When "One Size Fits All" Doesn't

Toronto Personal Injury Lawyer Albert Conforzi: When we look at our health care system, we Canadians can be smug at times, especially when we compare ourselves to our neighbours to the south.

Universal health care most definitely has its benefits. As the saying goes, "the measure of a great society is the manner in which it treats the least of its members." Canada does very well on that side of the ledger sheet.

The other side, however, is that our vast geographic size, combined with our relatively small population, reduces economies of scale on such things as research and development. Further, the size of the population means that any complex medical problem that arises here has usually been seen ten times more frequently down south.

I have always understood that there were instances when OHIP would fund necessary surgery in the U.S. In order for this to happen, your family physician would have to submit a request for out of province surgery.

I was surprised to hear that this is no longer the case:

As of April 1, 2011, patients had to find a specialist to request out-of-country care. Prior to that, family physicians could do so. And if a specialist in this province says they can perform the procedure, then OHIP coverage outside the country will automatically be denied.

How many specialists here do you think will say that they can't do something that is being done in the US?

By shifting the request away from the family doctor to the specialist, the government has no doubt seen a significant drop in out-of-country surgery requests. But is such a change aimed at helping people, or is the government more concerned about the bottom line?

As a lawyer, it does not surprise me that such a regulatory change could be quietly made by Order-in-Council. It is frequently done. But as a parent and a taxpayer, I am appalled that this could be done with such little discussion. If you had to choose between a local doctor here who might be learning their techniques at your child's expense, or seeing a foreign doctor who has a proven track record of success, I'm sure your choice would be the same as mine.

Perhaps rather than subjecting Ontarians to this dilemma, OHIP should consider having an Ontario surgeon attend the surgery in the US to help them gain experience for the future.

Whatever the case, if you feel you need foreign medical assistance, it is very important to consult a legal professional before seeking treatment.

Albert Conforzi is a personal injury lawyer with Pace Law Firm in Toronto. His posts generally appear on Mondays.

Doctor's Orders

Toronto Personal Injury Lawyer Albert Conforzi: Did you know that since 1968, doctors have been obligated to report unfit drivers to the Ministry of Transportation? Indeed, since 2006, your doctor has been paid to do so:

Since 1968, Ontario doctors have been required by law to report unfit drivers, but studies have shown that actual reporting of affected patients falls far below the prevalence of chronic diseases like dementia, alcoholism and diabetes in the population.

In 2006, physicians in the province began receiving a small fee — $36.25 — for counselling a patient that he or she should not be driving, and reporting them to the Ministry of Transportation.

The good news is that the identification of these drivers resulted in an immediate 45 percent drop in trauma from motor vehicle crashes.

The bad news is that 20 percent of those identified did not return to their doctor following the doctor having issued the warning. It's likely that these people simply changed doctors.

Let's face the facts -- if I am not fit to drive, I want my doctor to say so. Every member of the motoring public should feel the same way.

Minor Injury Guideline in Ontario: Problems and Solutions

In this video, Toronto personal injury lawyer Alex Voudouris and Access Rehab's Jim Anagnostopoulos discuss the problems with the Minor Injury Guideline in Ontario.

Loss Transfers and Delays for Accident Victims

Toronto Personal Injury Lawyer Albert Conforzi: A recent decision from the Ontario Court of Appeal has provided some further guidance to insurers on the issue of Loss Transfer.

Loss transfers exist between insurers of different classes of vehicles for accident benefit payments. For example, between a motorcycle and a car, or a car and a heavy commercial vehicle. The insurer of the motorcyclist who is responsible for paying accident benefits to that motorcyclist is entitled to reimbursement "in relation of benefits paid" from the car insurer. It's like a ladder: you can claim that reimbursement from any insurer involved in the accident on a rung above you.

In the Wawanesa v. Axa decision, Axa refused to pay for the cost of medical assessments incurred when they were determining entitlement to benefits as part of loss transfer. The case went through three levels of decision makers, and at all levels it was decided that Wawanesa could not recover those expenses, notwithstanding that the various decision makers all agreed that it was unfair. Based on the wording of s. 275 of the Insurance Act such expenses were not recoverable.

It is not unusual for delays to happen in payment to accident victims because of disputes between insurers in the handling of the loss transfer.

Only Blair J. of the Court of appeal disagreed that the section was not capable of being interpreted in the manner argued by Wawanesa. Because of the split decision in the Court of Appeal, it is at least possible for Wawanesa to ask for leave to appeal to the Supreme Court of Canada, although it is unclear whether they will try to do so.

In matters where injured victims are claiming accident benefits, and the insurer is seeking loss transfer for payments made, it is not unusual for delays to happen in payment to accident victims because of disputes between insurers. These delays shouldn't happen, as this loss transfer system is supposed to occur behind the scenes. Frequently, though, the first party insurer delays payments to victims while they are awaiting reimbursements back from the second insurer.

If your lawyer understands the loss transfer system and where to apply pressure in the event of a disruption in benefits payments, you as a victim stand a much better chance of not having to live through such disruption.

Albert Conforzi is a personal injury lawyer with Pace Law Firm in Toronto. His posts generally appear on Mondays.

Head Injuries In - and Out - Of the NFL

Albert Conforzi

Toronto Personal Injury Lawyer Albert Conforzi - I came across an interesting piece about lawsuits in the United States regarding head injuries from playing NFL football. The NFL is suing over 30 insurers for refusing to defend the NFL in some 143 injury lawsuits brought by former players. I wonder how long it will be before similar types of lawsuits are attempted in Canada, and how the insurers here will respond?

In the past couple of years, there has been a lot of talk about head injuries in the NHL. Indeed, our own Facebook page is highlighting the plight of people suffering from concussions. The NHL, no doubt, is paying very careful attention to what is happening in the NFL.

The NFL news story focuses on the insurance issues that arise in these types of cases, especially where multiple insurers are involved. Whenever there are a series of insurers exposed to a risk there will always be a protracted argument about which one of them will be on the hook when something happens. In sports where there is constant or repeated injury, the question is: when did the blow occur that actually caused the injury? The answer to that question can help define which insurer was actually on risk at the time of the incident.

Marian Hossa after a head shot during the 2012 playoffs. (Chicago Tribune)

The knowledge base regarding head injury and its "long tail" effects is growing exponentially. Even mild traumatic brain injury is now recognized as having the potential to cause lingering effects long after the acute phase has subsided. The arguments about the sufficiency of headgear, whether it be for football, hockey, or skiing, is ongoing. Cases like the Sidney Crosby hockey injury or the skiing related death of actress Natasha Richardson continue to fuel research into the area.

My experience with traumatic brain injury lies more with motor vehicle accidents than it does with sports, but in my opinion they are both trivialized. In motor vehicle accidents, the potential long term impact of mild traumatic brain injury has long been viewed through rose coloured glasses by insurers to avoid compensating victims.

We are fast arriving at the point where insurers will no longer be able to deny what medical science is busy proving: head injuries have long term effects, and the effects are serious. Unfortunately, it seems that many people are going to be hurt before that message is received.

Albert Conforzi is a personal injury lawyer with Pace Law Firm in Toronto. His posts generally appear on Mondays.

Pace Law Firm at Trillium Health Centre

Pace Law Firm hosted a Lunch and Learn event today at the Trillium Health Centre in Mississauga. The subject of the lecture was Humour and Social Work, with Anka Milligan presenting.

Here are a couple of photos from the event.

Anka Milligan with Pace GM Patrick Rocca

Humour and Social Work

Anka Milligan During the Lecture