By Ruth Wilcock, Executive Director, OBIA

It was only less than a year ago that the new Ontario Automobile Insurance Legislation took effect and, as a result, some accident benefit claims were drastically reduced. Among the most notable was the decrease in medical rehabilitation benefits being reduced from $100,000 to $50,000, caregiver benefits were eliminated for basic policies and attendant care benefits reduced from $72,000 to $36,000 for non-catastrophic cases. Each insurance policy holder received a notice in the mail from their insurance company noting that changes were coming to their policies. The letter that I personally received announced that I now had more choices when it came to my insurance. Indeed, this is true. I can choose to pay more for the same benefits that I previously received.

Furthermore, my letter stated in bold that there were some reductions in benefits but to minor injuries only. The average person may simply shrug this change off, as it only applies to minor injuries. However, those who work in the field of brain injury or who are survivors and/or caregivers of brain injury know that a moderate to severe brain injury is not a minor injury. We know that a person under this new legislation who sustains a brain injury will not be receiving the medical rehabilitation benefits that they were previously entitled, and as a result, the level of care and chances of positive outcome may be reduced. Nonetheless, the changes came into law and we have had no choice but to work with and deal with them. However, a document came across my desk in April of this year with yet another proposed change to Auto Insurance Legislation which, if passed, will again be detrimental to the quality of care that one may receive if they sustain a brain injury. On April 8th, FSCO released its final report of the Catastrophic Impairment Expert Panel and their recommendations for changes to the definition of catastrophic impairment. The proposed changes are covered in a twenty-five page document and, if you wish to review the report, it can be found at: www.fsco.gov.on.ca/english/insurance/auto/reform/Cat-Erratum.pdf. In theory, there are changes that may prove to be positive.

However, OBIA has grave concerns regarding several of the changes being proposed to the catastrophic (CAT) definition and the impact it will haveon those who are seriously injured in motor vehicle collisions. I would like to highlight two of these. 1. The panel is suggesting that physical and psychiatric impairments not be combined for the purposes of the CAT definition. The proposed change to the definition would require any impairment or impairments arising from traumatic brain injury, that could be classified as psychiatric, to be evaluated using the adult definition of CAT and not the Whole Person Impairment. This is completely discriminatory for brain injury survivors who may not fall into the severe disability, upper or moderate disability, lower criteria on the Glasgow Coma Outcome Scale-Extended. There is no reason why a brain injury survivor who sustains a mild to moderate brain injury resulting in psychiatric symptoms, along with a physical impairment should be excluded from being able to combine impairments.

2. In order for a brain injury survivor to be deemed catastrophic they must be accepted for admission into an inpatient neurological rehabilitation program. This suggestion is flawed in several ways. First, there are only 109 inpatient rehabilitation beds in the entire province of Ontario. It is our contention that the proposed changes will only increase the already long wait times for treatment on an already stressed system. Second, OBIA has members who have never spent a day in an inpatient rehabilitation facility but have severe brain injuries that meet the current definition of CAT. In our current system we know that people are falling through the cracks; under the proposed change this will become an even wider crevice. I think of one of our members, whose name is Tom. Tom was in an automobile collision several years ago. Tom was taken to the hospital on the day of his collision but was released that very day. Tom began to experience numerous difficulties after the accident and two years post injury was deemed to be catastrophic. Tom did not even stay overnight in a hospital and certainly was not accepted or admitted into an inpatient neurological program. Let me now share with you Tom’s perspective on his injury.

In Tom’s Words:

I can’t imagine how my life would be if I didn’t receive the catastrophic designation from the insurance industry. It put me on a different playing field because lawyers, clinicians and insurance people all recognized the term and the severity of the effects of my injury instantly. That it was conducted by an independent panel gave the distinction weight and credibility that was easily communicated. My family and I went through extreme financial difficulties because I was the wage earner and my wife was a stay at home mom. Thankfully I had benefits as a teacher but my long-term disability benefits were capped at 60% at what I was making at the time of the accident. I could go into a long description of the teacher pay grid but I think it is suffice to say that it was not enough to keep a family of six going. The ongoing therapy that has helped to get to where I am now would also not have been available to me and I am certain that I would not have made as much progress as I have without it. A special circumstance that I had was that I lived in a rural setting and a huge amount of my insurance money went towards transportation. When I was finally able to mediate my settlement, the amount I received did not recover everything I lost due to the accident that was not my fault but it will allow my family to live a reasonably comfortable lifestyle. If I had been forced to return to work full time, I would have been fired and would have not been able to support my family at all. The stress over money and dealing with the insurance industry almost destroyed me as it was but with the catastrophic designation returning in my favor, there was hope that I would be treated fairly. There were times where my mental health, also affected by my injury, left me considering difficult options. If I hadn’t had the benefits that a CAT designation gave, I might not be here today.

Under this proposed new definition, Tom and many others like him will never receive a catastrophic definition. I shudder when thinking of what will happen to these survivors of brain injury. OBIA will continue to work hard along with others to call into question and give input to the proposed changes to the definition of catastrophic impairment.