Toronto Injury Lawyer Blog
Last week a person called and told me about their car accident. It was pretty serious accident which took place at high speeds. The photos of the damage to the vehicles were frightening. Air bags deployed, cracked windshields, crushed bumpers, crumpled hoods and side panels. You couldn’t recognize the makes or models of the vehicles involved in the crash. It was like a scene out of a demolition derby, only it wasn’t an organized event for sporting entertainment. . It was real life. Everyone involved in the crash were luck to be alive.
The people involved in the car accident were rushed by ambulance to hospital. The x-rays and other digital imaging didn’t show any objective injuries. So, the doctors discharged the accident victims telling them to take some Tylenol or Advil, go see their family doctor, and to look in to getting physiotherapy. This might seem strange for some people who aren’t familiar with how car accident cases work, or with how Ontario hospitals work. But as a personal injury lawyer, I see this discharge routine all too frequently. If there isn’t anything broken, or which shows up on any scan or test, people are discharged from hospital fairly quickly in order to make room for the next patient to arrive. The responsibility is then on the client to see his/her family doctor, and arrange for physiotherapy.
But how do you go about arranging for physiotherapy, and who will pay for it?
These are great questions! It sounds easy enough to get physiotherapy, but it isn’t as easy as you would think.
The easiest way to get treatment after a car accident is to find a clinic near your home. Going to a clinic that’s hard to get to isn’t convenient for regular attendance at physiotherapy which is generally what’s required to see results. Once you’ve found a clinic nearby, the easiest way of getting treatment is paying for it out of pocket right there on site.
But that’s not fair considering that you weren’t at fault for the car accident; and considering that you have car insurance which is supposed to pay for this sort of treatment. Paying out of pocket also isn’t always an option due to financial constraints and because paying for regular treatment over the course of time gets very expensive.
So what should you do?
The magic with treatment isn’t necessarily the treatment itself. The treatment is the easy part. The hard part is the billing, and getting the treatment approved so that you don’t have to pay for treatment out of your own pocket.
You should know that clinics would love for you to pay for treatment out of your own pocket just before, or shortly after the treatment has been provided. That way, they can collect their money rather instantaneously, and there is a certainty of getting paid without delay or hassle. This is wonderful for the clinic; but not so wonderful for you.
It’s important that you get an insurance company involved with respect to your treatment. This creates an additional few steps for the clinics because there’s a lot of paperwork that goes with it; and the money does not arrive right away. In some cases, the clinics need to make follow up calls to the adjuster handling your file in inquire as to the status of payment for their services.
After a car accident, the first payee for your treatment is strangely enough NOT the car insurer. Rather, it’s your collateral benefit insurer. That means if you have health/rehab benefits through work, or through a private policy, you must first go through and exhaust those benefits before the car insurer will consider paying for anything.
So, if you have a max of $3,500 in health/rehab benefits through work, you have to max out those benefits, and then, and only then will the auto insurer respond.
In order to get the auto insurer to pay for your treatment, the clinic should be registered on the HCAI system (Health Claims for Auto Insurance). If they aren’t, then things are going to take a much longer time to get approved and processed. The clinic will then need to submit an OCF-18 Treatment Plan to the auto insurer. The auto insurer will respond with an approval, partial approval, denial, or will refer the Treatment Plan to an assessor and have you submit for an in person examination; or a paper review; in order to determine if the OCF-18 Treatment Plan is reasonable and necessary. You can see how this billing can get messy fast! The fact that getting the approvals requires so much paperwork, and so many steps, without any guarantee of payment, or of any immediate payment shows why clinics would much rather their clients pay upfront rather than deal with the mess of red tape for insurance company billings.
But, paying up front isn’t always an option, nor is it the right thing to do when insurance is available to an accident victim. This is why it’s so important that the clinic understand how to bill the right way. Without the approval, and without properly billing the insurance company, then the treatment won’t get done.
The last point on billings which I’d like to mention is the concept of clinics having clients sign “Irrevocable Directions” or “Promises to Pay“. These are legal documents which should be looked at by your personal injury lawyer. By signing these documents, the client is signing off on a blank cheque for treatment, often with high interest on the amount owing. The amount will be paid out of the proceeds of settlement. When the case settles, the client doesn’t know how much money they will owe to the clinic in accrued treatment and interest. Those bills can be shocking and eat into the proceeds of settlement leaving the client with far less than they expected. I call this the bar tab scenario. You run keep an open tab at the bar. You think that the tab won’t shock you at the end of the night when you go to settle up. But you’re wrong, and that bar tab is much more than you expected to pay. It’s important for clients to know what they’re getting into when they sign these agreements with clinics. In some cases, the clinics end up getting more money out of it than do the injured accident victims.
