So your spouse, child, mother, brother, friend is injured in a car accident. They broke both legs and have been quickly discharged from hospital. An Occupational Therapist visits the home and prescribes some equipment, sets them up on the main floor, makes sure they have options for bathing, toileting, sleeping, can eat and get out of the house if they needed to, and calculates the amount of care they need in order to safely survive at home in this state. This is calculated in minutes of care, and converted to a dollar benefit based on pre-determined (government) hourly rates.
Prior to 2010, this money (attendant care) would be given to the client, and they could use this to pay the providers of their care. They could choose the provider based on many factors, with most selecting the person that they were least embarrassed with in the washroom and shower.
In September 2010, FSCO decided that this benefit would only be provided when the care provider could prove an “economic loss”. I get why they wanted to do this. Too often, attendant care monies were “improving” the financial position of the injured (extra income) and was not always being used for care. As it is inherent in the insurance act to not “advantage” people, the industry decided they needed to make some changes.
Proving an “economic loss” became a hot topic. Some insurers wanted to only pay the amount of the loss, and others would pay the amount of attendant care benefit (as calculated by the OT), as long as a loss existed. This issue was tried in court, and in Henry vs Gore (2013) the decision was that “the extent of the economic loss was irrelevant…as long as there was any economic loss during the period in question the person can qualify for the services they provided…”
Then, just last month this decision was overturned by the Ontario government, the SABS were amended, and now people providing care cannot receive more “than the extent of the economic loss sustained by the attendant…as a direct result of providing the care…”
So, I ask, can the government really suck and blow? I guess so because there are so many elements of this that both defy logic and are clearly unfair. Here is my list:
- So, if my economic loss is $100 / week (I work part time at Tim Horton’s), I get $100 / week even when the care needed is calculated at more. So, if the care is calculated at 24 hours / day (as it can be) I get paid .59 cents per hour. Is that legal?
- Then the reverse must also be true. If I make $10,000 / month (as some people do) then I would get paid $10,000 / month (my economic loss) to provide care, right? WRONG. The max is $6000 regardless, and I suspect the insurer would only pay me the amount of the benefit which is often less than the max. So, they cannot “advantage” me, but they can “disadvantage” me?
- So, I guess they will pay the full amount for private care then, right? WRONG. The form calculates at rates of $10.25, $13.19 and $19.35 per hour (for recent accidents) but the agencies charge $25 / hour or more. So, the amount of hours I need is irrelevant as I can’t get the hours anyway in the calculated amount.
- If an agency is the only option (as my family will not work for .59 cents per hour), and most have a three hour per shift minimum, but my care is calculated at 2 hours per day, then I have to go without? Or I guess I will just use the toilet tomorrow instead?
- If I was making $30 / hour and worked 40 hours / week, but now need to provide care for 80 hours / week, they will pay me at my “economic loss” hourly rate, right? Nope. They will pay the amount of the benefit, again calculated at up to $19.35 / hour. So, I prove the loss, then take a loss following.
- If my family can’t live on .59 cents per hour, and an agency declines to work with me because of my behavior, complicated needs, or because my house is a health hazard, the insurer will change their mind and pay my family, right? Doubt it.
If the government wants to truly suck here, then they should not be able to blow. Either pay an agency the number of hours needed, at the agency hourly rate, without monthly or policy limits, OR pay an unqualified provider the amount of care needed calculated at the pre-determined rates. If you cannot advantage people, then you should not be able to disadvantage people either. Their accident already disadvantaged them enough.
It is easy to see how McGuinty, and now Wynne, (both political lackeys for the auto insurers) have amped up the Liberal’s never-ending attack on catastrophically injured auto accident victims. But people might want to pay some attention to the fact that the Liberals and the IBC are currently justifying gouging attendant care by saying this is the road to the 15% premium reduction Wynne promised. It is important to remember that Wynne only made that promise so the NDP wouldn’t join with the Conservative to bring down her government. Horwath and Singh trumpeted their demand for a 15% premium reduction in the hope that it will translate into votes for the NDP. But isn’t it insidious and deceptive for the NDP to sit quietly on the sidelines even as the Liberals have hijacked the NDP demand for a 15% premium deduction and turned it into the Liberal’s justification for a non-stop attack on access to attendant care and medical treatment for the most seriously injured of auto accident victims. Hiding in the bushes while the catastrophically injured are being pummeled due to an NDP electioneering ploy is cowardly and deceptive and greedily opportunistic – and just plain wrong. Wynne is no friend of injured auto accident victims. But only a fool would be taken in by Horwath’s self-serving hypocrisy. Put simply – Horwath and Singh who have sat silently on the sidelines as the catastrophically injured have come under attack – by their inaction – own a huge chunk of responsibility for the abuses being perpetrated against the catastrophically injured. Shame on the NDP.
We are woefully under-covered for the real costs if something truly catastrophic happens to us. No matter what – family and loved ones will make sacrifices and accommodations to take care of a seriously injured loved ones. It is in our nature. But at what point does it become unfair and unrealistic – well, long before it got this far. With coverage now so low, so out of touch with the real amounts needed and so punishing to families we need to voice our outrage at this unfair situation. It affects everybody, family members, their relationships, their jobs, their dreams and their options if they are to be impoverished because Ontarians are inadequately covered. And where are all our premium dollars going anyway? Not to accident victims – so where? It’s affecting all of us, past the victim, into the taxpayers pockets, through the download to our public systems.
$36 thousand dollars for the seriously injured, or $1 million dollars for catastrophic injuries compared to the $30 million dollars spent every year by the IBC for advertising and PR – how much rehab would those dollars pay for? As for the millions paid to individual insurance company CEOs and management – many make more in a year than a catastrophically injured victim can access for treatment in 10 years? And what does it cost to dispute half of all claims every year, hire insurer defense lawyers and pay for endless medical evaluations to uphold the claim denial position?
To see the shocking breakdown to .59 cents an hour for family members who do the care or the underpayment to those who choose to keep working and hire assistance speaks volumes about how Ontario’s insurers see their customers. The fact that our government facilitates and promotes these cuts to benefits while forcing us to buy this poor coverage says they too could care less what the citizens of Ontario need – real coverage in a time of need. The ‘contributions’ tossed to political parties by the insurance industry guarantee that it will stay that way. That our legislators will pass new regulations that will further restrict benefits to the seriously or catastrophically injured accident victims was seen in the Dec 2013 changes – Brian is right, our government hides behind mis-information while kicking the innocent accident victim right in the teeth.
I agree. What also baffles me is how the province can have strict rules about working conditions, rates of pay, overtime, and minimum wage for employees, but these become completely obsolete when it comes to insurers being able to take this approach with care giving. Essentially this decision is allowing insurers to, at times, knowingly create a situation whereby people are forced to work unlawfully. I can’t understand how they can be above law this way.