If your injury is related to a car accident, your therapy services should be covered by your car insurance benefits. This system can be overwhelming! But rest assured – we know the rules and how the system works. Let us take some of the stress away – we’ll stay on top of any forms, timelines and other rules related to getting you the speech-language pathology services you need.
Please read here about huge cuts to your auto insurance benefits imposed by the government in 2010 and the significant changes that took effect on June 1, 2016: http://www.ontariorehaballiance.com/page/insurancechanges
Some important things you may want to know:
- When your speech-language pathologist puts in a request to complete an assessment or provide treatment for you, the insurer must respond within 10 business days or else the treatment is deemed approved until they get around to responding.
- If your insurer denies the request for assessment or treatment, they are no longer required to get a second opinion from a regulated health professional. They can choose to get a second opinion, although after September 1, 2010, there are no longer regulated timeframes for this to occur, so you could potentially wait for months. The other option is to take your request for assessment or treatment to “mediation” at the Financial Services Commission of Ontario. This is not a simple process, so you will probably need a lawyer to assist you with navigating this system.
- There is a distinction in the auto insurance regulations between injuries that are “catastrophic” and those that are “non-catastrophic.” The distinction is unfortunately sometimes arbitrary – it is based on some rules and guidelines, but when it comes to cognitive and psychological injuries, it is incredibly difficult to make this distinction with any degree of accuracy. If your injury is considered “non-catastrophic”, your eligibility for therapy has been drastically reduced – instead of a combined limit of $86,000 for medical, rehabilitation and attendant care funding, the limit is dropping to $65,000. If your injury is considered “catastrophic”, the previous $2 million combined limit for medical, rehabilitation and attendant care funding is dropping to $1 million.
Insurance companies should be informing policy holders of these changes, via mail. Drivers can purchase additional coverage for higher premiums. Talk to your insurance broker to ensure you have sufficient coverage if you or a loved one is injured in a motor vehicle collision.
If you have other questions about obtaining services in the auto insurance system, please contact Julie and she will do her best to answer them.