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1 RESPONSE OF THE ONTARIO TRIAL LAWYERS ASSOCIATION TO THE RECOMMENDATIONS FOR CHANGES TO THE DEFINITION OF CATASTROPHIC IMPAIRMENT FINAL REPORT OF THE CATASTROPHIC IMPAIRMENT EXPERT PANEL TO THE SUPERINTENDENT Submitted by: The Ontario Trial Lawyers Association South Service Road Burlington ON L7L 4X5 Phone: (905) Fax: (905)

2 The Ontario Trial Lawyers Association (OTLA) is an association of lawyers dedicated to the fair representation of consumers who suffer traumatic injury. Founded 20 years ago, OTLA is comprised of lawyers who act on behalf of plaintiffs from Ontario and across Canada. Members of OTLA are dedicated to the preservation and improvement of a civil justice system, which is equally accessible to all, and which fully and fairly protects the rights of those who have suffered losses as a result of the wrongdoing of others. In 2010, OTLA launched Trial Lawyers for Veterans, a probono legal aid program dedicated to assisting Canadian Forces veterans in Ontario in their quest for fair benefits and compensation from the federal government. OTLA is a passionate advocate for safety initiatives having founded Bike Helmets on Kids. Since 2002, more than 10,000 bike helmets have been distributed to children across Ontario through this award-winning program. OTLA currently has more than 1,100 members. SUMMARY The current definition of catastrophic impairment remains largely as it was in The benefit of the longevity of this definition is that there is now a considerable body of jurisprudence, both at the FSCO and the Superior Court of Justice, interpreting this definition and providing some predictability in determining who will meet the definition for catastrophic impairment. Modification of the definition at this stage is completely unwarranted and will inject a considerable amount of uncertainty and cost into what is already one of the most complicated areas of the SABS. There is no need to make the test more stringent. Meeting the definition of catastrophic impairment does not directly equate to an entitlement to the injured person, it simply expands the monetary limits available to those who have suffered the most significant of impairments. All treatments and care requirements must still be shown to be reasonable and necessary for funding to be available. A tightening of the definition will simply mean that the most vulnerable class of accident victims who have reasonable and necessary medical needs will become an added burden to Ontario health care system or will have significant needs that are simply unmet. It is premature for the government to proceed with any amendment to the definition of catastrophic impairment based on the Report of the Catastrophic Impairment Expert Panel to the Superintendent dated April 8, It is clear that the Panel report is incomplete, with significant portions of the work deferred. Secondly, as acknowledged by the panel 1, the point at which an injury becomes catastrophic is not a medical question but a legal question and one of policy a matter requiring further review and investigation. The medical aspect is only one component of three important components in this review. 1 See page 13 1

3 Companies that sell auto insurance in the province of Ontario can administer and provide benefits in accordance with any definition of catastrophic that the Ontario Government decides. The question is one of fairness to those that suffer the most significant of injuries versus premiums charged to the motoring public that allow insurers to earn a reasonable profit. Before consideration is given to amending to a 15 year old definition that will lead to a significant contraction in the number of seriously injured accident victims that will have access to benefit entitlement beyond the new $50,000 minimum, it is incumbent upon the Government to make a decision that weighs the extraordinary need of those that are seriously injured with the need for insurance profitability. With a lack of financial data dealing with the cost of the current definition of catastrophic impairment and the absence of meaningful financial data concerning the impact of insurer profitability of the September 2010 changes to the accident benefit system, any contemplated changes to the current definition of catastrophic impairment is premature. Any change to the current definition of catastrophic determination at this time will be tantamount to attempting to fix a problem that nobody can show exists in a system that is primed to deliver healthy profits to insurers. Clearly a considerable amount of work was put into the Panel report in a rather short period of time. Indeed the mandate of the Panel was an ambitious one, in view of their time constraints however many important consumer issues were not addressed. While there are some recommendations in the report that may benefit consumers (for example, the proposal for interim catastrophic benefits), these have not been adequately developed by the report. Unfortunately the Panel report is not sufficiently comprehensive to allow due consideration to whether the current definition of catastrophic in the Statutory Accident Benefits Schedule ought to be revised. Consequently, on its own, this report cannot be relied upon to support any alteration to the current definition of catastrophic impairment. It is critical that the report of the Panel be viewed within the limitations under which the Panel was operating. The Panel was attempting to essentially predict the future by developing methods of assessing long-term disability from current circumstances. All predictive assessment protocols have flaws and limitations from a medical point of view, with some deserving claimants receiving benefits and other equally deserving claimants denied benefits. The following summarizes OTLA s concerns 1) The Panel report is based on a preconceived notion and an invalid premise about what a catastrophic impairment ought to be, and this fundamentally undermines the entire report; 2) The Panel has deferred many aspects of its recommendations for later consideration by committees yet to be formed, making the recommendations incomplete and premature; 2

