Treatment financing ensures rehab continuity
By Helen Burnett-Nichols, AdvocateDaily.com Contributor
Treatment financing could be the answer for injured claimants who have exhausted their medical-rehabilitation benefits or been denied coverage, enabling them to continue funding vital services and avoid losing any progress they've made, says Dawn Simons, client relations manager at CaseMark Financial.
As Simons explains to AdvocateDaily.com, treatment financing is a private funding product offered to clients who may need to continue with their rehabilitation but their benefits have run out or been terminated.
“CaseMark offers this product to help fill these gaps — so people can continue with their treatment and progress with their rehabilitation,” she says.
Clients can then use the funding for services such as physiotherapy, occupational therapy, transportation, counselling, home and vehicle modifications — ultimately, any treatment recommended by their medical providers that is required to help them heal, return to work or their regular day-to-day activities.
Treatment financing, says Simons, can also be used when benefits have run out and a claimant is looking to apply for a catastrophic designation.
“There’s a gap there when you’ve used up all your med-rehab benefits and you’re waiting to see if the insurance company is going to deem your injuries catastrophic. Sometimes the treatment financing can be used as a carry-over measure, to ensure rehabilitation continues,” she says.
For example, she says, med-rehab benefit limits in Ontario are $50,000 for a claimant with a non-minor, non-catastrophic injury.
“Once that $50,000 has been exhausted, if they’re not deemed catastrophic, they’re more or less out of luck unless there’s some sort of resolution to the claim. If the injuries are classified as catastrophic, they have access to up to $1 million in med-rehab benefits,” says Simons.
When the $50,000 benefit has been used up and there’s a time lag, treatment financing can be a valuable tool, she adds.
“If the person has an injury that needs constant treatment, and they have to miss it for a month or two because they don’t have the money to pay for it, any progress they’ve made over the last six or 12 months goes down the drain. We can help ensure that that doesn’t happen in appropriate cases,” she adds.
Treatment loans can also come into play when a person who requires attendant care has maxed out their spending limits but is still waiting for a catastrophic designation, says Simons.
“For someone who has severe injuries that haven’t been deemed catastrophic, but they still require attendant care, that’s another area where we’re able to assist and keep that client in their home, having somebody to assist them when they need it, until they receive their catastrophic designation.”
CaseMark Financial’s approach to treatment financing is one of transparency and flexibility, says Simons, which means counsel or their firm is not a guarantor of the funding on behalf of the client, invoices are not grossed up by way of factoring, and nothing is done without the client’s knowledge or consent. By contrast, he notes, other programs favour a relationship between counsel, a medical provider and a funding company.
“That transparency means that the client is the actual borrower. So the plaintiff knows what is going on and that the funds are being provided to them. Very often, the funds are administered either by way of counsel — so we can put the money in the counsel’s trust account and then they can disperse it to whoever needs to be paid — or we can pay treatment providers directly, or we can do a hybrid. Whatever is needed.”
Although Simons says there is nothing necessarily wrong with “behind-the-scenes” programs in appropriate cases, she says it doesn’t make sense when clients aren’t made fully aware of what is happening.
“Very often with those financing arrangements, because the client isn’t involved, the funding companies will say ‘where’s our underlying security? We’re not actually attached to any particular claim, your firm will have to pay us in the event that the funding goes sour.’
“Because we don’t believe that lawyers should have to be on the hook for this, we just attach ourselves to a particular claim because that is, after all, who we’re providing funding for.”
In addition to transparency, CaseMark’s treatment financing program does not have any partnerships or exclusive arrangements with certain treatment providers that counsel is restricted to use.
“We don’t force anyone to use a specific company or provider, but rather encourage them to use the one that’s optimal for them,” she says.
There is also a possibility that if treatment funding costs are presented appropriately, counsel may seek to recover the interest from the defendant, although the case law is still developing in this area, Simons adds.