IBC recommends $1,500 cap on minor injuries for post PAF treatments

In its recommendations to the Financial Services Commission of Ontario (FSCO), the Insurance Bureau of Canada (IBC) has recommended a $1,500 cap on post-PAF assessments and treatments for minor injuries.

The recommendation was one of 25 made to FSCO as part of the commission’s five-year review of the province’s auto insurance legislation.

IBC suggested that FSCO redefine the accident benefits medical/rehab package for minor injuries as follows:

For injuries defined as sprain and strain injuries, skin wounds and non-extensive burns and/or sequelae pain syndromes and psychological manifestations:

• The first term of treatment for these injuries is the PAF with no additional assessment through the PAF period except on referral of a physician specialist;

• The basic PAF treatment envelope is enhanced by $500 to permit examination/treatment by a social worker /psychologist/psychological associate, if psychological manifestations are present;

• Post-PAF assessments and treatment by all provider types are subject to a hard cap of $1,500.

• Other benefit restrictions applying to this group are: no access to attendant care (as at present); no access to in-home and worksite assessments; and ancillary benefits for housekeeping /home maintenance and caregiver support limited to the first two weeks following the collision.

“The elements of this recommendation address the issues compiled from industry studies and consultations to identify the reasons why the PAF has not lived up to its promise to promote early recovery and cost containment with respect to sprain/strain injuries — despite the PAF’s basis in the scientific literature on the treatment of these injuries and the much more successful use of similar protocols in other jurisdictions in Canada and abroad,” Don Forgeron, vice president, Ontario Region, IBC, wrote.

A complete set of all recommendations by stakeholders can be viewed on FSCO’s web site at: http://www.fsco.gov.on.ca/english/insurance/auto/5yrreview/default. asp. •