Subsidizing insurance rates by denying brain injury claims

Opinion

Hey there, time traveller!
This article was published 16/01/2025 (242 days ago), so information in it may no longer be current.

How angry would you feel if someone you love suffered a serious brain injury in a car accident and Autopac wouldn’t provide appropriate compensation for rehab and daily-living support?

If we suffer serious vehicular injuries, don’t we all expect the support and compensations we receive from Manitoba Public Insurance (MPI) will be proportionate to the harm we suffer? That even if our serious injuries are complex and persistent, the support for assessment and rehab will be ongoing, comprehensive and adaptive to our needs? That’s not happening. We’ll explain why.

First: some background.

Recent signals from the previous and the new provincial governments have suggested attitude change towards MPI and Manitoba Hydro. The province seems to want greater engagement with Crown corporations.

After media investigations in 2021 and successive Public Utilities Board rulings raised questions about MPI’s actions and spending plans, a formal corporate review was announced in 2023 by the previous Conservative minister. This action, and subsequent actions by the NDP, signified stronger cabinet interest in better MPI accountability to cabinet.

Accountability for what? For how the board and senior managers manage the corporate insurance monopoly. Some of that attitude change suggests that cabinet believes the Crown corporations have been setting performance targets at “low bar” levels. The province seems to want them to do better. Other changes imply that some Crown corporation operating protocols and methods are inscrutable to government. Cabinet appears concerned that it doesn’t understand how the Crown corporations do what they do.

And what they don’t do.

Both Manitoba Hydro and MPI are locked into a structural conflict of interest. Both Crown corporations are required to, and diligently do, focus on cost control and rate-growth minimization. They do this while simultaneously promising high levels of public service. But this structural conflict affects every individual’s daily experience with MPI and Hydro. The public is skeptical there’s as much “excellence” in the services provision as the corporations claim. Regarding MPI, there’s a significant public view that claims minimization and rejections, to limit costs, is the sole overarching goal.

Given these Crown corporation conflicts of interest, the province needs to get the balance of these competing objectives right. It must create the right policy environment for the corporations to do their process management. Crown corporations in B.C. and Saskatchewan seem to have greater public accountability in how their monopoly public insurance corporations meet performance goals. But the PC and the NDP governments’ apparent dissatisfaction with MPI’s effectiveness and transparency suggest a desire to catch up.

The plight of motor-vehicle accident victims suffering head trauma is one sad area of Crown corporation performance badly needing attention. MPI labels complex head-trauma impacts like concussion as merely transient “whiplash.” It justifies this by relying on an obscure sports-medicine diagnosis guideline. And it rejects specialists’ medical evidence showing these complex brain-trauma injuries can persist much longer than “whiplash.” It decides claims using a “balance of probabilities.” But it never provides the estimated “probabilities.” And it never explains how it determines their “balance.”

It rejects new medical evidence in support of claims. All this lowers MPI’s claims costs. Every hasty, simplified classification (or rejection) of a complicated head-injury claim leads to under-diagnosis of trauma. It causes under-estimation of its persistence, and of medical rehabilitation costs. This ruthlessness of cost-cutting wastes human capital.

MPI’s website says over 100 cases of “serious” brain injury occur every year. Medical statistics suggest four to six times more of so-called “mild” traumatic brain injuries. Such head trauma causes misery and extensive costs to families. It creates ongoing costs to the health-care system. How MPI manages its brain-injury claims constitutes a significant, immoral and hidden subsidy to the insurance rates of non-injured people.

How does MPI choose the anonymous medical specialists it selects to evaluate head-trauma claims and the supporting medical evidence submitted by claimants?

Why are so many of them sports-medicine doctors?

Why doesn’t it ensure current medical best practices are applied to the challenges of diagnosing and treating brain injuries?

Why isn’t there a Science Advisory Panel that periodically updates MPI’s case-management procedures for assessing brain-injury claims?

Why won’t the MPI use a “weight of evidence” approach, across a range of multidisciplinary medical expertise, in diagnosing head-injury traumas?

Why won’t MPI insist that medical experts use best practicable technology for head-trauma assessment?

Why does it rely primarily on only a single discipline (neuropsychiatry)?

On what legal basis can MPI case-management officers repeatedly reject new medical evidence supporting an ongoing claim? Just because of a hasty initial (and self-serving) judgment of “no causal effect?” Just “because?”

Nobody knows. Worse, the government doesn’t know. And it should.

MPI’s current claims-management system is unjust. A grey fog obscures the province’s relationship with MPI. It needs to be removed. Better oversight of MPI procedures is necessary. Surely the government can demand greater cost-efficiency by MPI bureaucrats without treating brain-injured people as if their human capital didn’t count.

MPI is a Crown monopoly. We are all forced to use it. As we have no choice, we deserve to believe that we can rely on receiving the full services we’ve paid for when we need them. Including when we’re rear-ended at stop lights or T-boned and our brains are damaged. It is unreasonable, even immoral, for MPI claims-management procedures to be as inscrutable, unscientific and outdated as they are because of case managers’ ruthless incentives to cut costs. This dishonours the government.

The new government ran on a health-care-sensitive platform. It’s looking for some “low-hanging fruit” to show healthcare improvements.

Given that it’s already concerned about how MPI does what it does, if the government wants a quick political — and ethical — “win” in the public-health front, why not take a hard look at how vulnerable brain-injured people are forced to subsidize the rates of uninjured drivers? Why not probe MPI’s hard resistance to obvious necessary improvements in these claims-management practices?

Even a small population of victims deserves to be treated as if they mattered. Voters elected this government to improve health care. That includes health care for people with injured brains, damaged through no fault of their own.

Barry Waito is a former international forest-management company executive, and then a respected national forestry consultant, before acquiring a traumatic brain injury when rear-ended by a semi in 2016. He needed, and received, substantial assistance in developing this piece from supportive members of the community.