Toronto, Ontario – Insurance companies in Ontario are turning down an increasing percentage of requests for the assessment and treatment of serious injuries sustained by motor vehicle crash victims, according to a new survey.
The survey, spearheaded by the Alliance of Community Medical and Rehabilitation Providers, found that 42 per cent of requests of treatment are now being rejected, up from 11 per cent prior to the government’s changes to the insurance system in September 2010, a jump of 282 per cent. The survey looked at 1,143 rehabilitation providers, including 889 sole practitioners and 254 company/practice owners.
The denial rate for initial assessment is now also 42 per cent, compared to 27 per cent a little more than a year ago. For those who want to challenge their insurance company’s denial, the wait is now at least a year for mediation, and in some instances, two years for arbitration. “Literature clearly shows that rehabilitation is most effective immediately following the accident,” said Alliance president Nick Gurevich. “Our concern is that by the time the matter is addressed in dispute resolution, it is simply too late for many of our clients.”
The Alliance said that it commissioned the survey after requesting information about the insurance industry’s denial rates from Health Claims for Auto Insurance, an initiative of Ontario auto insurers that transmits claim forms between insurers and health care facilities, but was turned down.
The province now permits insurers to deny assessment and treatment without having to obtain a second medical opinion, the Alliance said, which means that an insurance adjuster with no medical training decides whether or not the rehabilitation therapy or equipment recommended by a health care professional is accepted. The survey found that only about half of the requests for assessment and treatment now being turned down are referred to an independent examination. Prior to the government changes, all such denials had to be referred for a second medical opinion.
Other key findings include insurers which are now automatically classifying many cases as “minor injury” even though health care providers have identified the injury as serious, and that survey respondents said that more than half their patients who have been slotted into the minor injury category will run out of benefits before they recover.