4 3) The Panel has suggested amendments that will destabilize and complicate an already unduly complex product, a change not in the interests of consumers; 4) The Panel was not asked to and did not address the important policy considerations and fiscal considerations that are an essential element of the analysis, which analysis is required in order to ensure fairness for all Ontario consumers; 5) The recommendations are fundamentally unfair in that they discriminate against classes of impairments and exclude many with severe impairments, contrary to the interests of consumers. THE APPROACH AND REASONING OF THE PANEL THE INVALID PREMISE The Panel begins the review of the definition of catastrophic impairment by adopting a view that is not based on medicine, but rather policy. By first offering their subjective view on what constitutes a catastrophic impairment, the Panel then went on to define catastrophic to meet that preconceived view. In this sense, the reasoning and approach taken by the Panel is circular and logically flawed. The Panel begins by stating that a catastrophic impairment is an extremely serious impairment or combination of impairments that is expected to be permanent and which severely impacts an individual s ability to function independently. The Panel then goes on to craft regulations that it believes are in accordance with this presumed definition. Thus the amendments proposed are not truly based on matters of medicine, but rather medicine modified to fit with a particular policy objective determined by the Panel. In this respect, the Panel has stepped outside the arena of medicine and stepped into policy. The fact that the Panel immediately thereafter acknowledges that catastrophic impairment is not a medical entity; rather, it is a legal entity which defines a point along the medical spectrum of impairment severity 2 highlights the logical flaws in the report and fundamentally undermines the recommendations. There are other difficulties in the reasoning of the Panel. Despite their finding that there is little validity and reliability to the AMA Guides for determining catastrophic impairment 3, the Panel recommends its use as a measure for multi-system impairments, although they confine it to physical impairments only. The reason why the Panel would rely on the AMA Guides in this limited context is because a 2 See page 13 3 page 19 3

5 55% impairment of the whole person (WPI) is the same score given to a paraplegic, the exemplar, according to the report of catastrophic impairment. 4 Working from that exemplar, however, the Panel declines to combine physical and mental impairments as they cannot conceive how they could be equated to a severe injury to the brain, spinal cord or to blindness. 5 The error the Panel is making, or perhaps the incorrect assumption, is that somehow a 55% WPI must equate to paraplegia, which is an absurd and unjustifiable assumption. The Panel has again inserted its subjective view on the underlying policy issue. It is not possible to equate injuries with other injuries. Rather injuries, or combinations of injuries (both physical and psychological), give rise to extraordinary patient need that the benefit system may or may not satisfy, depending on where the line is drawn. The Panel failed to focus of its own objective of delivering benefits to the most seriously injured auto insurance consumers in Ontario. The treatment of consumers who suffer traumatic brain injury is of particular concern because the tests proposed are so complex. There may have been flaws in the Glasgow Coma Score test, but it was easy to apply and accurate in the vast majority of cases. It is not enough to say that a score of 9 out of 15 on the Glasgow Coma Scale is a poor predictor of outcome. As imprecise a tool as the GCS might be, the real question is whether there are strains created within the auto insurance system that render that test inappropriate. These are fairness and economic questions, not medical questions. Notably, when the Panel was asked whether a 9 or less on the GCS constituted a catastrophic injury the Panel was evenly split. On what basis would the government abandon a test when there is no consensus on the panel? THE GOALS OF STABILITY, SIMPLICITY AND FAIRNESS Having finally clarified and ensured stability to the existing product after more than a decade and a half, the new complicated proposals from the Panel promise to introduce new uncertainty, additional costs and an associated burden on the administration of justice. The current definition of catastrophic impairment has been in existence since the introduction of Bill 59 in 1996, with minor modifications. Claimants, insurers, arbitrators and courts have devoted significant effort, time and expense in clarifying the meaning of the current definition. Finally, some of the uncertainty associated with the definition of catastrophic impairment is set to be dealt with by the Ontario Court of Appeal. 6 These proposals will throw the delivery of benefits for seriously impaired consumers into chaos. This sort of disruption ought not to occur without compelling reason. Legislators cannot ignore the practical realities. The existing dispute resolution apparatus cannot possibly cope with the flood of disputes this new definition will 4 page 19 5 page 20 6 See Kusnierz and Pastore 4

