H i Lee,
I understand that some of our auto insurance coverages are going to be lowered to give us a break in premium cost. I have a master's degree but can't figure out if there are any hidden caveats. What's your take on it?
It's law. Effective Sept. 1, 2010, Ontario driver's medical and rehabilitation coverage for non-catastrophic injuries will be reduced from $100,000 to $50,000.
Previously, your minor injuries would be taken care of up to the $100,000 limit, but not now. There's a cap of $3,500 from what the insurance industry, not your doctor, considers to be "minor injuries."
This decrease in coverage is meant to save you some premium dollars, and even though you can "buy back" your $100,000 limit, you're still faced with this new cap of $3,500 for minor injuries.
A "minor injury" is defined as a sprain, strain, whiplash disorder, contusion, abrasion, laceration, partial dislocation of a joint or organ, and any pathological condition resulting from an injury or trauma.
And there's more, or less, depending on your perspective.
The cost of having your health professional assess your injury used to be separate from your $100,000 coverage, but there's conflicting information as to whether it is going to be taken from your $3,500 cap. The Insurance Bureau of Canada says it isn't; other health professionals say it is.
One may ask: if the cost of assessment is taken from the cap, and it takes up all of this money, what's left over for me getting better?
What is the process of getting the remaining $46,500 of coverage? If your injury falls into the definition of a "minor injury," there is none. Sorry. For more care, it's up to your insurance company to be convinced your injury qualifies for all or part of the remaining $46,500.
Unfortunately, it will be harder for people with some injuries to prove they need more care as there are also caps on assessments. For example, if you had a head injury, your neuropsychological assessment is limited to $2,000. Many kinds of these specialized testing are not covered by OHIP. You would be responsible for incurring the additional costs of the assessments to make your argument to the insurance company to get that additional health care.
What about injuries on top of pre-existing injuries?
What if you have a bad back, get into a car accident and it damages your back even more? You now need to provide to your insurance company "compelling evidence " - whatever that's supposed to mean -to have the injury treated.
In my opinion, injuries on top of pre-existing injuries need the most attention. I believe most people that are involved in car accidents suffer from minor injuries. From my experience, $3,500 would not go a long way in fixing me.
The $50,000 question for me is: "Why is there a $3,500 cap on minor injuries?"
A maximum payable medical rehabilitation benefit of $3,500 for all "minor injuries" will not be enough to return many people back to work. This would possibly create a whole new set of problems in Ontario.
The definition and understanding of pain is influenced by many factors. So is whiplash minor? Could there be a risk of a disc herniation eventually leading to neurological signs, even surgery?
Physiotherapist Thomas Hein asks: "Where would this fall? By the time the MRI is taken, the patient may well be past their $3,500 limit and will be rolling the dice to find out if they will be covered under the $3,500 cap or to the full amount of $50,000."
Will the more seriously injured be harmed the most? As the insurance industry reduces the medical and rehabilitation coverage from $100,000 to $50,000, has it really been reduced to $3,500, and how many premium dollars are we really going to save from this?
Lee Romanov is an insurance consumer advocate and creator of www.romanovreport.com.