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These benefits, such as income replacement, clinical rehabilitation, attendant care, caregiver and housekeeping expenses, cost the equivalent of $385 per insured Ontario vehicle in 2007.
That was 35 per cent more than in 2004, and was far beyond the near $37 per vehicle spent in Alberta and $84 in New Brunswick, according to the Insurance Bureau of Canada.
It seems accident victims here will fight hard to collect those benefits. Even when insurers successfully deny payments, they incur costs.
Consider the case of Kannan Kaneshan, who returned to driving his transport truck three days after a 2006 collision left him with a neck too sore, he claimed, to care for his children or keep house for an entire year.
The year's worth of weekly benefits he sought would have cost about $20,000. He also sought payment for eight months of rehabilitation treatments – well beyond the number and duration set out in a pre-approved framework for mild neck injuries.
Coachman Insurance Co. refused to pay any of it and an arbitrator has now endorsed its position. But the insurer still had the expense of assorted physical and in-home assessments, three days of surveillance, legal fees and more.
There are many other cases where insurers have been criticized for not paying benefits – they aren't always right. But arbitrator Robert Kominar ruled July 30 after holding three days of hearings in April that Kaneshan exaggerated his symptoms, his inability to help around the house and the amount of time he normally spent doing chores and caring for his children.
"I find that it is completely implausible to conclude that Mr. Kaneshan could continue to drive a transport truck full time but that he was unable to occasionally drop his children off at school," Kominar wrote.
The arbitrator observed that a young chiropractor who supported Kaneshan's claims and ongoing clinical treatment had relied too heavily on the patient's own reporting of symptoms.
Instead, Kominar accepted the view of a chiropractor hired by Coachman who concluded after doing some tests that the pain, while likely still present, was "not in any way disabling."
Auto insurers point to the cost of medical assessments as one reason their costs are soaring. A coalition of health professionals has retorted that insurers are slow to approve assessments, are arbitrary in their denials and rely on inexperienced assessors whose reports often do not stand up to rebuttal.
But, while assessment costs have risen nearly 57 per cent in three years, the total of $313 million in 2007 would obviously not be a big factor in whether insurers lose money or raise premiums.
More interesting to know is whether the pre-approved framework treatment is used as often as it should be. A survey conducted by health professionals found opinion was divided about whether it's used more or less than half of the time. Meanwhile, a new industry-sponsored system of collecting statistics on treatment of injuries has been a flop.
We can hardly wait to see what the province comes up with to address the thorny issue of rising accident benefit costs.
James Daw, CFP, appears Tuesday, Thursday and Saturday. He can be reached at Business, 1 Yonge St., Toronto M5E 1E6; at 416-945-8633; 416-865-3630 by fax; or at jdaw@thestar.ca by email.
