Wednesday 27 June 2012

Trial Lawyers Quit FSCO Advisory Committee - Is That A Good Thing?

The Toronto Star reported last week that a group of prominent personal injury lawyers has resigned en masse from an informal legal advisory committee on auto insurance reform in Ontario. The protest action by the trial lawyers was in response to the release by the Ontario Minister of Finance of a report from the Superintendent of Financial Services on recommended changes to the SABS definition of "catastrophic impairment."

The contentious nature of the proposals is the Superintendent’s recommendation to preclude allowing the combination of psychological and physical impacts when determining if someone qualifies as having suffered a catastrophic impairment, in constrast to the Ontario Court of Appeal which recently said it combining should be allowed.

The lawyers contend that the number of accident victims that will meet the catastrophic impairment threshold will fall. I think that is likely undisputable. Unfortunately there isn't sufficient data to make a determination on the numbers. Other changes could possibly increase the number of catastrophic determinations but again there is no way of confirming the numbers.

The group of personal injury lawyers, who include Richard Halpern, partner at Thomson Rogers, Roger Oatley of Oatley Vigmond Personal Injury Lawyers LLP, Nigel Gilby, partner at Lerners LLP and Stephen Firestone of Lackman Firestone, resigned because their recommendations on catastrophic impairment were ignored.

The Legal Advisory Committee was one of several advisory groups set up by the Superintendent to continue the dialogue with stakeholders during the development and implementation of the 2010 auto insurance reforms. These advisory committees were not created as policy or decision making groups and I believe those participating understand that. That doesn't make the process a sham. Nonetheless, there is always an expectation that discussions with senior public servants will influence policy makers. When they don't it invariable leads to frustration.

In my 20 plus years in government, I have conducted many stakeholder consultations and outreach. It is a considerable challenge to manage expectations. My advice to groups has always been to continue dialoguing. Ongoing participation is not a sign of acceptance of the policy direction.

No doubt the trial lawyers feel that their time on the committee is a waste of time and that lobbying efforts should be concentrated elsewhere. My view is that you have a role in ensuring transparency and accountability by continuing to participate.

Monday 25 June 2012

Treatment/Assessment Plan Numbers to Become Mandatory on HCAI Invoices

On November 8, 2011, the Superintendent released a bulletin (A-07/11) outlining changes to the HCAI Guideline to address abusive billing practices including frequent invoices, duplicate invoices, "double dipping" and invoicing for non-approved goods and services .

At the time the Superintendent committed to further changes to the Standard Invoice (OCF-21) that would provide that the “Plan Number” on the form would become a mandatory field. This is the unique number generated by the HCAI system when the Treatment and Assessment Plan (OCF-18) or Treatment Confirmtion Form (OCF-23) to which the OCF-21 refers is submitted, and will enable insurers to properly reconcile invoices.

These changes have now been made and announced by the Superintendent in a recent bulletin (A-02/12).
The updated HCAI system will become available at 8 a.m. EDT on July 3, 2012. At that point, HCAI will begin enforcing the new rules for OCF-21 submissions.

If there is no Plan Number because of a valid business scenario (e.g., the insurer has waived the requirement for an OCF-18 or OCF-23 as applicable) the word “exempt” must be inserted in the Plan Number field and details of the circumstances must be provided in the “Other Information” section of the OCF-21.

FSCO will in the near future be issuing an amended OCF-21 form to address information gaps a regarding Minor Injury Guideline (MIG) claims. These changes will be effective for use on and after November 1, 2012 and will contain the following changes:
  • The amended OCF-21C form will include two new mandatory additional data fields in which the date that the MIG treatment Block commenced and the profession(s) of the health care provider(s) who provided the treatment are to be identified. In addition, use of the OCF-21C will become mandatory for billing all amounts applicable under the MIG. The OCF-21B and OCF-18 will no longer be approved for use with MIG codes.

  • The amended OCF-21 form will also reflect the requirement, already noted above, that completion of the “Plan Number” field in the manner specified in the Guideline is mandatory effective July 1, 2012.

  • In addition, the OCF-21 will be amended to raise the awareness of those individuals signing the form of their responsibility and accountability in doing so.
The revised HCAI Guideline (No.2/12) can be found here.

