After a serious accident or collision, the injured party will require treatment.
Sometimes the treatment is covered by OHIP. Seeing your family doctor, getting surgery, assistance through LHIN, seeing a specialist, publicly funded physiotherapy; these are all examples of treatment which is covered under the OHIP system. That means that regardless of who was at fault for the accident, that you don’t need to pay for the treatment. This type of treatment is of particular important for all manners of accident and injury cases. If you hold a valid Health Card, there is no excuse for not at the very least, seeing your doctor. It’s free.
Sometimes treatment is NOT covered under the publicly funded OHIP system. Seeing a psychologist, a physiotherapist, occupational therapist, chiropractor, speech language pathologist, massage therapist; these are examples of treatment which is NOT commonly covered by OHIP.
To get these forms of treatment which are not covered, accident victims have a few options to access treatment.
Option #1: Pay for treatment out of your own pocket. Let’s be honest. This option isn’t for everyone. It’s for the few who can afford to pay for it. The pros are that you need not wait for the insurer to approve the treatment. You get the treatment where you want, when you want, for the duration you want. You as the customer calls the shots and you aren’t at the mercy of the insurance company. You also don’t need to attend at any insurance examinations and be exposed to hired gun insurance doctors with their boiler plate, one sided reports. The cons are that you are out of pocket. But, at the end of the litigation you can certainly claim these expenses from the other side. The insurer will question every dime you spend and likely argue the common things: the treatment was excessive, expensive and unnecessary. The insurer will use these arguments as an excuse to pay out a dime on the dollar. The reality is that this path is not for everyone. It’s for the privileged few who can afford it.
Option #2: Jump through the hoops which the insurance company sets up. This is the opposite of Option #1. In this scenario, you apply to treatment through your car insurer by way of OCF-18 Treatment Plan. Your personal injury lawyer cannot complete the OCF-18 Treatment Plan on your behalf, or submit it to the insurer through the Health Claims for Auto Insurance Centre (HCAI). Only your health care provider seeking to treat you can do this. Don’t believe me? Check out the homepage for HCAI on the link above. It’s just a Login and Password landing site; that’s it! Not much more information there unless you start clicking on the fine print links to get what you’re looking for. The pros of Option #2 is that you don’t have to pay for treatment out of your own pocket. The cons are that you have the complete the treatment on the insurer’s terms, on their frequency and at a place which they approve. At the end of the day, the insurer will only approve treatment which they deem to be both reasonable and necessary. The insurer calls the shots. If they don’t deem the treatment to be reasonable and necessary, then your treatment won’t get approved. The other major disadvantage is that the accident victim will need to attend at Insurance Examinations with doctors who are contracted by the insurance company. Despite all of the negatives, the harsh reality is that for the majority of accident victims, Option #2 is their only real course for getting the treatment which they need. Pro tip: here is a list of OHIP Funded Physio Clinics in Ontario. Funding is available to seniors over the age of 65, youth under 19, and people on OW or ODSP.
Option #3: Squeeze those collateral benefits as tightly as possible. If you are lucky enough to have private benefits through your employer, spouse, group plan, union etc., you are likely eligible for a set amount of annual treatment which is not covered by the OHIP System. Your plan may cover up to $500/year in physio, etc. This is great if you have it. Max it out. Analyze your policy carefully to find any loopholes. Here’s one: Many policies separate physio, from massage, and from other counselling. Max out all of those heads of benefits to get the most treatment possible. So, if your policy covers up to $500 of massage, $500 physio, $500 chiro and $500 counselling, get all of those treatments to top out the dollar amounts in treatment available to you. This is why a careful reading of your policy is important. Each policy is different so read carefully.
Option #4: Your family doctor or nurse practitioner is your best resource for healthcare you will ever have. Your personal injury lawyer cannot prescribe you with medication. Your personal injury lawyer cannot diagnose you or provide a prognosis for recovery. Nor can your personal injury lawyer order an x-ray, CT Scan, or MRI. Your family doctor can do all of the above, and more; including referring you to see a specialist who can treat you and monitor your condition. Seeing your family doctor or nurse practitioner is FREE and it would be foolish not to take advantage of it. Even if the wait time to see your doctor is weeks, it still beats not seeing a doctor at all. Our neighbours in the United States are envious of our free health care. When we hear that clients or prospective clients don’t want to see their doctor because the wait is too long, we remind them of how lucky we are in Canada to have Universal Health Care. Our system is the envy of many countries and we should not take it for granted. Your family doctor can refer you to a neurologist, rheumatologist, physiatrist, psychiatrist, orthopaedic surgeon, ophthalmologist, respirologist, internist, plastic surgeon and the list of specialists goes on. Your family doctor holds the keys to your treatment and well being. Don’t underestimate their power or importance on your case along with your health, treatment and well being.