This past fall, FSRA invited stakeholders across the auto insurance and healthcare sectors to weigh in on proposed reforms to its Health Service Provider Guideline and regulatory framework. The goal? To modernize the system and support the Ontario government’s broader auto insurance reform efforts.

A total of 80 submissions were received from insurers, legal professionals, health care providers, and advocacy organizations. You can view all of them here:
🔗 FSRA Auto Reform Consultation Feedback

The Problem: Malitskiy and the Erosion of Attendant Care

In the aftermath of Malitskiy v. Unica, we’ve witnessed insurers like Economical, Sonnet, and Definity implement troubling new interpretations of Form 1 payments. Rather than paying the monthly benefit calculated from the Form 1 (as was originally intended), these insurers now claim the outdated hourly rates represent a maximum payable—resulting in significant underpayments or complete denials.

The results are devastating:

• Critically injured claimants are going without care unless families can cover the shortfall
• Family members are leaving work to provide care themselves
• The public healthcare system (OHIP) is subsidizing private insurer obligations

Why Attendant Care Matters

Attendant care supports the most basic needs of those with serious injuries—brain injuries, spinal cord injuries, amputations, and complex orthopedic trauma. It provides:

• Supervision and safety
• Personal care and hygiene
• Meal preparation and mobility support
• Access to and participation in therapy

Without it, clients’ recovery and quality of life deteriorate rapidly, and families are left to fill in the gap.

The Cost of Providing Care Is Rising—But Rates Haven’t Moved in Decades

The Form 1’s hourly rates were meant to calculate a monthly budget—not to cap provider billing. Those rates ($14.00–$21.11/hour) are based on decades-old benchmarks and are now far below Ontario’s minimum wage, let alone the true cost of delivering services.

To deliver safe, reliable care, attendant care providers face:

• Competitive PSW wages ($25+/hr)
• Employment contributions (CPP, EI, WSIB)
• Overhead (insurance, recruiting, supervision, admin)
• Post-pandemic inflation

This brings actual operating costs to $33–$45/hour, before even factoring in a sustainable margin. A reasonable market rate of $55–$60/hour is required for this sector to remain viable.

What FSRA Heard – and What’s Missing

Stakeholders overwhelmingly asked FSRA to address the consequences of Malitskiy and fix the broken system. Highlights include:

• Over 500 health care providers signed onto a joint proposal recommending:
  • Updating Form 1 rates to reflect current costs and inflation
  • Clarifying that Form 1 rates are for monthly benefit calculation—not hourly billing caps
  • Expanding the pool of professionals authorized to complete Form 1s
• Desjardins acknowledged the risk of “problematic outcomes” from rate imbalances and recommended aligning Form 1 with WSIB standards.
• Aviva supported CPI-indexed increases for Level 1 and 2 rates.
• Ontario Brain Injury Association (OBIA) supported aligning Level 1 and 3 rates with current market standards and reviewing rates every 2–3 years.

Yet despite the seriousness of the issue, The Co-operators and several other insurers did not comment on Attendant Care at all—despite their adoption of cost-limiting policies that directly impact care access for some of Ontario’s most vulnerable citizens.

What Needs to Happen Next

The Injury Advocates are calling on FSRA and the Ontario government to adopt the following solutions:

✅ 1. Update Form 1 Rates

Index the outdated rates to reflect today’s costs, as WSIB and public healthcare employers have already done.

✅ 2. Clarify the Purpose of the Form 1

Confirm that Form 1 hourly rates are calculation tools, not maximum billable rates. Allow providers to charge reasonable commercial rates for the hours approved.

✅ 3. Expand Who Can Complete the Form 1

Allow qualified professionals like physiotherapists and chiropractors to complete the Form 1. This improves access and reduces unnecessary costs and delays.

✅ 4. Raise the Monthly Caps

The $3,000/month cap for non-catastrophic injuries and $6,000/month for catastrophic injuries have not changed in years. These limits must be raised to reflect today’s real care costs.

What The Injury Advocates Are Doing

The Injury Advocates are actively working to protect access to care for seriously injured Ontarians. We’ve maintained continuous communication with FSRA, submitted detailed consultation papers, and continue to advocate for regulatory reform that prioritizes client care and fairness. Our coalition of healthcare providers and legal professionals is united in pushing for clear, enforceable policies that prevent gaps in care, support ethical providers, and hold insurers accountable.