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June 27. 2008 r n v .... ,,., a \lr wm, Handler . cnior \ tanager Automobile lnsurance Policy Unit I inancial Scrv ices Commission of Ontario 5160 Yongc Street, 15"' Floo r Bo\ 85 I oromo. 0:- \ 12N 6 L9 Dear 1\1r. Handler. (In behalf of the Board of Direct ors o f the hank) ou for the opportunity to ma ke a submiss ion fo r input on the upcomi ng rev icw o r auto insurance in Ontario. The . is a registered charity that has been wor kin g to "enh"' lc ~ 1~ IIWS on Ontarians livin g with the effect s of acquired brain injury through educatio n. awa renes s and suppo rt" s ince 1986 . We o ffer no "hard rehabilitation services" to peop le with acquired brain injury. so we cannot benefit or be hurt by changes to auto insurance in Ontario, Th ere fore , we share with the Government the goal of a fforda ble, cost-e ffective au to insuran ce that offers adequate protecti on to co nsumers. As part of ou r "support" to Ontarians who han' ex perienced brain injury. we offer a toll-free help-line that take s about 250-30 0 call s per month from both "s urvi vo rs" and fam ily members. Many of these ca lls are from and about peo ple who have been injured in auto crashes. As a resu lt we have an abundance of oppo rtunities 10 hear the con sumer s perspectives on auto insurance , II is lair to say that . in spite ofthe regul ations and guidelines. there is still a great deal of variab ility in how con sumers perceive their insurer when a claim is made, Some compan ies are part icu larl y attentive to the need ofthe co nsumers, while others seem to spend as much time and money de nyi ng treatment plan as it would take to implement it. There are still reports o f delays in servi ces. and repeated assess me nts for the same treatment plan . The greatest prob lems con tinue to arise from the fact that many adj usters j ust have no idea wh at brain injury is all about. If their clie nt look s healthy, he is healthy , Ihey seemingly have no con cept of the cognitive, emotional and behavio ural co nsequences o f Brain Injury. Thi s is es pecially true in the case of m ild to mod erate brain injury. In ou r submiss ion (attached ). we address thi s need lor training for adjusters who are deal ing with brain inju ry ' LS well as three other concerns that \\~ would like to put before tho se who are undertaking the review. Once ag ain . thank ~ au for this o pportunity Yours truly . -- Issues for the Submission on the Auto Insurance Review I. Affon h,h ilily ami Accessihility Callas to our toll-free help -tine still report that they arc. ubjectc d 10 mul tiple assessments lor the same treatment. This excess of a .scssmcnts would appear to be an attempt to lind an assessor who is willing to deny thai a prescribed treatment as both reaso nable and necessary. With these multiple assessmen ts and the accompa nying dela ys. many injured peopl e seek help from the publicly fund ed system suc h as emergency depart ments at thei r loca l hospital. Not only docs the e:.ccssi vc number of assessments cause a grea t deal of anxi ety and inconvenience for the injured person and his/her family, it has also added consi dera bly to the cos t. Mone y spent o n unnecessary assessments is mone y that could better be spent on treatment. RECO:\t:\1 ENI)ATION: T hat the insurer be lim ited to a max imum of two assessments per treatment plan . Ideally. these ass ess ments should be done by qualified IIcalth Care Professiona ls who wo rks at arm 's length from the insurer and are paid by an independent agency other than the Insurer. 2. C onsumer Protection Currently. it would appear that training for insurance adju sters is at best variable among the competing insurance companies. It becomes evident that some adjusters are making health cure decisions and den ying treatment plan s without any specific training or knowledge o f the condi tions that the injured part y has suff ered, The result is that reaso nable and nece ssary treatment is frequentl y delayed or denied with the result that the injured person s wind up in the Emergency Room s of their local hospitals. A related problem is the frequent turnover o f adjusters on a particular file, There are report s of injured persons who have had as many as 6 adjusters in the space of a year and a half. Th e result is that the adj usters are repeatedly starting from scratch. learning the new file. challenging findings. and ordering new assessments. Not only is the practice frustrating for the injured perso n. it causes delays and adds to the cost. In some cases the injured person just gives up the claim and goes to the neare st Emergency Room for treatment of their symptoms. RECOMMENDATION: That all adju sters have some basic I Icalth Care training and that Insurers he required to have spec ialized adju sters to adjudicate serious injury cases such as Brain Injury and Spinal Co rd Injury . These specialized Adjusters and employees who arc functi oning as Registered lI ealth Care Professionals or Case Managers should have to be certified in a eourse designed to educate them about the nature o f both the impairments a nd the treatments nece ssary to address them. In addit ion. there should be in place a regulation that curbs the practice of frequ ently changing adjusters. -'. Statuln~ Accident Bellefits III theory. the SAilS arc the backbo ne