In 2020, Alberta released a report that looked at auto insurance across Canada and in other countries. The panel of three experts recommended a no-fault auto insurance system, like that in British Columbia. This year, Quebec’s Panel of Experts on Automobile Insurance Contributions (Conseil d’experts sur les contributions d’assurance automobile) invited the public to voice their opinions on the amendments proposed by the Société de l’assurance automobile du Québec (SAAQ) to its auto insurance contributions.
In March 2021, the Financial Services Regulatory Authority of Ontario (FSRA) released its report from a panel of 36 citizens who volunteered to hear from 18 experts, including insurance company representatives, healthcare professionals, lawyers, and accident victim advocates. This article focuses on the panel’s recommendations about MVA personal injury.
The panel said claims should be resolved quickly and fairly, and injured people should reliably access the care they need. Their recommendations include streamlining care for personal injury claimants, creating publicly available fee schedules, and limiting the need for lengthy tort processes to access additional care or support. The report focuses on enabling the fastest pathways to recovery and limiting the appointments, assessments, and paperwork needed. The recommendations stress the importance of creating standardized, easy-to-use claims processes for all injury claimants, and reducing barriers to healthcare access.
The panel also recommends a stronger and more visible external dispute resolution process that is easy to access, resolves complaints quickly, and allows injured people to receive needed care. From developing plain-language document templates and a centralized online marketplace, to creating an easy-to-understand risk-rating system and a centralized personal injury claims system, several recommendations reflect the desire for the auto insurance sector become more user-friendly. Although FSRA seldom interacts directly with consumers, the recommendations highlight the role FSRA can play by convening stakeholders, creating standards, and ensuring the industry develops impartial tools. FSRA should work with partners to create mechanisms for consumers to escalate complaints relating to other service providers, such as personal injury lawyers and health service providers.
Currently, many Ontarians injured in MVAs have difficulty receiving needed care in a timely way. “Complicated and opaque” claims processes, the need for ongoing (and sometimes duplicate) medical assessments, and lengthy dispute processes mean that many people cannot recover quickly. In future, people injured in MVAs should understand how their claims process will proceed, and insurers should minimize the number of required health assessments. Then MVA victims will receive more effective and efficient care to support the fastest possible recovery. Streamlined processes will also lower the systemic costs of care delivery to people injured in MVAs, resulting in lower premiums for all Ontarians.
The panel suggested that FSRA work with insurers to standardize the injury claims process and make it easier to navigate. Simplifying the process would decrease operating costs for insurers while maximizing claimants’ benefits. In the short term, this could include encouraging all insurers to develop an online claims system that gives injury claimants the option to submit documentation electronically, receive information from their insurer, and stay abreast of their recovery. In the longer term, this could include creating a new industry-wide agency (like the Workplace Safety and Insurance Board) where claimants submit health coverage claims, thereby reducing operating costs for insurers and fraud, resulting in lower premiums. The panel also said FSRA should work with insurers to develop a centralized online marketplace where consumers can easily find information about auto insurance and explain what benefits people will receive if they are injured.
The panel said FSRA should collaborate with key stakeholders such as the Ministry of Health, insurance companies, doctors, and paramedical service providers to establish clear, evidence-based clinical “pathways” to recovery, ensuring timely and comprehensive care for common and uncomplicated injuries. These pathways should guide insurers, care providers, and injured parties about the typical care needed, setting expectations for reasonable recovery timelines. Pathways will help improve the patient experience and access to care by reducing the number of assessments needed and decreasing wait times. They will also help decrease costs to the healthcare system and reduce disputes about access to care.
The panel felt FSRA should provide recommendations to the Ministry of Finance on how to modernize legislative and regulatory frameworks, including the Insurance Act and the Statutory Accident Benefits Schedule (SABS). Establishing public fee schedules for service providers, including medical assessment professionals, lawyers, and other services involved in claims processes, would inform consumers of their right to choose a service provider and maximum payable amounts.
While any of these recommendations might or might not be implemented, several are of concern to personal injury lawyers. Creating a mechanism for escalating consumer complaints is a warning flag. A schedule showing maximum payable amounts needs to take contingency fees into account. Any changes to the Insurance Act and SABS need close monitoring by the profession. And the mechanics of limiting or removing the tort process is still an open question.
NOTE: 20 of the panelists had been involved in MVAs (five of them had been injured) and 23 had experience making an auto insurance claim. Panelists were not auto insurance experts but volunteers with diverse backgrounds. (Elected officials, government employees working in auto insurance policy, and employees of auto insurance companies could not volunteer.)