Can the Ontario Government Suck AND Blow?

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:

  1. 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?
  2. 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?
  3. 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.
  4. 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?
  5. 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.
  6. 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.
Then, there are policy limits.  So, regardless of my economic loss, or the care needs of my family member, there will still only be $36K available if they are seriously injured, or $1M if they are catastrophic.

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.