Wednesday 20 June 2012

Insurance News - Thursday, June 20, 2012

New System To Verify Alabama Auto Insurance Coverage

About 22 percent of Alabama’s drivers don’t have liability insurance, but a new online system could change that starting next year.

The system will allow officials who issue license plates to immediately verify the insurance status of the vehicle’s owner. If insurance can’t be verified, proof of insurance will have to be presented before a tag is issued.

The new system was necessitated by the passage of the Alabama Mandatory Liability Insurance Law, which State Sen. Arthur Orr, R-Decatur, helped sponsor during the 2011 session.

read more...

The new Alabama system is similar to the Unisured Vehicle Project (UVP) in Ontario. The UVP is an initiative that is led by the Ministry of Transportation of Ontario that will provide an electronic means of determining whether a vehicle carries mandatory insurance coverage at the time their license plates are being renewed. The vehicle identification number and mandatory coverage status of each insured vehicle are maintained in a database by Insurance Bureau of Canada on behalf of the insurance industry.

read more...


Driverless Cars Inching Closer To Reality

Last month, Google received permission to test driverless vehicles in Nevada. The state set regulations for the companies before issuing the permit, but before we get to those, there are some obvious concerns that other motorists have about the new technology.

The California Senate has approved legislation that would have the California Highway Patrol develop standards and performance requirements for "autonomous" vehicles to be licensed for testing and operation on public roads.

Building autonomous vehicles that don't cause accidents is a difficult but crucial challenge. It's not enough to be as safe as the human driver. We need to be crashless," said John Maddox, an associate administrator at the National Highway Traffic Safety Administration (NHTSA) and keynote speaker at the Driverless Car Summit in Detroit.

read more...

Sebastian Thrun helped build Google's amazing driverless car, powered by a very personal quest to save lives and reduce traffic accidents.



Driverless car driving through heavy city traffic.




Tuesday 12 June 2012

Superintendent's Report on the Definition of Catastrophic Impairment in the SABS

The Minister of Finance has now released the Superintendent's Report on the Definition of Catastrophic Impairment in the Statutory Accident Benefits Schedule. The Superintendent's report recommends changes to the SABS definition that reflect the two reports submitted by the Catastrophic Impairment Expert Panel as well as consultations conducted last year by FSCO.

The recommended changes if implemented would update the catastrophic impairment definition to reflect current scientific knowledge. The chart below describes the current test and the proposed test for each impairment group covered by the definition as well as the evidence used by the Expert Panel to support the recommended changes.

In addition to changes to the definition, the Superintendent recommends the payment of interim benefits to some claimants awaiting catastrophic impairment designation and automatic designation to other claimants. Only some of the Expert Panel's recommendations regarding the qualifications of catastrophic impairment assessors has been accepted by the Superintendent.

The most contentious recommendation deals with the combining of physical and psychiatric impairments. The Superintendent agrees with the recommendation originally made by the Expert Panel that these impairments not be combined which reverses the direction provided in the 2004 court case, Desbiens v. Mordini. The Superintendent also recommended that the catastrophic impairment definition not allow pain to be quantified as a separate impairment which would exclude chronic pain and fibromyalgia as catastrophic impairments.


Impairment
Current Test
Proposed Test
Evidence
paraplegia and tetraplegia (quadriplegia)
none
American Spinal Injury Association classification of spinal cord injuries
standard in medical practices
literature suggests classification system is valid and reliable
amputations
none
none
clinical and scientific judgment of Expert Panel members
burn and crush injuries to limbs
not covered in SABS
Spinal Cord Independence Measure
clinical and scientific judgment of Expert Panel members
The scientific evidence supports the validity and reliability of the SCIM
blindness
none
Legal blindness

traumatic brain injuries in adults
Glasgow Coma Scale
Glasgow Outcome Scale
Extended Glasgow Outcome Scale
strong psychometric properties and reliable when used with a structured interview and standard scoring algorithm
other physical impairments
whole body impairment rating using American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th Edition
whole body impairment rating using American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th Edition, Chapters 3-13
very little scientific literature supporting use for determining catastrophic impairment but Expert Panel found no alternative rating system
psychiatric impairments
class of mental or behavioural disorder using American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th Edition, Chapter 14
Global Assessment of Functioning Scale
literature suggests scale has adequate reliability and validity
combining physical and non-physical impairments
none but the courts have assigning whole body impairment scores to impairments under Chapter 14 of AMA Guides to allow combining with scores under Chapters 3-13
no combining
no scientific literature to support combining physical and non-physical impairment ratings
The physical and mental/behavioural impairement rating chapters were not developed to be combined
traumatic brain injuries in children
none
King’s Outcome Scale for Children Head Injury
little scientific evidence to support so Expert Panel recommended a study be conducted

