The Liberal Government s Leadership on Mental Health

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1 September 2014 Issue Brief Auto Insurance Reducing Auto Insurance Costs and Improving Access Mental Health Services Objective Reducing auto insurance costs and premiums while improving access to treatment and care for Ontarians who need mental health services. Issue Auto insurance costs and premiums are too high. Unfortunately, attempts to reduce costs are adversely affecting accident victims with brain injuries and mental disorders. The result will be greater strain on the public health care system and increased cost to government. We need to reduce auto insurance costs in a way that does not compromise access to mental health services. A Balanced Approach Ontarians should not have to choose between lower premiums and mental health services. The Ontario Psychological Association is committed to working with Government, FSCO, and other stakeholders to reduce auto insurance costs while protecting access to care and minimizing the risk of harm to accident victims with brain injuries and mental disorders. The Liberal Government s Leadership on Mental Health Since 2003, the Liberal Government has demonstrated great leadership in building awareness of mental health issues and improving access to mental health services. Premier Kathleen Wynne was re-elected in part on her renewed commitment to the Ontario Mental Health and Addictions Strategy. The Government s commitment addresses the reality that people with brain injuries and mental disorders lack timely access to necessary mental health services.1 The result is personal suffering and disability, and far-reaching costs for society and our provincial health care system. Limits on patient access to mental health services put greater strain on other resources in our health care system and increase the cost to Government. How Psychology Helps Psychologists provide critically important and evidence-based services for comprehensive assessment and correct treatment of brain injuries and mental disorders. No-Fault Benefits and Mental Health 1 Navigating the Journey to Wellness: The Comprehensive Mental Health and Addictions Action Plan for Ontarians (August 2010), Final Report of the Select Committee on Mental Health and Addictions. 21 St. Clair Avenue East, Suite 403 Toronto, ON M4T 1L opa@psych.on.ca

2 OPA Issue Brief Auto Insurance 2 No-fault accident benefits were introduced to provide timely access to treatment and rehabilitation for those injured in auto accidents. In addition, no-fault benefits help to avoid the shifting of costs and demand to the already strained public health care system. In recent years, however, access to no-fault benefits for accident victims with brain injuries and mental disorders has been reduced. The causes: 1. A presumption that the existence and severity of mental disorders is determined by the nature of the physical injuries. 2. The legal requirement that only a physician not a psychologist may conduct an examination or assessment to determine the existence of catastrophic impairment (except, in very limited circumstances, a neuropsychologist).2 In fact, psychologists are often being better placed and have more expertise to conduct these assessments. Prior to 2010, psychologists were permitted to conduct them. 3. The rule that, in a lawsuit, an auto accident victim who suffers permanent serious impairment of an important mental or psychological function must produce evidence from one or more physicians evidence from a psychologist alone is not good enough3 This restriction is an unfortunately legacy of the previous Progressive Conservative government. For those suffering from mental disorders, it impedes access to justice and adds unnecessary costs to expensive court proceedings. Despite its adverse impact on mental health patients under psychologists care, the regulation remains on the books. Together, these restrictions act as significant barriers to treatment, and they impose additional costs on accident victims and our health care system. Further, they are contrary to the Government s leadership in increasing awareness of mental health issues and improving access to mental health services. Finally, these restrictions fail to recognize the significant expertise and relative cost-effectiveness of psychologists in these matters. Solutions The OPA fully supports action to reduce auto insurance costs and premiums. The following solutions would both reduce costs and help relieve some of the strain on our health care resources, while minimizing the risk of harm to accident victims with brain injuries and mental disorders by providing greater access to mental health services. 1. Implement a health provider licencing regime to create a mechanism to address fraud and inappropriate billing practices. Such a mechanism has been lacking for those providers who are not regulated health professionals. 2. Address the excessive costs of the towing and storage. 3. Target accident prevention and injury reduction. 4. Utilize telemetrics to reduce individual premiums for safe drivers and reinforce safe driving. 2 3 O. Reg. 34/10, subs. 45(2). O. Reg. 461/96, subs. 4.3(2), en. O. Reg. 381/03.

