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It's Covered

Ontario's insult to injury Add to ...

An Ontario driver has asked me what insurance coverage and limits there are for personal injury from a car accident.

The answer is twofold, as coverage Ontario drivers have now will be greatly reduced when the new auto insurance policy comes into effect.

Presently, Ontario has superior coverage to every other province. But after Sept. 1, it will be inferior when it comes to the treatment of minor injuries resulting from a car accident. The Ontario driver's coverage for medical and rehabilitation limits will be cut in half, from $100,000 to $50,000.

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But that's not the biggest bomb that's about to be dropped.

No, the bigger bomb is the cap of $3,500 that's being placed on the treatment of minor injuries. Even if you need further medical treatment, you will not have access to the remaining $46,500 of coverage you paid for.

Insurance companies lowered coverage from $100,000 to $50,000 to give Ontario drivers a break in their premium. But this cap is actually reducing your coverage for minor injuries from $100,000 to $3,500. So how much premium is exactly being saved by the Ontario driver - and at what consequence?

This cap may be the breaking point for the Ontario driver's confidence in the government and insurance industry regarding their level of concern to provide adequate medical coverage for drivers injured in car accidents.

Both the government and insurance industry are well aware that $3,500 is insufficient to treat minor injuries. The average claim made by Ontario drivers for rehabilitation in 2008 - as reported by the Insurance Bureau of Canada - was $42,217. Although this number takes into account all injuries - from mild to serious, including catastrophic - it's safe to conclude that most injuries are minor.

Given the average claim exceeds $40,000, capping treatment for a minor injury at $3,500 appears to be a savings for the insurance industry, and a serious handicap for the Ontario driver.

A minor injury will be defined as a sprain, strain, whiplash disorder, contusion, abrasion, laceration, partial dislocation of a joint or organ, and any pathological condition resulting from an injury, or trauma. Additionally, age isn't addressed. A minor injury to a 25-year-old is not so minor to a 70-year-old.

Further, a major injury can initially appear minor, like whiplash, muscle or a ligament tear, leaving the injured subjected to an arbitrary limit of $3,500 for rehabilitation, regardless of whether or not they require the full limit of the $50,000 that they have already paid for to get better.

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Adding insult to injury, there's no formal process in place for a person to qualify for the additional $46,500 if their so-called minor injury is actually serious, other than pursuing legal action.

Ontario drivers have the option of buying back their coverage to $100,000, but the cap of $3,500 for treating minor injuries remains in force.

Coverage varies from province to province. Alberta and New Brunswick have a $50,000 limit for accident benefits, but with no cap for minor injuries. P.E.I., N.W.T. and Nova Scotia have $25,000. In Newfoundland and Labrador there is an option to purchase $25,000 in coverage, while the coverage in Yukon is at $10,000. However, nowhere are there "Caps for Minor Injuries" in any of these provinces.

Ontario drivers are about to have the poorest coverage in Canada for treatment of minor injuries from auto accidents.

"These caps will be devastating. Those that require treatment will be subject to the insurance's definition of minor and may not be able to receive all the treatment they require," says Jeremy Diamond, a personal injury lawyer at Diamond and Diamond. "Furthermore, if the insurance company's doctor pegs your injury as minor, an excessive amount of expense and litigation will be needed to extract you from that category. If you require immediate treatment after your $3,500 cap is exhausted and cannot afford out-of-pocket expenses, you will be left waiting for treatment - which often makes the injury worse. Basically, the average person that gets injured will suffer waiting for their claims to be reviewed as the lawyers spend years trying to figure out the new definitions and guidelines."

If you'd like to add your comments as to why you believe the $3,500 arbitrary cap should be eliminated, go to romanovreport.com and I'll attach your comments to my letter of concern to the government.

Other coverages being affected Sept. 1 are:

  • Attendant care, for non-catastrophic injuries, is being reduced to $36,000 from $72,000 in coverage.
  • House keeping and caregiver expenses are all gone, unless the injuries are deemed to be catastrophic.

These benefits will only be provided if you pay extra for them. The question is: Will they be sold back for the amount equal to what you're paying now?

But the most explosive fact remains that the Ontario driver has not been given the option of buying back no cap coverage for minor injuries. If this is all about the insurance company saving you money, then why have you been blocked from buying this coverage back?

This new insurance policy offers nothing new and is a ticking time bomb for Ontario drivers when they will need their medical coverage the most.

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