Monday 11 June 2012

Insurance News - Monday, June 11, 2012

Assault Victim May Qualifies for SABS Because of Psychological Trauma

The plaintiff was physically assaulted by several unidentified assailants while parked at a gas station sorting his money. He escaped by putting his car in gear and driving away. He believed he may have run over one of his assailants in the course of fleeing. He claimed he sustained psychological and physical injuries as a result of the incident.

This case is revolves on the meaning of subsection 2(1) of the SABS, which defines an "accident" as “an incident in which the use or operation of an automobile directly causes an impairment”. The motion judge granted a declaration that the plaintiff was involved in an “accident” within the meaning of the SABS. The insurer appealed.

The Court of Appeal allowed the appeal with respect to the physical injuries, holding that the physical assault did not constitute an “accident”. The Court held that a trial was required to determine whether the psychological injuries were caused by the ordinary use of a motor vehicle.

With respect to the psychological injuries, the Court held that running someone over could be considered a normal incident of the risk created by the use or operation of a vehicle.

read more...

Louisiana Cracks Down on Uninsured Drivers


A new law has passed in Louisiana, giving the state’s law enforcement expanded authority over vehicles that may not be insured.The legislation, House Bill 1053, was signed into law this week by Governor Bobby Jindal. State officials believe the new law will help law enforcement ensure that drivers are protected while taking to the state’s roadways.

According to the new auto insurance law, officers will now be able to tow vehicles if drivers cannot show proof of insurance coverage on their first offense. State officials suggests that more than 850,000 vehicles are currently uninsured in Louisiana, many of which are likely to have been targeted by citation in the past but were allowed to stay on the road due to faulty laws.

read more...

Top 7 Most Dangerous Cars in America

The Insurance Institute for Highway Safety recently performed crash tests and rated the cars in four separate categories. 24/7 Wall St. analyzed the ratings and ranked the seven most dangerous cars in the country.

1. Dodge Ram 1500
2. Chevrolet Colorado Crew Cab
3. Mazda CX-7
4. Mazda CX-9
5. Nissan Pathfinder
6. Jeep Wrangler
7. Suzuki SX4

read more...

Friday 8 June 2012

Update on Auto Insurance Private Member's Bills

Reducing Automobile Insurance Premiums by Eliminating Fraud Act, 2012 (Bill 41)

Bill 41 was introduced by Mississauga-Brampton South MPP Amrit Mangat to protect people who report insurance fraud. The bill is also intended to ensure that insurance investigators have the proper tools to investigate fraud.

Bill 41 was introduced on March 7, 2012 and passed second reading on March 22, 2012 a which time it was sent to the Standing Committee on Good Government for review.


Insurance Amendment Act (Elements in Classifying Risks for Automobile Insurance), 2012 (Bill 43)

Bill 43
was introduced by
York West MPP Mario Sergio and deals with allowable elements of a risk classification system.

Bill 43 was introduced on March 7, 2012 and has not proceeded yet to second reading debate.


Insurance Amendment Act (Risk Classification Systems for Automobile Insurance), 2012 (Bill 45)

Bill 45 was introduced by
Bramalea-Gore-Malton MPP Jagmeet Singh and also deals allowable elements of a risk classification system and would prohibit auto insurers from using a person’s home address or postal code and any element prescribed by regulation in classifying such risks.

Bill 45 was introduced on March 7, 2012 and was defeated on second reading on June 2, 2012.


New Drivers' Insurance Rate Reduction Act , 2012 (Bill 71)

Bill 71 was also introduced by
York West MPP Mario Sergio and is intended to lower rates for new drivers by crediting new drivers with additional years of driving experience.

