Ont. auto accident benefits shouldn't entail ‘arguing about what care is appropriate each and every time'

Addressing the problems of both Ontario’s auto insurance and workers compensation systems calls for packages of care that work for most injured people and not for cash settlements, the former chief executive officer of the Workplace Safety Insurance Board suggested to Ontario brokers Wednesday.

In Conversation with David Marshall was one of Wednesday’s topics at BIP Talks, a series of half-hour talks for which attendees at the Insurance Brokers Association of Ontario (IBAO) Convention can get Registered Insurance Brokers of Ontario education credits.

Don Forgeron, president and chief executive officer of Insurance Bureau of Canada, interviewed Marshall, whose report on Ontario auto insurance was published April 11. Marshall, a former CEO of WSIB, was appointed in 2015 to make recommendations on reforming the auto insurance system.

Auto insurance claims costs “continue to rise” in Ontario “while automobile accidents continue to fall,” Marshall said in his report.

Among Marshall’s 35 recommendations were that “there should be no cash settlements in the accident benefits portion of the Ontario auto insurance system for those benefits specified in the legislation as being for medical and rehabilitation care.”

Forgeron noted Wednesday during the BIP Talk that “most of us in the room likely have group insurance” through work or an association which provides for programs such as physiotherapy and dental care.

“So you may say have $200 annually for physio,” Forgeron said. “I can’t imagine that any of us would ever think of picking up the phone one day and calling Sun Life and saying, ‘You know, I’ve got $200 as a limit for physio but I am willing to settle for $100. Send me a cheque for $100 and I won’t take any physio treatments this year.’ We have that very same phenomenon that takes place in auto insurance.”

Ontario’s Statutory Accident Benefits Schedule was “never intended the auto insurance system to be a cash jackpot,” Marshall wrote in the report. But many auto insurers, Marshall suggested, “are incented to close their liability with as little cash cost as possible and hence they introduce the practice of negotiating cash settlements with claimants in lieu of medical treatment, future wage and other future benefits under the SABS.”

At Wednesday’s BIP Talk, held at the Shaw Centre in Ottawa, Marshall noted that when he took over as WSIB CEO, the organization was losing $900 million a year and had an unfunded liability of $14 billion.

“When I got there, people saw their job as providing compensation,” he recounted. But Marshall suggested that their job was not truly done until the claimant was well.

“You’re got to get that medical care to the person quickly which means you can’t start wringing your hands and doing your research and arguing about what care is appropriate each and every time,” Marshall said. “There’s lots of medical evidence to show that for straightforward injuries, which are 85% or so of auto injuries – they are not complex.”

An insurance system needs “to figure out, what is a package of care that works for most people,” Marshall suggested Wednesday.

Related: Road to Reform

In his report, Marshall recommended that the Ontario auto insurance regulator “should move as quickly as possible to create programs of care for the most common types of automobile injuries.”

In its budget document for 2017-18, released April 27, the Ontario government says it is “reviewing” the 35 recommendations from the Marshall report and it promised to hold consultations.

“There is nothing that I recommended that is revolutionary in itself,” Marshall told IBAO Convention attendees Wednesday. “The problem is that the government has devised a social safety net … but it does not have a mechanism for resolving structural problems and really what you needed is for the government to have a regulator or someone in the middle that is able to understand where the problems are occurring and to resolve them on an efficient basis.”

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Ont. auto accident benefits shouldn’t entail ‘arguing about what care is appropriate each and every time’

Jason Contant