Marshall.Benefits

Question 1

What are the component benefits of Ontario’s mandatory auto insurance system? (2)

Answer 1

• No-fault (Accident benefits): provides benefits regardless of fault
• Tort (Bodily Injury): allows injured party to sue the at-fault driver

Question 2

Which is true for Ontario Auto insurance:
1. Benefits are fair
2. Benefits are DELIVERED fairly

Answer 2

1. Is true - benefits are fair
2. Is false - benefits are NOT delivered fairly

Question 3

What are the causes of unfair delivery of auto insurance benefits in Ontario? (4)

Exam question: According to the Marshall report, explain how the Ontario automobile injury compensation system is flawed

Answer 3

1. Cost control at the expense of care
   - Insurers emphazise cost control instead of care
   - But then victims don’t recover and final costs are HIGHER not lower
2. Lawyers
   - Lawyer’s contingency fees are a % of settlements
   - So lawyers seek higher settlements, not better care for victims
3. Entitlements
   - Victims seek to maximize entitlements vs addressing own care needs
4. Volume
   - Providers are paid on volume of treatment not results of treatment

Question 4

Identify the actions items in Ontario’s five-part action plan for addressing the unfair delivery of benefits

Exam question: According to the Marshall report, briefly describe three actions the government can take to improve the system

Answer 4

1. Structural Flaws
   - Fix structural flaws by appointing an arms-length regulator with powers to enact policies & procedures
2. Catastrophic Injuries
   - Change compensation system for catastrophic injuries because lawyers are taking too big of a chunk out of settlement payments
3. Lawyers
   - Make contingency fees transparent and simplify benefits so there is less need to hire lawyers
4. Care not Ca$h
   - Focus on timely, appropriate medical care, not cash payouts
5. Smart regulation
   - Allow insurers more regulatory freedom to compete on price & service

Question 5

What is the “opportunity gap” in Ontario auto insurance

Answer 5

There is an OPPORTUNITY for Ontario auto premiums to be much lower without impacting qualtity

Question 6

What is the “value gap” in Ontario auto insurance

Answer 6

The VALUE of medical care could be better if there were more focus on active medical management vs maximizing cash payouts