Bill 71 was introduced on April 23, 2012
and passed second reading on April 26, 2012 a which time it was sent to the Standing Committee on Good Government for review.

Wednesday 6 June 2012

Standing Committee on General Government Auto Insurance Hearings - Day 2

The following are presentations made on May 30, 2012


City of Brampton
Elaine Moore, Regional Councillor
John Sanderson, Regional Councillor

Why should where you live be the primary determinant of your insurance rates? Brampton has many residents who travel outside of Brampton for employment or school, hence their vehicles spend more time outside of Brampton but their insurance rates are based on their home address.

Conversely; Brampton’s business community, including the corporation of the city of Brampton, has employees with addresses in Guelph, Georgetown, Erin, Orangeville. Their vehicles probably spend more time in Brampton than in their home community, yet these good folks enjoy a cheaper insurance rate. This just simply is not fair or right.

In the areas that Councillor Sanderson and myself represent in Brampton, there are five insurance brokers—all have been located within half a kilometre of each other in the downtown, and they’ve been there for decades. So we have a particular concern for the sustainability of the generational relationships that they have built over these many years. We’ve had many conversations with our local brokers, and they are losing clients for as little as $100 a year in savings. They have had clients return because at the expiry date of their policies their rates have returned or surpassed what they would have paid, had they remained with their broker. Call this what you want, but I call it “bait and switch,” and it’s happening every day. It’s unfair, and it’s wrong. Controls need to be put in place to prevent this practice.

If Brampton residents are hiring paralegals to extract from insurance companies what they believe the policyholder is entitled to, then the industry needs to address this within their operating budgets and stop sending the invoices extract from insurance companies what they believe the policy holder is entitled to, then the industry needs to address this within their operating budgets and stop sending the invoices to recover the costs from the Brampton residents. If some rehabilitation centres are a problem, then deal with the centres.


Insurance Brokers Association of Ontario
Randy Carroll, Executive Director
Bryan Yutman, Past President


The lnsurance Brokers Association of Ontario represents over 12,000 insurance brokers who assist over 5 million consumers across Ontario with their insurance needs. Our priority is to protect the interests of consumers, from the purchase of a policy right through to when they need an independent advocate at the time of claim.

On the issue of broker independence, we take a look at the motion establishing this committee’s study, and it makes reference to the role of brokers and their independence. This is a matter that is fundamental to the IBAO and to the value of the broker channel. One of the key advantages of the broker channel versus the direct writers or agents who represent only one company or market is that brokers are independent and shop the market on behalf of their customers to get the best combination of coverages and price for that consumer. This means that a broker compares coverages from more than one insurance company provider. Typically it’s four or five, but it can be as many as a dozen different markets.

Over the last decade, however, financial linkages between insurance companies and brokerages have begun to increase. These linkages tend to take the form of ownership stakes in some brokerages and/or loans. Of course, this raised flags about conflicts of interest and steerage of business to insurers who had a financial interest in a brokerage.

IBAO took this development very seriously and notably, in 2005, our regulator, the Registered Insurance Brokers of Ontario, or RIBO, took two important actions. First, it required that all brokers disclose any financial relationships to their customers, including their commission rates. Second, it conducted a detailed study on the matter to determine the extent of financial or business relationships with an insurance company and the existence of concentration or steering issues among those brokers.

With respect to the issue of auto insurance fraud and abuse, we want to turn to the specific issues again related to fraud and abuse in the auto insurance product. IBAO believes that this is the single most important thing that can be done to lower claims costs and thus, to lower insurance premiums and that is to tackle fraud and abuse in Ontario’s auto insurance system, particularly in the accident benefits area. IBAO will support constructive recommendations to combat fraud and abuse from all parties in this Legislature. We can’t tolerate the abuse of the auto insurance product any further, as it’s costing the customers we serve too much money, as Ontarians pay the highest auto premiums in Canada. However, we would like to caution against further tampering with the system in the wake of the 2010 auto reforms. Those reforms are only beginning to make themselves felt, and we believe they are working.

