Car injury claims increasingly denied
As reported by the CBC at http://www.cbc.ca/news/canada/toronto/story/2011/12/30/car-insurance-therapy.html
Hamilton speech therapist says car insurance companies are increasingly rejecting her recommended treatments for people who’ve been hurt in accidents.
Deidre Sperry helps her clients recover from brain injuries. Those who have been hurt in car accidents represent 95 per cent of her client base.
Car insurance companies rejected five of Sperry’s recommended treatment plans this year. She said that is more rejections than in her previous 11 years of practice combined.
“I have to be far more adversarial,” she told CBC News. “The treatment plans I’m asking for are only being partially approved when they are approved. There’s more denials and I can’t do the work in the way that I used to be able to do my work.”
Sperry had one client who was hit by a driver who ran a red light. She excpected the man’s insurance company to pay for his entire treatment, but that did not happen.
“The treatment plans that were submitted for his physiotherapy, his occupational therapy and his speech therapy have all been declined,” she said. “He’s a good guy. A wife, two kids in college, paying his taxes.”
“It seems they’re trying to deny more and wear people down so they aren’t going to fight back,” she said.
Rehab patients feel like they are under the gun.
Now, she said, patients already struggling to get through rehab and return to work are made to feel like they are somehow trying to cheat the system.
“They feel like their integrity is being questioned,” she said. “It sets them up to being under the gun and they’ve already got a host of problems to live with.”
Those who decide to fight back are facing a tougher battle than ever before.
All disputed insurance claims must first go to mediation but the average wait time for a hearing has swollen to nearly a year.
Adam Wagman, who represents the Ontario Trial Lawyers Association said the current backlog is “in the tens of thousands”.
“If I were to apply for mediation today, my client might be able to have that mediation heard 10 or 11 months from now,” he said. “By that point in time the physiotherapy treatment that’s been recommended and rejected is almost useless.”
Ontario’s auditor general is calling on the province’s insurance mediator to come up with a plan for reducing the wait time.