6 generate. The Insurance Act requires a FSCO mediation take place before a lawsuit or arbitration is commenced. And the system is already totally broken down, because FSCO mediators are 9 months behind in holding hearings. So at a time when the system is broken the government could introduce amendments that will create impossible burden. Justice delayed is justice denied. Treatment denied because justice is delayed will cause unnecessary hardship to consumers and their families and greater cost to society as a whole. The Panel would introduce the requirement for inpatient rehabilitation at an approved public rehabilitation hospital as a measure of catastrophic impairment. Quite apart from the impact that this criterion might have on a health care system, the Panel is attempting to impose a mitigation criteria that is not tied to patient outcome and often arbitrary. It is beyond the scope of the Panel s mandate and expertise to impose such a condition, which inevitably creates a gap into which some otherwise deserving patients will be caught. Health care providers will attest that many who need inpatient hospitalization are returned to the community for a variety of reasons including extensive wait times for rehabilitation beds, regional differences in availability of rehabilitation beds and patient needs that are too complex to be accommodated at a rehabilitation hospital. How fair will it be to exclude a consumer who needs the catastrophic level of support because the public system lacked the resources to provide inpatient care? While purporting to improve the accuracy, relevance and clarity of the catastrophic definition, the Panel has rather added complexity and obscurity to the process. Under the current definition the only external protocols to be dealt with are the AMA Guides 4 th Edition, the rather easily applied Glasgow Coma Scale and the Glasgow Outcome Scale. Application of the current assessment protocols are challenging enough, but consider the complexity the Expert Panel would see introduced now. The Panel recommends that we add the American Spinal Injury Association (ASIA) classification in cases involving spinal cord impairment. For adults with traumatic brain injury the Expert Panel has recommended two new measures: the Extended Glasgow Outcome Scale (GOS-E) and the Spinal Cord Independence Measure to assess dysfunction related to ambulation. With regard to psychiatric disorders, the Panel has recommended using the Global Assessment of Functioning (GAF) test. Despite the Expert Panel s observation that the AMA Guides 4 th Edition is ambiguous and limited, and despite the fact that there are newer editions, the Panel suggests continued use of the AMA Guides 4 th Edition for rating multi-system physical impairments. One of the objectives of the recent round of reforms implemented in September 2010 was to reduce assessment costs. With the introduction of at least four new assessment protocols recommended by the Panel additional detailed assessments will be required by appropriately trained health care professionals. This will undoubtedly increase costs. 5

7 There has been little controversy over the definition of paraplegia and quadriplegia in the current definition. The Panel s recommendations will inject a degree of uncertainty unnecessarily. Is there really a need or any justification for introducing this level of certainty into determining spinal cord injury when, as far as the auto insurance system in Ontario is concerned, there has been relative certainty and stability with this class of consumer? Similarly, there is no justification for the proposal relating to impairment of ambulatory mobility 7 unless it can be demonstrated that the current system is failing. There is no such evidence. SOME OF THE RECOMMENDATIONS ARE LIKELY UNCONSTITUTIONAL The Panel s recommendations for defining Psychiatric Impairment 8 seek to exclude pain from impairment ratings and introduce new terms and phrases that will take decades to interpret through our courts. Phrases like demonstrable and persuasive evidence or very seriously compromise independence and psychological functioning are vague and uncertain. The Panel s proposal to exclude pain-related impairments from the rating of traumatic physical impairment ignores the very real and debilitating physical impairments that pain produces. The proposed changes are also discriminatory and will likely be found to be unconstitutional. In Martin v. Nova Scotia (Workers' Compensation Board), 9 the Supreme Court of Canada held that a compensation scheme that excludes chronic pain patients violated the equality guarantees in s. 15 of the Charter of Rights and Freedoms: Despite this lack of objective findings, there is no doubt that chronic pain patients are suffering and in distress, and that the disability they experience is real. In the context of the Act, and given the nature of chronic pain, this differential treatment is discriminatory. It is discriminatory because it does not correspond to the actual needs and circumstances of injured workers suffering from chronic pain, who are deprived of any individual assessment of their needs and circumstances. Such workers are, instead, subject to uniform, limited benefits based on their 7 page 15 8 page 20 9 [2003] S.C.R

