The hidden costs of not purchasing optional benefits

By Jeffrey Shinehoft June 16, 2022

I am involved with a case where both husband and wife were unfortunate victims of a car accident. Both suffered serious injury. Fortunately, the clients had purchased optional benefits.

The purchasing of optional benefits allows for a number of additional supports, including but not limited to:

  1. Increased non-catastrophic medical rehabilitation dollars from $65,000.00 – $1,000,000.00;
  2. Access to a Case Manager without proving catastrophic impairment;
  3. Increased attendant care.

While working on this case with the support of a qualified Case Manager, Mr. Joey Nativ of Innovative Case Management, it became clear just how much of a game changer the optional benefits are for everyone involved in the case at the crucial “early” file stages. It is easy to understand that when someone has hundreds of thousands of less money available, recovery will be limited. However, there is also a significant institutional effect on having limited benefits. Working with Mr. Nativ, we are speaking on a regular basis handling various case related issue. Whether it be additional supports needed, removing clients from the Minor Injury Guideline, accessing needed therapy, I am struck by just how much support is needed right now. Not only does this give the clients the best chance to focus on recovery it gives the team the best chance to do what they are trained and assigned to do. For example, we have a wonderful Occupational Therapist on the team, Miranda Mo. Without the formalized support of a Case Manager much of the “treatment gap” would fall on her. The remaining gap would fall on the client, myself as the clients’ lawyer, OHIP, the insurer and the remaining shortfall would simply go unserved.

Additionally, without the funding restrictions, our team can determine the best assessments required for the clients without having to “choose” between say additional attendant care and having a needed therapy assessment. This also greatly reduces the need to consider undertaking protected accounts which places additional stress on both the client and providers of uncertain funding sources.

A further benefit of the optional benefits is allowing for a more facilitative less charged relationship with the insurance company. When everyone is ultra-concerned with limited funding, especially at the critical time of need, parties are less likely to be empathetic to each other’s position. While a catastrophic designation still matters when optional benefits are purchased (i.e. housekeeping), generally less is a “stake” with the designation and certainly the timing of such a designation is less critical in most scenarios.

The decrease in Accident Benefit funding has had a profound effect on recovery. We all share this cost as an industry committed to helping people recovery from traumatic personal injury.