We are not here to defend the insurers, but we do believe that any aggressive tampering with the system will threaten market stability which is just starting to get a foothold post reform. Nevertheless, we do believe there are measures that can be taken to deal with unfair pricing practices in the property and casualty insurance market. The measure we are referring to is banning the use of credit scoring in personal property insurance. Almost immediately after the credit ban was introduced in auto insurance in 2010, insurers began to use credit far more aggressively to price people’s property insurance, once again subverting the ban on auto.


Ontario Trial Lawyers Association
John Karapita, Director of Public Affairs
Andrew Murray, President-Elect


The association represents more than 1,300 personal injury lawyers, law clerks and students from across Ontario.

The association, for many years, has suggested when looking at the auto insurance system to focus on the three P's: profits, which is a reasonable return on equity for the insurers; premiums, which of course is fair prices for consumers; and protection, which is fair and appropriate coverage.

If you think of the three Ps as a stool, you cut off one of those legs—any one of those legs—it’s unbalanced and it doesn’t work. In anything that you recommend or anything that gets done as a result of the good work of this committee, please be mindful of the three P's. I would, indeed, add a fourth P, changing it from a stool perhaps into a table, which is predictability.

When a change is made, the law of unintended consequences always occurs and you have uncertainty injected. You’ve tried to help something here and now nobody knows exactly what the rules are and it gets sent back to the courts for years and years and years trying to sort it out.

We’ve just gone through 15 years or more of uncertainty with respect to certain issues pertaining to catastrophic impairment. Not long ago, the court of appeal in Ontario, our highest court in this province, provided great clarity to a lot of those issues. If we were to now make some changes that have been suggested, it would essentially throw out 15 years of hard work in the trenches, coming to terms with what are the rules of engagement. I would really try to dissuade anyone from doing that because it would not help.

We should suspend the introduction of restrictions on the definition of catastrophic impairment. There had been a lot of talk of that back in the fall, following the release of an expert panel report. We said, instead, we must focus on eliminating the backlog for mandatory mediations at the Financial Services Commission of Ontario because it is one of the most significant impediments, on both sides, to having a resolution of disputes in the system.

The expert report led to the superintendent, apparently, making some recommendations directly to Minister Duncan. That’s referenced in the budget announcement from back in March. It’s been at least that long that the minister has had that report from Phil Howell, and it has never been released publicly, and we don’t know why. We’ve called for its release, and I would hope that this committee calls for its release.

There needs to be an analysis of the impact of the changes that were made in September 2010 to the accident benefit schedule. Because until we know how those changes have filtered their way down in the system, we don’t really know whether there is a need to make further changes. There needs to be better anti-fraud measures taken in the system.


Ontario Safety League
Brian Patterson, President


The Ontario Safety League has been the chief public safety advocate in the province of Ontario for almost 100 years.

The public perception with respect to automobile insurance and its impact on homes and individual participants in the system leads me to one very significant conclusion, and that is that the general education level of the public with respect to what they’re buying when they’re receiving their insurance and what they’re going to receive when, in fact, they have an issue is significantly—there’s a significant education deficit among the public on what they’re purchasing with respect to insurance.

I know from those who are involved in the investigation of insurance fraud that between 40 and 60 major files are opened every month in this province, involving people who have actively targeted the insurance industry. In my mind, those are the thieves who go through the back door of your house when you’re not at home and steal directly from you, and all of us are paying.

Our concern is that right now—I know it’s limited time, but the issue we have is that the most vulnerable citizens in this province are often those with post-traumatic crash. The two areas that I think you should spend some focus on are the GCS, the Glasgow coma scale.

The other area is, of course, traumatic brain injury. A lot has been done with regard to engineering in vehicles, but we still have traumatic brain injury that results directly from an automobile crash involving two automobiles. If you look to the changes that are currently proposed, the resources in some areas of the province are non-existent. It will limit the likelihood of a victim to be brought into the catastrophic category, and in some areas of the province, they’re non-existent. To get someone into a recognized neuro-trauma rehabilitation centre, there are only a limited number. They tend to be in southern Ontario and they are not available for access.

Without a dedicated fraud unit you’re not going to be able to proceed effectively. These are complicated cases. You want to have dedicated resources because, in fact, there are a number of areas, both administrative and criminal, involved in this.


