We are in the midst of an unprecedented COVID-19 Crisis, and while everyone is facing challenges, individuals who were already recovering from traumatic injuries face unique challenges.
These individuals are those that were facing devastating life challenges before the global pandemic hit. They were working diligently with rehabilitation providers and caregivers on their way to eventual recoveries. Like everything else in this new COVID world, some of this progress has unfortunately been disrupted by the challenges associated with COVID-19 and car insurers have a significant role to play in minimizing this disruption going forward.
Ontario's car insurers can and should take immediate steps to assist in the coming weeks. Some of those steps include:
A.) Approve all treatment plans during the pandemic. Where necessary, make it clear this is being done on a "without prejudice" basis.
Insurers have stopped all insurer assessments as a result of the restrictions in place. We have clients who have assessments scheduled in the next few weeks that may now be delayed for months. Some of these assessments relate to treatment plans that were prepared several months ago. As a matter of good faith, insurance companies should approve ALL treatment plans that are in limbo and all treatment plans submitted during the COVID-19 crisis. Insurers can approve these goods and services on a "without prejudice" basis and make it clear that the treatment plan will be subject to insurer assessments in the future when it is safe and appropriate to do so. Taking this step will allow accident victims to access care, prevent further deterioration of their health and help avoid arguments of unreasonable delay.
B.) Allow attendant care support to be provided by family members.
In September of 2010, the insurance industry made it extremely difficult to access the attendant care benefit. They did so by largely restricting payment for attendant care services to professional service providers. Back then, insurers were concerned (unreasonably, in my opinion) about family members taking advantage of this benefit. Rightly or wrongly this limitation, which has remained in place for nearly a decade, makes it nearly impossible for family members to be paid for providing attendant care services to their loved ones.
We are now in a period where many professional caregivers are staying home and many victims are not comfortable with outside caregivers in their homes. This has lead to a withdrawal of services for some of the most seriously injured car accident victims who require high level care.
For the immediate future, insurers should agree to unconditionally allow family members to provide paid attendant care services to their loved ones.
C.) Avoid use of the Minor Injury Guideline (MIG) during this period.
The MIG limits the cost of treatments for certain conditions to up to $3,500.00 for medical benefits. The MIG does not apply where an accident victim has a pre-existing condition that will prevent the accident victim from making a maximum medical recovery. The MIG typically starts immediately after the accident and is completed within approximately 12 weeks. Anyone injured in an accident in the next several weeks/months will have a difficult time accessing treatment and will face highly unusual challenges that will likely impact their recovery times. Now is not the time for insurers to rely on the restrictive MIG for accident victims who need help.
D.) Be Flexible.
During these uncertain times we all need to be flexible and avoid rigid business practices. Whether it means accepting an authorization in a virtual manner, communicating by email (where inexplicably the insurer routinely refuses do so), providing flexibility on timelines, agreeing to make electronic funds transfers and much more, now is the time to be flexible and creative.
I have not made the legal case for taking the steps above (though there are some), nor have I made the financial case (though we know that car insurer's costs will be much lower in the coming months). At times like this, we should simply focus on what is moral and fair for accident victims in need.
When the pandemic is over there will be time to take a look at many of the inherently restrictive parts of the motor vehicle accident claim system and how we can all better assist accident victims. Until then, now is the time for Ontario's insurers to be reasonable and flexible and help their insured's who are more vulnerable than ever.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