of the no-fault insur ance concept because they o utline the pa rame ters o f ".." an injured person might expect from his inSUTl'T in the C\\:nI that he/she is hat injured. While we know that disputes over "hat may he reasonable and necessary arc far from ran: in the real world, the concept of the SABS remains an essentia l framework to gu arantee that the need s of till' injured per son" ill he addressed ill a just and timely fas hio n, ,\ t a recent two day summit on auto insurance legislation. the re was a great dea l of talk about the necl'~si t y of providing greater compensation for ··thc· innocent victims" of car crashes by making more money available to To rt cases hy reducing the amount available in the SAilS . As a consumer advocacy o rganiza tio n, _ _ 6 s opposed to any such changes for IwO reasons. First we know that the current SAilS. specifi cally. the rued-rehab portio n is inadequate to meet the needs of many injured persons and their families who wil l requ ire lifelong treatment or support. Secondly. the specter of injured persons waiting for trea tment or support while lawyers argue can only add to both the delay and the cost. It would a lso mean that many injured persons who arc not receiving treatment arc going to seck assistance through the Emergency Room of their nearest hospi tal. A seco ndary issue in this discussion about the monies avai lab le through the SAilS versus monies available thro ugh Tort is the d istinc tion betwee n "innocent Crash victims" and "at fault drivers". C lea rly. hot h cat egories arc a rea lity. but I would s uggest that the curre nt legislati on a llows the issue of fault to be adequately addressed throug h To rt claim s. To sugges t tha t To rt elai ms should be increased at the expense of the SAilS is to fa il to recognize thai a se rious inj ury . pa rticularly Ilrain Inj ury. docs not happen to individuals. It ha ppe ns to fam ilies. To. so mehow, consider reducing the benefits available to "a t fault drivers" through the SA ilS in order to increase co mpensatio n to "innocent victims" would further penalize not only u person who se life has been shattered. but would do irreparable damage to the injured pe rson 's spouse and children. Finally, I would point out thaI reducing the amount of money available through the SAilS and redeploying that money to make it available through tort would certainly mean that there would be increased lawyers' fees . Money spent on legal fees is money tha t canno t be spent on treatment. Rf.COMMENIlATION: That an)' mo ve to erode the co mpensatio n avail able throu gh the SABS be turned down, and that the dollar amo unts stated in the SA RS be inc reased to re fl ect inllationary trends si nce the last rev iew. Page 3 ~. Ot her Issu es I recently had the privi lege of silting on an expert pancl to consider a better way of determin ing Catastrophic Brain Inj ury other than the Glasgow Coma Sca le (GCS) whic h is widely known to he a highly ineffect ive too l for prognos is. The fact that it was neve r intended to forecast functiona l outcome after Brain Injury. comb ined with the fact that its use is either totally or partial ly limited in situations where the inj ured party has been dr inking or using drugs or is intubated makes the search fo r new de terminants j ustifi ed. This panel. representing medical and scientific personnel from a wide range of disciplines was funded jointly by the Ontario Nc urotrnuma Foundation and the Insura nce Bureau o r Canada. The panel met for a full da y to discuss the shortcomings of the GCS and suggest alterna tive tools or procedures. Then a highl y qualified team was sent away to do a Literature search to dete rmine the efficacy of the various methods suggested. Two months later. the panel was reconvened and presented with an overview of thc fin dings of the Literat ure sea rch. Aller considerab le deliberation a series of recommendations were mad e. I and my co lleagues on the panel believe that the reco mmendations rellcc t the most current scie ntific knowledge and would. indeed. provide a more reliable prog nosis for long term functional outcomes than the current reliance on the GCS . We further believe that these recommendations would provide bette r o utcomes for a broader range of inj ured persons beca use they would facilit ate more timely inte rventions without sig nificant increased cost Unfortunately. I am not at liberty to share those recommendations with yo u because the Insurance Bureau of Canada wants the findin gs kept out o f the Pub lic Doma in until after July l-ith 2008 which. coincidentally. is the dead line for these submissions. I would. however, a lert you to the fact that the final paper made the point that the recommendations should be taken as a whole. In fact. if someone were to 'cherry pick" from among the recom mendations grave injustices co uld occur that could result in untold misery lor injured persons and increased costs for the Pub lic Healt h Care System. RECOMMENDATION: Ifthere is a move to change the method of de term ining the catastrophic designati on in cases of Brain Inj ury the Review Panel should demand to see the document entitled "Evidence Based Classification of Brain Im pairmcnt: Application To Catastrophic Impairment Classi fi cation - Result s of a Consensus Panel."
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