8 presumed characteristics as a group. The scheme also ignores the needs of those workers who, despite treatment, remain permanently disabled by chronic pain. Nothing indicates that the scheme is aimed at improving the circumstances of a more disadvantaged group or that the interests affected are merely economic or otherwise minor. On the contrary, the denial of the reality of the pain suffered by the affected workers reinforces widespread negative assumptions held by employers, compensation officials and some members of the medical profession, and demeans the essential human dignity of chronic pain sufferers. The challenged provisions clearly violate s. 15(1) of the Charter. 10 The Court went on to say that cutting off benefits for injured workers with chronic pain sends a clear message that chronic pain sufferers are not equally valued and deserving of respect as members of Canadian society. 11 Similarly, the Catastrophic Impairment Review Panel s proposal to remove pain as a rateable impairment for the purpose of the Whole Person Impairment Score amounts to a statement that pain is not a true physical impairment and that a person impaired by pain is not entitled to the same consideration as an injured person with other physical impairments. THE RECOMMENDATIONS ARE INCOMPLETE The Panel has deferred any consideration of the combination of physical and psychiatric impairments. It has not been suggested that physical and psychiatric impairments should never be combined, but only that further scientific evidence is needed. This makes their report incomplete. In recommending research into the most appropriate threshold for WPI scores relating to psychophysical combinations 12, the Panel tacitly acknowledges that the combination of psychological impairments with physical impairments can give rise to greater impairment, and therefore need. It is troubling that the panel has recommended that physical and psychiatric impairments not be combined for the purpose of catastrophic determination 13 due to their inability to define a measure, based on a lack of available time and resources. Essentially, the panel has proposed that those injured people do without, pending further research. How can that be justified on any policy grounds that have anything to do with fairness? The Panel recognized the legitimacy of evaluating the physical and mental/behavioural impairments of injured consumers but finds that currently available tools for doing so are not readily identifiable, and thus has deferred a 10 Ibid., at paras 1 & Ibid., at para page See Executive Summary page 1, and page 20 7

9 method for doing so to later deliberations by an entirely different committee. The fact that the panel found further investigation is needed 14 highlights the fact that change is premature. It is unacceptable to implement change when these and other limitations are acknowledged. Even an imperfect test is preferable to eliminating a whole class of injured consumers. A review of the vast majority of the considerable jurisprudence on the issue of combining provides reasonable and compelling arguments for the necessity of considering all impairments, including psychological/psychiatric, in arriving at a formulation for whole person impairment. Combining of these impairments is consistent with the purpose of the SABS in that it promotes fairness for victims of motor vehicle accidents and is necessary to ensure that those with the greatest needs have access to expanded benefits. As stated by MacKinnon, J. in Arts v. State Farm Insurance Company, May 23, 2008, Ontario Superior Court of Justice File No. 03-B6188, An injured victim may fall short of being found catastrophically impaired on the basis of any one of the other seven parts to the definition of catastrophic impairment, but when all of his/her impairments are considered, he/she may well have a 55 percent Whole Body Impairment. To deprive Ontario motor vehicle accident victims in these circumstances the right to recover needed attendant care and medical-rehabilitative benefits is both unreasonable and unjust. The Panel acknowledged that complexity relating to distinguishing the adult population from the pediatric population could not be resolved and the Panel recommended a pediatric working group to address this. 15 While OTLA supports the idea of workable definitions specific to pediatrics, there ought to be no revisions as they relate to young consumers before the recommended complete analysis takes place. The panel has proposed that there be interim catastrophic impairment status. Unfortunately while such a proposal could be in the interests of consumers and would address some inequities in the SABs, the report is short on detail as to how such a status would operate. They have failed to consider the impact on benefit levels and other important issues. Without this detail no one can know whether this further complexity to the system would be a benefit or a curse. POLICY AND FISCAL CONSIDERATIONS Policy and fiscal considerations do not support the revisions to of the definition of catastrophic as recommended by the Panel. The changes suggested by the Panel are premised on the assumption that the current methods of assessing catastrophic 14 See Executive Summary page See section 4.1 page 13 8

