Ontario auto insurance companies shortchanging crash victims with outdated rules and fees, health professionals say

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Health care professionals who treat people injured in car collisions say Ontario’s auto insurance rules are shortchanging them and their patients by keeping reimbursements low and unnecessarily draining workplace benefit plans.

Auto insurance is mandated for vehicle owners and heavily regulated by both the provincial government and the Financial Services Regulatory Authority of Ontario (FSRA). The Ontario government has, in recent years, made reform of auto insurance rules a priority, but health care providers, including physiotherapists, occupational therapists and nurses, say progress has been slow.

One major issue is that the amount that auto insurance companies pay for services has essentially been frozen for a decade. The fees are set by FSRA through the professional services guideline and have not been updated since 2014.

The Ontario Rehab Alliance, which represents 4,000 health care professionals who do at least some work with patients injured in auto accidents, surveyed its members last summer and three-quarters said rates from auto insurers were lower than what they earned from other providers.

“The guideline hasn’t been touched, it’s basically been hermetically sealed, since 2014,” said Laurie Davis, executive director of the Ontario Rehab Alliance.

At the same time as revenue has been flat, expenses have gone up. Anthony Grande, a registered physiotherapist and owner of Toronto chain Focus Physiotherapy, said his rent has tripled and salaries have doubled since 2000, while the fee he can get from an auto insurer for a one-hour session has gone up modestly to $99.75 from $84.

“As small businesses, this is hurting us,” he said.

FSRA spokesperson Russ Courtney did not directly answer a question about whether the regulator would consider updating the guideline, but said the fees are minimums and FSRA does not place an upper limit on the amount that professionals can bill. “Insurers are not prohibited from paying above the rates provided in the guidelines,” he said in an e-mail.

Ms. Davis said that while individual adjustors may agree on a case-by-case basis to pay out a fee that is higher than the guideline, by and large it is in the nature of insurance companies to reimburse based on the minimum they are allowed to pay.

“It doesn’t prevent them from paying more,” she said of the guidelines. “Well, right, it doesn’t prevent them from giving all their money away to the poor either, but they don’t do it.”

The Insurance Bureau of Canada said it is focused on working with the government to lower auto insurance rates, and the amount paid to professionals is out of its hands.

“Rates for medical/rehabilitation services under an auto insurance claim are prescribed by the provincial regulator, FSRA,” spokesperson Brett Weltman said.

Another amount that has remained flat is what the auto insurance industry reimburses to the Health Ministry for costs incurred by government services such as ambulances, related to auto accidents. That has been fixed at $142-million a year since 2006.

The Ontario government, which said it had no hand in changing what professionals are charged, indicated it is open to changing the amount it collects from insurers itself.

“The assessment of heath system costs could be considered as part of any potential future reforms,” government spokesperson Scott Blodgett said in an e-mail, referring to the annual levy from auto insurers.

Health providers have also been pushing to change what an insurance plan pays first for treatment after an auto collision. Currently, Ontario requires workplace benefit plans to pay for treatment first, and only when those are exhausted do auto insurers have to pay. Alberta is the only other province with this law.

From the perspective of the professionals, making auto insurers pay first would cut down on the onerous paperwork involved in juggling two insurance providers, Mr. Grande said. But more important, it could mean patients aren’t maxing out their workplace plans, which can affect the treatment they and their families get, as well as increasing the premiums paid by them and their employers, he said.

“The rest of the world doesn’t punish people who have a job when they get into a car accident,” Mr. Grande said.

The Ontario government suggested in its 2022 budget that it was looking at this issue, but it has not made any changes in the past year.

Mr. Blodgett of Ontario’s Finance Ministry confirmed a change to which insurance plan pays first is still on the table.

“As part of its commitment to enhancing fairness the government will review whether automobile insurance should continue being the last payor in an automobile accident,” he said.

Ontario’s next budget is scheduled for March 23.

The government has said its other priorities for reform include giving consumers more options when choosing their insurance plan and holding insurers accountable for tracking and reporting fraud.