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You sustained injuries in a car accident. You call your insurance company and they take your information. Next thing you know, you receive a package in the mail with many forms inside it that you are “required” to fill out. This can be a very overwhelming process, especially if your injuries have affected your abilities to carry out your daily routine as well as manage your injuries. You go to your treatment providers (doctors, physiotherapists etc.) and they assure you that you will receive the appropriate treatment.

Today, even if you are seriously injured, you will be entitled to a maximum of $65,000.00 in medical, rehabilitation and attendant care benefits unless you are “catastrophically injured”. The cost to treat your injuries can add up quickly.

What you need to know:

In Ontario, under our current automobile insurance system, treatment providers such as physiotherapists, chiropractors, psychologists and osteopaths, are required to submit Treatment Plans to your insurance company in advance of treating you. These Treatment Plans detail all the treatment requirements that the health provider has determined that you will need including the cost of those services. The Treatment Plans are then sent by your healthcare provider to the insurance company for approval. Only if that Treatment Plan is approved will the insurance company pay for the proposed treatments. In approving the Treatment Plan, all the funds required to fund that Treatment Plan will be set aside or reserved for that treatment by the insurance company. These fund would no longer be available for other treatments.

What often happens is that the treatment providers don’t end up billing for all the proposed treatment. Unfortunately, you will no longer have access to those “treatment funds” because they are reserved to pay the Treatment Plan even if they are never billed by the treatment provider.

If treatment was provided but was not approved, you will have to pay for any invoiced services yourself and the insurance company will refuse to reimburse you for past unapproved services.

In the event that you are approaching the maximum treatment limits ($65,000.00), you will be denied further treatment if there are not enough funds to cover a Treatment Plan. EVEN if those funds are available but simply were reserved for a previous Treatment Plan that is no longer required. It is important to ensure that these funds are released in the event that you require those funds for further treatment.

In order to discover the total amount of reserved but unbilled funds, you or your lawyer, can write to the insurance company to find out what amounts have been paid-out. If you compare this paid-out list to the actual submitted treatment plans, you can discover what funds are available for further treatment. The next step is to have the treatment providers confirm with your insurance company that they no longer intend to bill on the previous Treatment Plan. In a few weeks, these unbilled funds should become available for any further treatment required.

We have many examples where we have freed up thousands of dollars of treatment funds for our clients who are in need of further treatment. The process is a bit complicated but well worth it.

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