10 impairment, which have been in place for 15 years, are failing Ontario consumers. In fact, there is no evidence to support this proposition. Indeed industry spokespeople have always said that it is not the catastrophically injured consumer that is threatening the system it is the minor injuries. In fact, the evidence is that the current definition works well for the most severely impaired. Further, the Panel ignores the fact that being designated catastrophic does not entitle a claimant to a payment. Once designated catastrophic, each claimant must prove both reasonableness and need. OTLA recognizes that there are financial issues that need to be considered in this analysis. The insurance product ought to be affordable to Ontario consumers, provide real and adequate protection to accident victims, and provide the insurers with reasonable profitability. If the current definition of catastrophic impairment was impacting negatively on the cost of the insurance product or insurer profitability, then consideration might be given to changing that definition. As a result, OTLA has requested financial data from both FSCO and from the IBC on insurer claims experience related to catastrophic impairment. It is only with this financial data that a policy decision can be made to change the definition of catastrophic impairment in order to reduce the number of victims who will meet the definition. Apparently the necessary financial data is not available. In fact, the only available financial data (through GISA) suggests very clearly that large claims are on the decline. In the face of this available data, there is absolutely no policy justification to eliminate the current definition. THE IMPACT ON THE CONSUMER Implementing any part of the Panel s recommendations is not in the interests of consumers. It is very much a work in progress, requiring far more than merely medical input. The interest of consumers requires a more fulsome analysis, with time to do a thorough job. Certainly insurer profits should not be allowed to trump fairness to consumers and accident victims. There is no reason to believe that there are any accident victims receiving undeserved benefits by virtue of the current definition, including the GCS and the combination of physical and mental impairments. Fraud is not an issue where catastrophically impaired consumers are concerned. The insurance industry was provided with a considerable boost to profitability by virtue of changes to auto insurance that came into effect in September There is no compelling reason to make additional changes that might further diminish protection to Ontario consumers until the full impact of this benefit to insurers is realized. The fundamental problem with the Panel s report is that the wrong questions were being asked. Where the line should be drawn depends entirely on what the system can afford. At the moment there is no reason to believe that the claimants now qualifying under the current definition are a financial burden on the system. In fact, 9

11 all of the available financial data, combined with the substantial savings to be realized under the recent and drastic reduction in non-catastrophic benefits, supports the conclusion that the catastrophic definition ought to be expanded so that truly seriously impaired consumers are not hurt by the recent reduction in benefits to the non-catastrophically impaired. The Panel purportedly also determined the feasibility of implementing the recommendations 16, a matter beyond their mandate, not to mention their expertise. It is lawyers (both for injured victims and insurers), Arbitrators and Judges who must deal with the fallout of these recommendations. And many of the recommendations are practically unworkable for the reasons described herein. Without input from these stakeholders, consumers are seriously prejudiced. The government must also appreciate the disruption and stress that complex proposals such as these would have on health care providers in the community. The vast majority of health care providers want only to assist impaired consumers with their rehabilitation and their quality of life. The complexity of the changes recommended and the uncertainty they will cause will have a seriously detrimental impact on the provision of health care to seriously injured consumers. Consumers will pay the price for this disruption. The community health care system that has developed around auto insurance in Ontario is the envy of other jurisdictions. Occasionally one hears industry representatives denigrate these providers, but the government would be wise to consider whether the public health care system can afford to take over if the community system now serving most of the traumatically injured in Ontario is seriously undermined. REPORT TO MINISTER FROM THE ADVISORY PANEL ON CATASTROPHIC IMPAIRMENT 2001 Report In examining these issues, the Government ought to consider the 2001 report of the Advisory Panel that was commissioned to re-assess the definition of catastrophic impairment and report to then-minister Young. The members of the 2001 Panel were: Dr. Harold Becker, Stephen Firestone, Dr. Robert Gates, Willie Handler, Carol Jardine, Dr. Faith Kaplan, Cathryn MacFarlane, Edward Mulvihill, David Oakden, Dr. Peter Rumney, Philippa Samworth, Richard Tillmann, Steven Whitelaw The panel made numerous recommendations including the following: 16 Page 12, section

