Democracy Gone Astray

Democracy, being a human construct, needs to be thought of as directionality rather than an object. As such, to understand it requires not so much a description of existing structures and/or other related phenomena but a declaration of intentionality.
This blog aims at creating labeled lists of published infringements of such intentionality, of points in time where democracy strays from its intended directionality. In addition to outright infringements, this blog also collects important contemporary information and/or discussions that impact our socio-political landscape.

All the posts here were published in the electronic media – main-stream as well as fringe, and maintain links to the original texts.

[NOTE: Due to changes I haven't caught on time in the blogging software, all of the 'Original Article' links were nullified between September 11, 2012 and December 11, 2012. My apologies.]

Wednesday, April 25, 2012

Many insurers reject requests - will yours?

Suppose you’re driving your car with three passengers and you hit a deer. No one is hurt, except the animal.

Your insurance company quickly pays $24,000 to cover repairs to your damaged car. It’s happy to protect you from financial harm after an accident.

Now suppose you and your passengers are all injured after hitting the deer. This time, the insurance company is slower to respond.

It may turn down your requests to be repaid for rehabilitation treatments not covered by the health care system (such as physiotherapy or psychological counselling). It may treat you as fakers, exaggerating your injuries.

Related: Why women pay less for insurance

You and your passengers are entitled to maximum benefits of $3,500 each, or $14,000 in total, under Ontario’s minor injury guideline. That’s far less than the $24,000 paid for car repairs.

But you may fight for months — perhaps even years — to get the amount owed to you.

I heard this story at the Hamilton Medical-Legal Society Spring Symposium last weekend. The driver who hit the deer and escaped injury is married to an occupational therapist. He knows how tough it is to get accident benefits if you’re hurt in a collision.

In a speech to the group, I said Ontario was protecting insurers’ profits at the expense of accident victims’ rights to timely treatment. Many professionals agreed with me.

On Sept. 1, 2010, the Liberal government slashed accident benefits, hoping to stop car insurance rates from rising before the election of October 2011. There used to be a maximum limit for $100,000.

Today, 20 per cent of victims get benefits of up to $50,000 for moderate to major injuries. Meanwhile, 70 to 80 per cent of victims with minor injuries have their medical and rehabilitation benefits capped at $3,500.

Even if you want to buy extra insurance coverage for minor injuries, you can’t. You’re stuck with this bare-bones limit, the lowest in Canada.

The government still has a $1 million limit on treatments for those with “catastrophic impairment.” But it will soon bring in a new definition that is expected to make benefits harder to get.

Health professionals talked despairingly about patients losing precious time for recovery when adjusters refused to pay for recommended treatments.

Lawyers talked about the Financial Services Commission of Ontario’s failure to meet a 60-day time limit to mediate disputes between insurers and clients. Injured people can wait a year or more to be heard.

The courts are starting to recognize victims’ rights. In a recent case (McQueen vs. Echelon), a woman was awarded $25,000 for mental stress after her insurer made 21 denials of benefits over a three-year period.

“Routine and rubber-stamp denials are illegal,” said the plaintiff’s lawyer Lou Ferro, “and insurance companies will be penalized by making them pay aggravated damages on top of the cost of the benefit.”

Last week, an Ontario Legislature committee voted to hold public hearings on car insurance. Something is wrong when 42 per cent of treatment plans are rejected, up from 11 per cent before, says NDP MPP Rosario Marchese.

Many people working in the rehabilitation field think Ontario’s recent insurance reforms have veered too far in the wrong direction.

Let’s hope the three parties — after hearing testimony from accident victims — can come up with suggestions on reversing the unfair treatment.

Original Article
Source: moneyville
Author: Ellen Roseman

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