Drivers in Ontario, Canada, are discovering that due to changes in auto insurance, if their doctors prescribe rehab after a car accident, the associated costs may not be covered by their policies.
The brain injury clinic director from St. Michael’s Hospital in Toronto, Dr. Donna Ouchterlony, explained that there have been a growing number of declined claims for treatment plans by insurance companies.
She explained that this is having a very deep impact and that “They no longer have to have a doctor review [in order] to refuse [treatment].” She went on to say that individuals representing the insurance company, such as adjusters, who have been provided with very little training, have the authority to turn down a policyholder’s request for payment even after a certain treatment has been prescribed by a specialized team of experts.
Ouchterlony stated that while they are required to have medical justification for the denial for coverage, the adjustors are not doctors, nurses, or any other type of individual with a professional medical background.
Some are estimating that the percentage of refused claims could be as high as 40 percent.
A new auto insurance regulation was introduced by the Ontario government in September 2010, in an effort to cease the problems with rising premiums and fraudulent claims. The cost of fraud alone has been estimated at over $1 billion per year within that province.
Though the coverage level for what is considered to be a catastrophic injury is still at its previous figure of $1 million, it is the non-catastrophic injuries that have seen slashes by 50 percent, and are now $50,000. Minor injuries now have a $3,500 cap.