The Right to Sue for Health Care Expenses and the $15,000 Deductible

Author(s): Wendy Moore Mandel

September 1, 2002

Under the current auto insurance law, an injured person is not entitled to sue the person(s) at fault for the accident, unless they have suffered a catastrophic injury. The draft legislation proposes to allow all injured persons to sue for health care expenses, where they have suffered a permanent and serious injury. Allowing a person to sue for health care expenses is an important change and should be supported. It addresses a significant deficiency in the existing legislation for non-catastrophically injured persons. Currently, non-catastrophically injured persons have limited access to health care expenses from their nofault policy and at the same time are prevented from claiming any shortfall from a wrongdoer.

However, the draft auto insurance reform also includes a proposal to apply a $15,000 deductible against health care expense claims. Therefore, all innocent accident victims who can sue for their legitimate health care expenses, will not be permitted to collect the first $15,000 of their claims.

Applying a $15,000 deductible to health care claims is patently unfair and unjustifiable. The auto insurance regime in Ontario already places a number of restrictions on the right to sue for health care expenses:

  1. The accident victim must suffer a permanent and serious injury;
  2. The Health Care expense must be accepted by a Court as both reasonable and necessary; and
  3. The accident victim will likely have exhausted $100,000 in medical/rehabilitation benefits available from his/her no-fault insurer before seeking reimbursement through the Court.

There is no justification for depriving accident victims of $15,000 for medical and rehabilitation services that they clearly require. In most cases, victims with permanent and serious injuries are disabled from work. How will they pay the first $15,000 of their medical expenses?

Accident victims have often had their world turned upside down – they are not working, their home life is in disarray, their future is uncertain – economic pressures can be great. The proposed deductible will only add greater pressure.

No deductible should be applied against health care costs. They are legitimate, out-of-pocket expenses that are only claimed in serious cases of permanent injury.

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