Accessing Care in Remote Areas

• 
  Lisa Fraser
  Lawyer

After sustaining a spinal cord injury, access to medical care and a rehabilitation team are crucial. However, a person’s location and the distance from their healthcare providers has an impact on how treatment and support is obtained. 

Those who sustain a SCI in a motor vehicle accident and live in remote areas might require in-home care, but they often must deal with their insurance companies to determine whether the mileage of their treatment or support providers will be covered. The Statutory Accident Benefits Schedule (SABS) is a regulation under the Insurance Act which outlines the benefits individuals injured in a motor vehicle accident may be entitled to. Those injured in a motor vehicle have access to benefits, regardless of fault for the accident. Many insurance companies are not approving the cost of mileage, as there is no obligation for them to cover this expense. While this can work to the injured person’s advantage by preserving the limited funds available for medical and rehabilitation under the SABS, it can create barriers in receiving required treatment, thereby delaying a person’s progress. Similarly, providers otherwise able to travel long distances to provide care are left with the financial burden of the cost of transportation to their patients. 

Those with newly sustained SCIs who have the ability to travel from a remote location to a clinic are still faced with the unfair burden of funding the majority of their transportation. Under the SABS, people injured in an accident are faced with a 50 km deductible before mileage is paid by the insurer, and when mileage is paid, it is capped at $0.40 per kilometer. With the rising cost of fuel and vehicle maintenance, this burden faced by injured parties is a major barrier, especially when many need to modify their vehicles following a SCI. A case manager can be invaluable to people with injuries, as they can help coordinate treatment and provide assistance in communicating with insurance companies. 

If an individual is injured as a result of a fall, or some other non-motor vehicle related accident, there may be little to no funding for support unless there is private coverage in place through an employer or family member, which can make it more difficult to access care in remote areas. 

In our practice, we have noticed that those with a SCI in remote areas also have difficulties finding and retaining Personal Support Workers (PSWs). Often, clients need round the clock care, and when PSWs cannot be accessed on a consistent basis, significant interruptions occur, affecting treatment and personal safety. The pandemic has only amplified this issue, requiring family members and friends to step in and provide critical care, often without financial support or adequate training. To make things worse, those without family and friends nearby can be left without the support they require. 

The rise of virtual medical appointments during the pandemic has helped to improve access to care for people in remote areas. This has allowed people with a SCI to avoid long and stressful travel to clinics by receiving care in the comfort of their homes. However, this is not always an appropriate solution and often not viable due to bandwidth limitations in remote areas. 

An experienced legal team can make all the difference in receiving the necessary care following a SCI. With the right legal support behind you, you’ll have a team working to help you access necessary treatment through funding options available, and ultimately obtain fair compensation. 

This blog was authored by Personal Injury Lawyers Lisa Fraser and Michelle McLeod, and was originally written for and published by Spinal Cord Injury Ontario (SCIO).