3 OPA Issue Brief Auto Insurance 3 5. Reduce non-accident benefit cost drivers within the insurance industry. 6. Improve insurance companies internal claims adjudication practices.. 7. Implement strategies to improve access to services for accident victims with mental disorders. 1) Licencing of health provider facilities The OPA welcomes the opportunity for greater involvement in the development and implementation of the licencing system. To reduce the potential for unintended negative consequences, the OPA recommends: a) Creation of a limited exemption from the licence fee for clinicians who have received payment for only a relatively small number claimants in the previous calendar year. This accommodation would not significantly interfere with cost recovery within the overall licencing model or its anti-fraud objectives. b) Development of due processes to be used for the protection against vexatious complaints and unreasonable removal of licenced status. c) Direct and timely payment to all licenced health professionals by all insurers. d) Funding of relevant continuing education opportunities for all who are licenced. 2) Address the excessive costs of towing and storage The OPA strongly agrees that these should be vigorously addressed. As health professionals we hear complaints from patients regarding the costs involved. 3) Target accident prevention and injury reduction Compared to provinces with public auto insurance, Ontario (with a private auto insurance system) lacks the structure and incentives to invest in accident prevention. In British Columbia, for example, if an intersection is the location of a disproportionate number of accidents, the cause is addressed. The benefits accrue immediately as the number of accidents and claims costs are reduced. Ontario needs to explore ways to align these interests in Ontario and create a greater focus on accident prevention and injury reduction. 4) Utilize telemetrics to reduce individual premiums for safe drivers and reinforce safe driving Telemetrics offer an opportunity to better determine individual insurance premiums based on driving behavior. Importantly, they provide feedback information and incentives to the driver to reinforce safer driving, resulting in fewer accidents and injuries. Thus, they hold promises of reduced premiums for the individual, fewer injuries, and reduced over all costs. 5) Reduce non-accident benefit cost drivers within the insurance industry

4 OPA Issue Brief Auto Insurance 4 The available cost data reveal a consistent pattern over time in which a reduced percentage of total funds are being paid to accident victims through accident benefits. At the same time, an increased proportion of each premium dollar is eaten up by commissions, general expenses, profits and taxes. These should be addressed as they account for approximately one third of the costs in the system and offer opportunity for significant savings. Significant variability in these areas across insurance companies suggests that some have found opportunities for cost savings. 6) Improve insurance companies internal claims adjudication practices Adjudication practices vary greatly across companies even though they are operating within the same regulations. While some companies have relatively fair and efficient processes, others are highly inefficient and generate needless delays and costs. Still others disregard evidence-based treatment guidelines and take an overtly adversarial position with any claimant whose injuries are less visible, such as those with mental disorders. These practices contribute to higher levels of distress in already injured patients. Additional distress, combined with delays in provision of care, lead to increased disability and treatment costs and subsequent higher levels of dispute, litigation, and settlement costs. 7) Implement strategies to improve access to services for accident victims with mental disorders We must improve education regarding the nature of mental disorders, with the aim of reducing discrimination and overcoming the continued narrow focus on severity of physical injury as a proxy for mental injury. Standards must be created for proper adjudication, including consideration of the relevant evidencebased guidelines regarding assessment and treatment of mental disorders when making decisions. Insurers should require examiners to have appropriate training and expertise, and to utilize a professional peer reviewer whenever appropriate and rely upon psychologists to diagnose mental disorders, comment on reasonable and necessary treatment, and resultant disability. Psychologists must be allowed to certify applications for catastrophic impairment determination and to be relied upon as the sole expert to adduce evidence regarding mental disorders in tort-based legal actions under the Insurance Act. Key Recommendations Reduce the barriers to necessary psychological services for accident victims with mental disorders. Continue to acknowledge that mental disorders are not minor injuries. Do not make changes to the catastrophic impairment criteria that require a much higher level of impairment for those with mental and behavioral disorders compared with those who sustained physical problems. Re-instate provisions to reflect expertise and competence of psychologists by allowing them to conduct assessments and examinations for catastrophic impairment due to mental disorder.

5 OPA Issue Brief Auto Insurance 5 Do not reduce the supply of psychological treatment providers by imposing disproportionate licencing fees on psychologists who only treat a few patients under auto insurance. Provide a limited exemption from licencing fees for these regulated health professionals. Reinstate the right of an accident victim who suffers permanent serious impairment of an important mental or psychological function to rely in court solely on evidence from a psychologist with appropriate expertise. For additional information, contact: Jan Kasperski Chief Executive Officer, OPA jan_kasperski@psych.on.ca Phone: (416)