12 Regarding GCS the panel recommended maintaining the definition of catastrophic on the basis of a GCS score of 9 or less with some minor modifications as set out below. a. the words "within a reasonable period of time after the accident" should be removed from the definition. b. The second recommendation is that a new provision be added under brain impairment to cover situations particularly in rural hospitals where the Glasgow Coma Scale is not administered. It was felt by the Panel that this resulted in an unfairness to those individuals who would clearly have had a Glasgow Coma Scale of 9 or less had that test been administered. Therefore, to cover this fairly limited situation, the Panel recommends that the following definition be added in under the present paragraph (e) as a second subheading: "an episode of unconsciousness that is equivalent to a score of 9 or less on the Glasgow Coma Scale as set out in paragraph (i) herein, that is observed by a person trained for that purpose and is recorded in the insured person's medical record". With respect to the issue of combining physical impairments with mental/behavioural impairments, the recommendation of this panel was to add a new section of the definition to deal with individuals who have significant trauma in the first two years of the accident but may ultimately not be found to be catastrophically impaired on an outcome basis under Sections (f) and (g). Accordingly, they recommended that Sections (f) and (g) should not be read independently of each other. It was this Panel's recommendation that an insured person be entitled to add the two impairments so that a combination of the mental and behavioral impairment and the physical impairment under the 55% whole body definition result in a catastrophic impairment. It was this Panel's recommendation that failure to allow combining would result in a number of individuals who have clear catastrophic impairment as a result of a combination of physical and behavioral problems who would not otherwise be able to access needed attendant care, case managers, let alone medical and rehabilitation benefits. CONCLUSIONS Drafting regulations affecting the rights of Ontario consumers is primarily a matter for legal experts, elected officials and policy advisors. The expertise that the panel members bring to their task is entirely medical and of necessity fails to give due consideration to matters of policy. 11

13 Some of the questions and answers in the Baseline Survey I 17 are in themselves troubling. In Question A.1.3. the Panel was not unanimous in considering paraplegia or quadriplegia catastrophic. Likewise, there was not a consensus amongst Panel members that arm or leg amputation or the total and permanent loss of use of an arm or a leg is catastrophic. That is the current definition, yet some Panel members did not agree. While the majority of the Panel agreed with the two questions above, the disagreement is illustrative of the fact that the Panel was more than prepared to substitute its own policy for that of the legislature and to use purely subjective draconian standards. There was considerable disagreement amongst Panel members as to whether any of the current criteria for catastrophic designation are really catastrophic impairment. The fact that the Panel was so divided is further evidence of the peril of tinkering further with the definition without more evidence to justify a change. The problem is that the wrong questions were being asked. The issue is not what one health care professional or another considers a catastrophic injury. The first question is simply this: which seriously injured accident victims are going to have the medical and rehabilitation needs met through enhanced benefits and which seriously injured victims will not have their needs met? Where the line gets drawn depends entirely on what the system can afford. Knowing what the system can afford depends on first determining which claimants now get over the threshold and how much it is costing. The next question is whether we want to raise the bar, to keep more out, keep the bar at its current level, or perhaps lower the bar to allow more in. It all depends on cost. At the moment there is no reason to believe that the claimants now qualifying are too much of a burden on the system. The Panel suggested that the recommendations are at two levels: accuracy and fairness of the determination. 18 While accuracy of medical assessments is within the scope of the panel s expertise, the matter of fairness is one of consumer interest to be defined by policy makers. The Panel failed to meet its own stated objective. In suggesting that their recommendations aim to ensure that individuals who are most seriously injured in traffic accidents receive appropriate treatment 19, OTLA supports fully that goal. However, the recommendations made by the Panel fail to achieve their own stated objective. The Panel purportedly also determined the feasibility of implementing the recommendations 20, a matter beyond their mandate, not to mention their expertise. The report must be considered in the context of all of the relevant circumstances. The additional circumstances include, but are not limited to: coverage issues; limits 17 Appendix 1, page Page 1, Executive Summary 19 Page 1, Executive Summary 20 Page 12, section

14 issues; difficulty in interpretation; establishing new jurisprudence; instability of insurance; policy considerations; cost issue relating to catastrophic specifically and the auto insurance industry as a whole; the scope of any currently problematic issues; uncertainty for consumers; and, the limits of and incompleteness of the Expert Panel Report. OTLA looks forward to assisting in the completion of this analysis and to promoting appropriate reforms that better meet the needs of consumers in Ontario. 13

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