Reforming Medical Assessments for Automobile Insurance Accident Benefits

Earlier this year, the Ontario Government announced in its budget the intention to reform a number of areas of Ontario’s automobile insurance system. The budget stated that the province will seek to “reform the flawed medical assessment process to bring credibility and accountability to the assessment that injured claimants must undergo after an accident.”

The Ministry of Finance, Financial Services Policy Division has been consulting with key stakeholders and it appears that it is only a matter of time before specific changes are announced. Many of the proposed reforms in the budget raise concerns as to whether they will truly improve the system and provide an effective and fair statutory accident benefits system for those injured in car accidents in Ontario. There is likely general consensus amongst all stakeholders that the current system can be improved. The amount of red tape currently involved in SABs system is costly and inefficient. Accident victims are incurring significant expenses in order to establish eligibility for benefits and insurers are spending significant dollars to evaluate these claims.

One proposed solution is the implementation of a standardized medical assessment process, the purpose of which would be to provide a reasonable and credible assessment of the injured person’s entitlement to accident benefits. The government’s goal is to create an assessment system based on the principles of credibility, neutrality and accountability.

• Credibility would be created by restricting the assessors to qualified practitioners that have demonstrated the required training, experience and expertise in diagnosing and treating these injuries.
• Neutrality would be established by having a system of independent practitioners who generate impartial and unbiased reports.
• Accountability would be achieved by holding participants accountable and enforcing consequences for any misconduct.

At a high level, it’s hard to quarrel with these desired outcomes, but the details have yet to be unveiled. This province’s proposal sounds very much like the previous Designated Assessment Centres (DACs) which were created by a previous government. In the end, DACs were abandoned as they became costly and failed to improve the accident benefit system.

Many stakeholders in the auto insurance industry are understandably skeptical with respect to yet another round of changes in accident benefits. Many believe that establishing a formal assessment system will simply repeat the mistakes of the past. However, these changes are likely inevitable and we await the details with great interest. In the mean time, we can only hope that the Government will consider and implement other changes proposed by the stakeholders, which will make statutory accident benefits more accessible on a reasonable and fair basis to those who need them and affordable to those who pay insurance premiums in Ontario.