Marshall.Benefits Flashcards
Identify the 2 component benefits of Ontario’s mandatory auto insurance system.
- No fault (accident benefits): provides benefits regardless of fault
- Tort (bodily injury): allows you to sue the at-fault driver
True or False?
Ontario component benefits are fair and are delivered fairly.
These benefits are fair, but are not delivered fairly.
Identify the 4 causes of unfair delivery of auto insurance benefits in Ontario.
(Hint = CLEV)
- Cost control at the expense of care
- insurers emphasize cost control instead of care
- but then victims don’t recover and final costs are HIGHER not lower - Lawyers
- lawyers’ contingency fees are a percent of the settlement
- so lawyers seek higher settlements, not better care for victims - Entitlements
- victims seek to maximize entitlements versus addressing own care needs - Volume
- providers are paid on VOLUME of treatment not results
Identify the 5 ACTION ITEMS in Ontario’s five-part ACTION PLAN for addressing the unfair delivery of benefits.
- Structural flaws
- Catastrophic injuries
- Lawyers
- Care not ca$h
- Smart regulation
Explain the action item: STRUCTURAL FLAWS
Fix structural flaws by appointing an arms-length regulator with powers to enact policies & procedures
Explain the action item: CATASTROPHIC INJURIES
Change compensation system for catastrophic injuries because lawyers are taking too big a chunk
Explain the action item: CARE NOT CASH
Focus on timely, appropriate medical care, not cash payouts
Explain the action item: LAWYERS
Make contingency fees transparent (and simplify benefits so there is less need to hire lawyers)
Explain the action item: SMART REGULATION
Allow insurers more regulatory freedom to compete on price & service
What is the ‘opportunity gap’ in Ontario auto insurance?
There is an OPPORTUNITY for Ontario auto premiums to be much lower without impacting quality
What is the ‘value gap’ in Ontario auto insurance?
The VALUE of medical care could be better if there were more focus on active medical management.