Expert Assessor Network: Gone But Not Forgotten

As many of you will recall, in the weeks and days leading up to the October 3, 2003 provincial election, Dalton McGuinty and his provincial Liberals promised to make fundamental changes to the delivery of medical and rehabilitation benefits as part of a larger plan to change the face of automobile insurance in Ontario. In particular, during their campaign the Liberals promised to abolish all Designated Assessment Centres (DACs) stating that DACs were too expensive, too cumbersome and failed to respond to the needs of accident victims. After October 3, 2003, the public waited and wondered whether the Liberals’ proposal to bring an end to the DAC system was an empty promise.

The White Paper

On March 19, 2004, the Honourable Mike Colle, Parliamentary Assistant to the Minister of Finance and the man in charge of reforming Ontario’s auto insurance system, released a White Paper entitled “Expert Assessor Network: Proposed Model to Replace the Designated Assessment Centre System”. According to this White Paper, the Liberals proposed to abolish the DAC system altogether and in its place, implement a new system which would not only replace the DAC system but also abolish the need for section 24 evaluations (Evaluations initiated by an automobile accident victim) and section 42 evaluations (Insurer Evaluations) which would result in a huge cost savings for all Ontario drivers.

What is the Expert Assessor Network?

The Expert Assessor Network system involved a network of local doctors who would receive auto accident injury cases referred to them by the Financial Services Commission of Ontario (FSCO). The Network would include a pool of, for the most part, family physicians, who, within 5 days of a referral would assess, diagnose and propose a rehabilitation plan for the accident victim with a report to follow 5 days later. If the physician required input from additional health professionals, a specialist would be drawn from a second pool of assessors and would be obliged to conduct the second assessment within an additional 5 days.

What Went Wrong

After the release of the White Paper, numerous critical comments were received by the provincial Liberals questioning their ability to implement what seemed on its face to be a fair and rational scheme. As it is with most things related to Statutory Accident Benefits, the devils were in the details. The most scathing response to the White Paper came from the Association of Designated Assessment Centres who concluded that the Expert Assessor Network is a completely unworkable scheme. According to the Association of Designated Assessment Centres, the Expert Assessor Network would never work in Ontario for the following reasons:

• The Expert Assessor Network is contingent upon finding a pool of independent physicians in general practice when there are already too few of these doctors in Ontario.
• Physicians in general practice are not always the health professionals most suitable to make treatment recommendations in light of the injuries commonly sustained by automobile accident victims.
• It was impractical to believe that both insurers and insured persons would find the Expert Assessor Network’s pool of physicians neutral which would ultimately lead to costly insurance disputes.
• The proposed system would likely lead to health professionals assuming the role of claims manager which is unfair to the physicians and a wasteful use of resources.
• The Expert Assessor Network system provided no appeal mechanism for what was intended to be binding assessments.
• The system creates a physician-centric model of assessment which was inconsistent with the community-based healthcare approach recommended in the Romanow Report.
• Elimination of all section 24 assessments is unfair, unmanageable and would likely lead to enormous disputes.

Back to the Drawing Board

As a result of the numerous and thoughtful critiques received through the consultation process, Arthur Lofsky, Special Assistant to Michael Colle, stated that the Liberal government would be going back to the drawing board to find a new system to replace the current DAC system as the Liberals had promised. According to Mr. Lofsky, “we listened, and we heard some problems [with the proposal] and we’re going to fix them.”

Insiders in the insurance industry believe that the Liberal government is working on a new proposal to replace both the current DAC and insurer evaluation systems. From all accounts, the Liberals seem committed to reducing the expense and duplication of the existing model. The Statement of Priorities currently found on the Financial Services Commission of Ontario website states that FSCO and the Liberal government remain committed to replacing the Designated Assessment Centre system with a new assessment process. According to the Statement of Priorities, “monitoring and evaluation will be a key component for the new system to be launched in 2004-05”.