Marshall.Benefits Flashcards

1
Q

Identify the 2 component benefits of Ontario’s mandatory auto insurance system.

A
  1. No fault (accident benefits): provides benefits regardless of fault
  2. Tort (bodily injury): allows you to sue the at-fault driver
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2
Q

True or False?

Ontario component benefits are fair and are delivered fairly.

A

These benefits are fair, but are not delivered fairly.

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3
Q

Identify the 4 causes of unfair delivery of auto insurance benefits in Ontario.
(Hint = CLEV)

A
  1. 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
  2. Lawyers
    - lawyers’ contingency fees are a percent of the settlement
    - so lawyers seek higher settlements, not better care for victims
  3. Entitlements
    - victims seek to maximize entitlements versus addressing own care needs
  4. Volume
    - providers are paid on VOLUME of treatment not results
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4
Q

Identify the 5 ACTION ITEMS in Ontario’s five-part ACTION PLAN for addressing the unfair delivery of benefits.

A
  1. Structural flaws
  2. Catastrophic injuries
  3. Lawyers
  4. Care not ca$h
  5. Smart regulation
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5
Q

Explain the action item: STRUCTURAL FLAWS

A

Fix structural flaws by appointing an arms-length regulator with powers to enact policies & procedures

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6
Q

Explain the action item: CATASTROPHIC INJURIES

A

Change compensation system for catastrophic injuries because lawyers are taking too big a chunk

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7
Q

Explain the action item: CARE NOT CASH

A

Focus on timely, appropriate medical care, not cash payouts

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8
Q

Explain the action item: LAWYERS

A

Make contingency fees transparent (and simplify benefits so there is less need to hire lawyers)

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9
Q

Explain the action item: SMART REGULATION

A

Allow insurers more regulatory freedom to compete on price & service

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10
Q

What is the ‘opportunity gap’ in Ontario auto insurance?

A

There is an OPPORTUNITY for Ontario auto premiums to be much lower without impacting quality

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11
Q

What is the ‘value gap’ in Ontario auto insurance?

A

The VALUE of medical care could be better if there were more focus on active medical management.

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