New Changes
EFFECTIVE MARCH 1, 2006: "THE END OF DACS"!!!!
Dramatic changes to the "no-fault' benefit system were enacted by the Liberal government of Dalton McGuinty. It is feared that the changes will make it much harder for injured persons to access treatment, and gain benefits without having to resort to costly disputes or giving up entirely.
Some of the changes are as follows:
- For any benefit you want to be paid, you will likely need your doctor or health practitioner to complete a disability certificate to confirm that you need the care - and such certificates have to be done at the time of each benefit application
- the insurer can ask for a medical examination by their own doctors in response to any benefit claimed by the injured person
- the injured person is now faced with demands for information that has to be provided within very short timelines to avoid forfeiture of benefits
- the injured person's doctors can do a rebuttal report to each insurance medical - at the insurance company's expense - but the rate of pay is less than most doctors would likely charge. The rebuttal is not binding, and the insurer is not obligated to pay benefits.
- simple things like prescriptions have to be set out on specific forms, and may trigger an insurer right to their own medical examination.
The Liberals have created a bureaucratic nightmare for injured persons that will do nothing to help them recover, or sustain themselves while trying to heal and return to work.
EFFECTIVE OCTOBER 1, 2003 !!!!!
There has been a lot of news about the Ontario car insurance system lately. Specific details of what those changes mean to injured persons is often not mentioned. Here are some of the things that affect you as an injured person:
Note: the following changes, except where noted remain in effect at present, despite the election results. The Liberal government has enacted further regulations to apply to accidents occuring in April 2004 and later, and further changes are anticipated shortly. See headlines for a link to the latest regulation. We will be providing a summary of the latest changes shortly.
FOR ALL ACCIDENTS - before or after October 1st
Insurance Medical Examinations: Insurers often used this right to arrange examinations with insurer-friendly doctors and others who would minimize your injuries, or declare you fit for work despite your ongoing problems. The insurers rights have been curtailed somewhat - they must provide you with advance notice of what examinations they are requesting and what benefit the examination pertains to. They cannot arrange for an IME to comment on your right to medical or rehabilitation assistance (such as vocational rehabilitation) unless you are at the mediation stage of proceedings.
Medical Assessments at your request: prior to October 1st you had a right to arrange for an assessment by a health practitioner of your choice at the insurer's cost in circumstances where it was reasonable to determine your need for a particular treatment or other benefit. This was often helpful to counter medical reports by the insurance company doctors. Such reports though can be costly. Now, to get such an assessment, the health practitioner you choose must complete a request form (you will have to pay for that), and if the insurer doesn't agree, a DAC will conduct a written review to decide if the insurer must pay for you to have the requested assessment.
Designated Assessment Centres: There is a new procedure if you want a DAC assessment. Before, the insurer would be obligated to choose the closest one to your home. Now you and the insurer have two days to agree on any DAC location, and if you can't agree, the insurer must send a form into the Financial Services Commssion who will then decide which DAC you will have to go to. In Toronto, this can be within 30 km of your home, while elsewhere in Ontario, this can be within 50 km of your home. DAC's may be eliminated if a draft regulation introduced by the government is passed (Dec/04).
Stoppage and Repayment of Benefits: When insurance companies want to stop paying your weekly benefits, they have to provide you with written notice and the opportunity for you to be assessed by a DAC. You would be entitled to continue to receive your benefits in the meantime. If the DAC said you were no longer disabled, the insurer could only stop payments from the date of the report. The rules have now changed, so that you could be liable for repaying all benefits paid between the time you first received the "stoppage" notice and the date of the DAC report. Therefore, even though you are struggling to get by and pay your bills with the weekly benefit cheques, the opinion of a DAC may mean that you will be hit with a large debt.
FOR ACCIDENTS ON OR AFTER OCTOBER 1, 2003
Time limits for claiming benefits: under the old system you had 30 days to report any benefit that you wanted covered. This has dropped to 7 days. Now reimbursement of expenses, or requests for payment of benefits will have to be made immediately. You can no longer sit on prescription receipts or other costs
Treatment for Whiplash Injuries: The Financial Services Commission has now issued guidelines (which are really rules that will likely be followed by courts and tribunals) that determine what kind of treatment the insurer has to pay for if you are diagnosed with Grade 1 or 2 whiplash. These guidelines set out the maximum number of treatments you can have and other expenses. Insurance companies cannot arrange "insurance medical examinations" for injuries that fall under this guideline.
Examinations under oath: this is a new and very invasive procedure to the accident benefit scheme. Just by applying for benefits, your insurer can require you to attend an examination before a court reporter to testify about your injuries, and anything relevant to the benefit that you are claiming.
Greater difficulty in recovering pain and suffering compensation from the negligent driver: The Tory government made two fundamental changes before losing the recent election, and unless the Liberal government revokes these, there are two critical changes that have been made: The deductible (or reduction from the fair value) for such claims is increased to $30,000. As well, the threshold test for proving entitlement has become much more complicated and will no doubt deny pain and suffering compensation to many seriously injured accident victims. The deductible won't apply to pain and suffering judged to be worth more than $100,000. If you do meet the new "threshold" you can sue for medical and rehabilitation expenses over the limit offered by your own insurer - but the threshold appears so difficult to meet, it will be very hard for most victims to take advantage of this change.
Drop in income replacement benefit: For policies issued commencing in 2004, the maximum payable is reduced from $400 to $300 unless you have purchased optional coverage. Note - this regulation was revoked by the Liberal government shortly after the election, so the maximum benefit remains at $400 for the time being.
