Schedule will only be payable if they are “essential” and agreed upon by the insurer. Currently, they have to be “reasonable and necessary”;

6. Updating the definition of catastrophic impairment (CAT) with the following proposed updates:

a) paraplegic or quadriplegia: revise the definition with updated detailed criteria and new diagnostic tools;

b) total and permanent loss of use of an arm or leg: revise the definition with detailed criteria and new diagnostic tools dealing with impairment of ambulatory mobility;

c) total blindness: update the definition by adding reference to 20/200 visual acuity threshold (legal blindness);

d) traumatic brain injury: for adults, eliminate Glasgow Coma Scale (GCS) and adopt the Extended Glasgow Outcome Scale (GOS-E) as the clinical assessment tool; for children under age 18 adopt the use of King’s Outcome Scale for Childhood Head Injury (KOSHI) as the clinical assessment tool;

e) allow for automatic CAT designation of children in certain cases;

f) mental and behavioural impairments: revise the definition to include updated detailed criteria and new diagnostic tools; and

g) combination of impairments: for other physical impairments not listed retain the current definition and adopt a new diagnostic tool (6th Edition of AMA Guides to the Evaluation of Permanent Impairment) for quantifying mental and behavioural impairments for the purposes of combining.

Given all of these cuts, accident victims are going to need to rely on the court system in efforts to recover their lost medical and rehabilitation expenses. However, unfortunately the budget also proposes amendments to the Insurance Act that includes increasing the tort deductible from the current $30,000 on court awards for pain and suffering to reflect inflation and will be linked to inflation in the future. Similarly, the monetary thresholds for the vanishing deductible ($100,000 for pain and suffering and $50,000 for the Family Law Act claims) will also be increased to reflect inflation. However, accident benefits paid by the insurers are not being adjusted to reflect inflation.

High income earners are in a better position and can afford to purchase the optional benefits so that they have sufficient accident benefits coverage, but what about everyone else who cannot afford these optional benefits? They cannot afford the extra expense of optional benefits and likely will not have the medical benefits available at work. What are these people going to do?