Ontario's 2015 budget proposes many changes that will
drastically cut statutory accident benefits. You had better be
prepared to purchase optional benefits because the basic coverage
is not going to be very beneficial if you are involved in a serious
accident.
Here are the proposed changes:
1. Medical/rehab benefits will be $65,000 (from $50,000) but
will include attendant care. There will be an option to purchase
increased coverage to up to $1 million;
2. Medical/rehab benefits that are currently available for 10 years
will be reduced to 5 years for all claimants except for children
and catastrophic impairments;
3. For catastrophic claims, the $1 million medical/rehab benefit
will include attendant care. There will be the option to purchase
an additional $1 million for a total $2 million coverage;
4. The non-earner benefit will be available right away with the six
month waiting period removed but it will only be available for two
years after the accident;
5. Goods and services that are not specifically listed in the
Statutory Accident Benefits Schedule will only be payable if they
are "essential" and agreed upon by the insurer.
Currently, they have to be "reasonable and
necessary";
6. Updating the definition of catastrophic impairment (CAT) with
the following proposed updates:
a) paraplegic or quadriplegia: revise the definition with updated
detailed criteria and new diagnostic tools;
b) total and permanent loss of use of an arm or leg: revise the
definition with detailed criteria and new diagnostic tools dealing
with impairment of ambulatory mobility;
c) total blindness: update the definition by adding reference to
20/200 visual acuity threshold (legal blindness);
d) traumatic brain injury: for adults, eliminate Glasgow Coma Scale
(GCS) and adopt the Extended Glasgow Outcome Scale (GOS-E) as the
clinical assessment tool; for children under age 18 adopt the use
of King's Outcome Scale for Childhood Head Injury (KOSHI) as
the clinical assessment tool;
e) allow for automatic CAT designation of children in certain
cases;
f) mental and behavioural impairments: revise the definition to
include updated detailed criteria and new diagnostic tools;
and
g) combination of impairments: for other physical impairments not
listed retain the current definition and adopt a new diagnostic
tool (6th Edition of AMA Guides to the Evaluation of Permanent
Impairment) for quantifying mental and behavioural impairments for
the purposes of combining.
Given all of these cuts, accident victims are going to need to rely
on the court system in efforts to recover their lost medical and
rehabilitation expenses. However, unfortunately the budget also
proposes amendments to the Insurance Act that includes increasing
the tort deductible from the current $30,000 on court awards for
pain and suffering to reflect inflation and will be linked to
inflation in the future. Similarly, the monetary thresholds for the
vanishing deductible ($100,000 for pain and suffering and $50,000
for the Family Law Act claims) will also be increased to reflect
inflation. However, accident benefits paid by the insurers are not
being adjusted to reflect inflation.
High income earners are in a better position and can afford to
purchase the optional benefits so that they have sufficient
accident benefits coverage, but what about everyone else who cannot
afford these optional benefits? They cannot afford the extra
expense of optional benefits and likely will not have the medical
benefits available at work. What are these people going to do?
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