For seriously injured Ontarians, attendant care is not a luxury—it is a necessity. It is the most basic level of care that allows individuals with brain injuries, spinal cord injuries, amputations, and other serious conditions to live with dignity. Yet, despite paying into mandatory auto insurance, accident victims are being denied the benefits they need due to outdated regulations, insurance industry loopholes, and unfair payment practices.

The recent Malitskiy v. Unica decision has worsened this crisis, allowing insurers to manipulate attendant care payments, shortchange claimants, and effectively undermine the entire system. If this trend continues, the burden will shift to families, the public healthcare system, and ultimately, taxpayers.

How Did We Get Here? The Decline of Attendant Care Benefits

Over the years, Ontario’s Statutory Accident Benefits (SABs) have been steadily eroded. It has become harder for injured individuals to access the benefits they are entitled to, despite being innocent, premium-paying accident victims.

Key issues include:
✔ Outdated Form 1 Rates – The hourly rates used to calculate attendant care benefits have not been updated in decades. The result? Many Personal Support Workers (PSWs) are being paid less than minimum wage for their services.
✔ Insurers Underpaying Benefits – Instead of paying the full amount approved on the Form 1 assessment, insurers pay only partial amounts, forcing claimants to cover the shortfall.
✔ Restricted Access to Form 1 Assessments – Only Occupational Therapists (OTs) and nurses can complete Form 1 assessments, despite physiotherapists and chiropractors being equally qualified to determine attendant care needs.

The consequence? More accident victims are left without care, relying on overburdened family members or OHIP-funded services that were never designed to fill this gap.

The Malitskiy v. Unica Decision: A Dangerous Precedent

The Malitskiy v. Unica case has set a damaging precedent in the auto insurance industry. Following the decision, insurers such as Economical, Sonnet, and Definity have refused to pay fair rates for attendant care, citing the outdated hourly rates set in the Form 1.

This means:
🚨 Attendant care providers are being forced to work for unsustainable wages.
🚨 Claimants must pay out-of-pocket to make up the difference.
🚨 Families are being left to care for seriously injured loved ones, often quitting their jobs to do so.

If this loophole is not addressed, more insurers will follow suit, leading to a total breakdown of access to care.

The True Cost of Attendant Care: Why the System Is Unsustainable

The insurance industry’s refusal to update rates ignores the real-world costs of providing attendant care. Since the COVID-19 pandemic, the cost of hiring and retaining PSWs has risen significantly.

Here’s why:
✔ Higher Wages – The Ontario government increased PSW wages in the public sector by $3 per hour, forcing private employers to follow suit.
✔ Rising Business Costs – Employers must cover CPP, EI, WSIB, liability insurance, recruitment, training, and administrative costs.
✔ Health Care Inflation – The cost of healthcare services rises 1.5 to 2 times faster than general inflation—yet Form 1 rates remain stuck in the past.

For example, a PSW earning $25 per hour actually costs an employer $27.48 per hour when employment costs are factored in. Add business overhead, and the actual cost of providing care is between $55-$60 per hour—yet insurers refuse to recognize this.

If this issue is not addressed, the pool of available PSWs will shrink, leaving seriously injured individuals without professional care.

Solutions: Fixing Ontario’s Attendant Care System

✅ 1. Update Form 1 Rates
The Form 1 rates should reflect current wages, employment costs, and the true cost of providing care. Rates should be adjusted regularly to align with public health facility rates and inflation.

✅ 2. Pay Based on Approved Time, Not Arbitrary Hourly Caps
The Form 1 was intended to provide a monthly benefit, not to enforce below-market hourly rates. Insurers must be required to pay for the full approved time, at competitive market rates, as originally intended.

✅ 3. Expand the Pool of Professionals Who Can Complete Form 1
Occupational Therapists and nurses are not the only qualified professionals to assess attendant care needs. Physiotherapists and chiropractors—who are often the first-line healthcare providers for injured individuals—must be allowed to complete Form 1 assessments. This will increase accessibility and reduce costs for patients.

✅ 4. Increase Cap Rates for Attendant Care
The current $3,000/month (non-catastrophic) and $6,000/month (catastrophic) caps are outdated and unrealistic. These limits must be increased to ensure that individuals receive the level of care they need.

Why This Matters for Ontarians

This issue doesn’t just affect those injured in car accidents—it affects everyone in Ontario.

🔹 Families are being forced to care for loved ones without proper support.
🔹 The public healthcare system is absorbing costs that insurers should be covering.
🔹 PSWs and care providers are leaving the field due to unsustainable wages.
🔹 Insurers are profiting while victims are left without the care they paid for.

Ontarians pay for auto insurance expecting to be covered if the worst happens. Yet, insurers are denying care, shifting costs to families, and exploiting outdated policies. This must change.

Conclusion: Time for Action

The Malitskiy v. Unica decision has exposed a major flaw in Ontario’s auto insurance system—one that will harm victims, burden families, and strain public healthcare resources if left unchecked.

To protect seriously injured Ontarians, we must:
✔ Update Form 1 rates to reflect real costs
✔ Ensure full payment for approved services
✔ Allow more healthcare professionals to assess needs
✔ Increase cap rates to ensure adequate care

If action isn’t taken now, access to attendant care will continue to decline, and Ontario’s most vulnerable will pay the price.

💡 It’s time to hold insurers accountable and demand fair access to care for all Ontarians.

#InjuryAdvocacy #FairAccessToCare #AutoInsuranceReform #AttendantCareRights