Alliance of Community Medical and Rehabilitation Providers
Nick Gurevich
Patricia Howell


The Alliance is a collection of 90 member practices, health care providers in the province of Ontario. Many of them conduct work within the auto insurance sector. The vast majority treat injuries that are not minor in nature; they are serious injuries.

After the last set of changes, implemented in 2010, benefits have been slashed by over 70%, to a point where Ontario now has the second worst auto insurance health care coverage in Canada.

We’re in complete agreement with fighting fraud. What we are not in agreement with is the steps taken to address the symptoms rather than the root cause, resulting in an imposition of a collective punishment of all victims.

A word of caution: New measures intended to fight fraud must be precise and focused. There cannot be measures introduced that will have the effect of imposing new barriers to victims to access services or prevent health care providers from delivering them.

Let’s admit that we made a mistake a couple of years ago when we cut the non-cat benefits so drastically. Let’s put those $100,000 plus assessment costs back in the system. The pediatric brain injured population have legitimate long-term needs and $50,000 is not nearly sufficient. It will run out in less than a year.

Let’s also admit that we made a mistake around when we revamped the IE system a couple of years ago. This is one of the root causes for the escalation in applications for mediation. Of course denial rates for treatment have skyrocketed. For your information, they’ve gone from 11% of treatment plans denied before the changes were introduced in 2010 to, now, 42% of treatment plans are denied.

The FSCO Catastrophic Impairment Expert Panel had some good suggestions. For example, they introduced the notion of interim catastrophic designation. So a way that someone could be qualified as catastrophic early on and then later reassessed if that’s appropriate. That was a great idea. However, there were many, many basic premises in the expert report that need to be revisited.


Baron Insurance Services
Barb Addie


I am an actuary and have been a fellow of both the Canadian Institute of Actuaries and the Casualty Actuarial Society since 1983. I began work in 1979 and have been actively involved in Ontario auto insurance since.

Return on equity went up slightly between 2010-2011 from 7.6% from 8.0%. What this does not tell you is that personal lines insurers have, over the last five years, had returns on equities sub 4%.

Ontario auto results: I’m sorry, from an actuarial point of view, it is just much too early. For the bodily injury claims, right now we know about 5% have been paid and 50% to 60% of the claims that will ultimately be paid are unreported. If the MIG holds, the reforms may well be more effective than the actuaries had originally estimated. The original estimate was 32% of claims. It may well be closer to 40%.

The next area I wanted to direct you to is return on investment. Iif you look at the yield for 3-to-5-year bonds it’s gone from a high of 11% in 1991 down to slightly less than 2% in 2011. For P&C insurers, this is a massive issue. Approximately 83% of their investments are in bonds, and a high percentage of those are in government bonds. Insurers take huge risks with underwriting insurance, and they tend to have conservative portfolios to offset the insurance risks they’re taking on.

From an economic perspective, the rate of return on equity that achieves the goals that FSCO has set apart is the cost of capital. If insurers are receiving their cost of capital, consumers will pay the lowest possible rates in the long run and investors will make their expected returns. If the ROE is too high, investors earn more and consumers pay more, however, in the medium term, the rates would decrease as the P and C insurers with their 80-plus competitors are very competitive. They will bring down the rates or else they will lose business. If the ROE is too low, consumers benefit in the short term, but in the longer term firms either leave the market in search of better returns or rates will have to increase. There’s no magic to it.

If the territories were removed, because there’s such a significant difference in what happens between territories, people who live in territories where it is underrated would find that they might have a supply problem. As an insurer, why should I knowingly put a risk on my book that is underrated? If I do that, I’m being unfair to my policyholders because I’m impairing my solvency, and I am being unfair to my shareholders because I’m impairing profitability. I cannot, in good conscience, put that risk on my book. What do I do? If I’m a broker company, I cancel all my brokers in those areas. I can’t take that. If I am a direct writer, I’m going to have to go to FSCO and say, “I will write in this area because I cannot put that badly an underpriced risk on my books.”

The whole concept of a rating structure is to match risk and rate. If I arbitrarily choose to take out a variable that I know to be very predictive, then I am not matching risk and rate. I am putting underpriced risk and overpriced risk in my book.


