What is Cost of Care and Why Does it Matter?
We are lucky to live in a country where our fellow citizens believe that each of us has a right to basic medical care. This includes doctor’s visits, hospital care, medically necessary surgeries, and some continuing care outreach services. The Pharmacare Plan assists with the cost of medication. This plan has a deductible and the extent of the benefit received depends on family income. Much of our taxes are allocated to pay for the cost of health care. In addition, each person or family pays a premium to the Medical Service Plan, which administers the provision of medical services to people resident in British Columbia. Even with the plans that exist, anyone who does not have an extended health care package through work, and even some of those who do, know that the medical services that are provided through the government, do not cover all of the costs of medical treatment.
Many people carry life insurance, to protect their families should they die. If an injury happens at work, during the course of their duties, an employee is likely covered by Worker’s Compensation and may receive wage replacement, as well as have their medical expenses paid. Those who work, often have plans that provide for wage replacement (long term disability benefits) should they be injured or become sick, such that they cannot work. If the injury is serious, however, they often lose both their employment and their extended health care coverage through their workplace. The reality is that few of us, plan for catastrophic injuries and the effect it will have on us. This means there is a significant gap between what our medical needs may be and our ability to pay for those needs.
Unfortunately one of our everyday activities which can and often does result in injury is driving a car.
When you purchase insurance through ICBC every policy comes with what is called “Part 7” benefits. Part 7 refers to a section of the Regulations under the Insurance (Vehicle) Act. This Part provides for payment of basic medical benefits, for all insured who are involved in an accident, regardless of who is at fault for the accident. Insured has a relatively broad definition, and includes the owner of an insured vehicle, occupants of their vehicles, and members of their household. ICBC must “pay as benefits all reasonable expenses incurred by the insured as a result of the injury for necessary medical, surgical, dental, hospital, ambulance or professional nursing services, or for necessary physical therapy, chiropractic treatment, occupational therapy or speech therapy or for prosthesis or orthosis.” There are limits on the amount that they will pay for chiropractic and other physical therapies. ICBC has the discretion to pay additional medical expenses that are not within the listed types of treatment. They will pay medical benefits to a maximum of $150,000.
In catastrophic injuries, the cost of care may well exceed $150,000. Imagine that you have to purchase electric wheelchairs, prosthesis to replace missing limbs, need daily attendant or nursing care, have extensive medications, need crutches, walkers, and scooters. What if you cannot clean your house, or drive a car? If you are injured in a motor vehicle accident, for which you are not at fault, a part of the claim that you bring against the at-fault driver, is a claim for the future cost of all of the reasonable medical expenses and services which you will require for the rest of your life. Expert evidence from your doctors, and occupational therapists, will provide a list of treatments and medical assistance which you will require over your lifetime. An actuary or economist will calculate the present value of those medical needs. The present value amount is a lump sum, which will provide a stream of income to you to pay for the cost of your future care needs, once the effect of interest and inflation and your life expectancy have been taken into account.
Although the future cost of care claims and calculations are extremely important when the injury has been very serious, the court will also make awards to people who have been involved in motor vehicle accidents, where their injuries are not catastrophic. Often to assist with soft tissue injuries, back injuries, or a psychiatric injury, an injured person will require periodic physiotherapy, must stay active and attend a gym program regularly, or may require periodic counselling. The court will make awards, for these items, in appropriate cases.
When you are injured, it is not just about today, but is about the future as well. The courts recognize this and will provide compensation for those future care needs.The information provided above is for educational purposes only. This information is not intended to replace the advice of a lawyer or address specific situations. Your personal situation should be discussed with a lawyer. If you have any questions or concerns, contact a legal professional.