Ontario auto insurance companies are cheating accident victims with outdated rules and fees, health professionals say [Boss Insurance]

Medical professionals who treat those injured in car collisions say Ontario’s auto insurance rules are hurting them and their patients by keeping reimbursements low and exhausting benefit plans unnecessarily social in the workplace.

Auto insurance is mandatory for vehicle owners and heavily regulated by the provincial government and the Financial Services Regulatory Authority of Ontario (FSRA). The Ontario government has in recent years made reforming auto insurance rules a priority, but health-care providers, including physiotherapists, occupational therapists and nurses, say progress has been slow.

A major problem is that the amount auto insurance companies pay for services has essentially been frozen for a decade. Fees are set by FSRA through the Professional Services Guideline and have not been updated since 2014.

The Ontario Rehab Alliance, which represents 4,000 medical professionals who work at least in part with patients injured in car crashes, surveyed its members last summer and three-quarters said auto insurer rates were less than what they earned from other suppliers.

“The guideline hasn’t been touched, it’s basically been hermetically sealed since 2014,” said Laurie Davis, executive director of the Ontario Rehab Alliance.

At the same time that revenues have remained stable, expenses have increased. Anthony Grande, a licensed physiotherapist and owner of the Toronto chain Focus Physiotherapy, said his rent has tripled and his wages have doubled since 2000, while the fees he can get from a car insurer for a one-day session hour had risen slightly from $84 to $99.75. .

“As small businesses, this hurts us,” he said.

FSRA spokesman Russ Courtney did not respond directly to whether the regulator would consider updating the guideline, but said the fees are minimums and the FSRA does not impose no upper limit to the amount that professionals can charge. “Insurers are not prohibited from paying above the rates set out in the guidelines,” he said in an email.

Ms Davis said that while individual adjusters may agree on a case-by-case basis to pay above the guideline, it is overall in the nature of insurance companies to reimburse based on the minimum at which they are allowed. pay.

“It doesn’t stop them from paying more,” she said of the guidelines. “Well, that doesn’t stop them from giving all their money to the poor either, but they don’t.”

The Insurance Bureau of Canada said it was focused on working with the government to reduce car insurance rates, and the amount paid to professionals was out of its hands.

“Rates for medical/rehabilitation services under an auto insurance claim are prescribed by the provincial regulator, FSRA,” spokesperson Brett Weltman said.

Another amount that has held steady is what the auto insurance industry reimburses the Department of Health for costs incurred by government services such as ambulances, related to road accidents. This has been set at $142 million per year since 2006.

The Ontario government, which has said it has no influence over the fees charged to professionals, has indicated that it is prepared to change the amount it collects itself from insurers.

“Health system costing could be considered part of any potential future reform,” government spokesman Scott Blodgett said in an email, referring to the annual fee for car insurers. .

Health care providers have also lobbied to change what an insurance plan pays first for treatment after an auto collision. Currently, Ontario requires workplace benefit plans to pay for treatment first, and only when those are exhausted do auto insurers have to pay. Alberta is the only other province with this law.

From a professional perspective, having auto insurers pay first would reduce the onerous paperwork needed to juggle two insurers, Grande said. But more importantly, it could mean that patients are not maximizing their work plans, which can affect the treatment they and their families receive, as well as the increased premiums paid by them and their employers, a he declared.

“The rest of the world doesn’t punish people who have jobs when they get in a car crash,” Grande said.

The Ontario government hinted in its 2022 budget that it was addressing this issue, but it has made no changes in the past year.

Mr. Blodgett of the Ontario Ministry of Finance confirmed that a change regarding which insurance plan pays first is still on the table.

“As part of its commitment to improving fairness, the government will consider whether motor insurance should continue to be the last payer in the event of a motor vehicle accident,” he said.

Ontario’s next budget is scheduled for March 23.

The government has said its other reform priorities include giving consumers more options when choosing their insurance plan and holding insurers accountable for tracking and reporting fraud.