Dr. Milan Unarket, Physiatrist
Dr. J. Douglas Salmon, Neuropsychologist


One of the comments I wanted to make regarding the Catastrophic Impairment Expert Panel is on the GCS. The GCS, the level of how unconscious you are after a brain injury, although it has flaws, is very widely used and it’s done by paramedics, done by nursing; it’s done by and during the trauma centres, done even in in-patient rehabilitation. GCS is still not a bad predictor of injury severity. Basically, even though there are some better predictors of injury severity, it’s something that widely used and should probably still continue to be used to deem whether someone is catastrophic or not in brain impairment because it’s something that can be done quickly and easily, it’s accessible and it’s done very widely.

One of the recommendations was that those who are admitted to an in-patient rehabilitation get an automatic catastrophic designation. That’s a good idea, but there are a lot of people who have brain injuries who just don’t get access to in-patient rehabilitation.

The change that was made in 2010 is that all the assessments that are done are also of that $50,000 medical and rehabilitation limit. It actually significantly impacts on someone’s treatment. So if you have $6,000 or $8,000 in assessments or $10,000 in assessments, that’s 20% of someone’s treatment. That’s 205% of $50,000. That significantly impacts. That further reduces the amount of money available.

I do have concerns about the expert panel recommendations, particularly with respect to the combination of physical and psychological impairments as well as changing the mental behavioural definition. Both of these will clearly, dramatically decrease the number eligible victims who will be eligible for catastrophic designation.

I also have concern with respect to the lack of clarity in the MIG relative to the inclusion of mood, anxiety and other mental health disorders with respect to what levels of severity are considered to be in or outside the MIG. Lack of interpretive definition, which will eventually come through case law—it’s still potentially many months to years away. And without this clarification, obviously both insurers as well as IE providers have a certain sense of confusion, lack of clarity and, as such, there will be many denials and lack of mental health services provision on that basis.

I also have concerns with respect to the insurer buy-up option. It’s understood that the buy-up has been very poorly undertaken by most consumers so far. That leaves folks greatly exposed. As well, within the buy-up, there’s no option to actually buy up relative to the MIG.

The removal of the DAC structure in 2006 basically removed the impartiality, the neutrality and the evidence-based assessment system. Other colleagues have already commented on the importance of and the stress and pressure on IE examiners relative to the relationship between an IE assessment centre and the IE. With a $2,000 cap, as well, there are significant, added cost-related pressures that have resulted in increased use of inexperienced new graduates and the like within the system.


Catastrophic Impairment Expert Panel
Dr. Pierre Côté, Chair


I am an associate professor of epidemiology at the Dalla Lana School of Public Health here at the University of Toronto and a scientist within the Division of Healthcare and Outcomes Research at the University Health Network.

The overarching goal of the panel’s work was to ensure that the individuals who are the most seriously injured in traffic collisions are assessed according to the best scientific and medical evidence. The expert panel included an independent multidisciplinary team of internationally renowned clinicians and scientists who are highly skilled in the evaluation of impairment and in scientific methodology.

With regards to the definition of catastrophic impairment, the expert panel was given two functions. First, to identify ambiguities and gaps in the current SABS definition of catastrophic impairment and to use emerging scientific knowledge and judgment to make recommendations for changes in the definition. In other words, the expert panel was asked to review the scientific evidence to modernize the definition which was initially developed in 1996 and to improve the accuracy of the determination of catastrophic impairments following traffic injuries.

All our recommendations were developed following an established methodology called the Delphi methodology which is a well-accepted scientific method to develop consensus statements in medicine. According to our methodology, consensus was reached when 75% of the panel, that is six out of eight members, agreed with the recommendation.

The expert panel proposed 10 main revisions to the current definition of catastrophic impairment. The panel reached consensus on all recommendations. The panel spent a great deal of time and energy to ensure that children with traumatic brain injury are assessed and managed according to state-of-the-art criteria and in a timely manner.

Saturday 2 June 2012

This may have been one of the most expensive crashes ever

The collision, involving a Bentley Azure (worth an estimated $400,000), a Mercedes S Class ($120,000), a Ferrari F430 ($230,000), an Aston Martin Rapide ($230,000) and a Porsche 911 ($130,000), occurred in front of Monaco's Place du Casino.