张良成律师：新车祸保险系统不会提供如此高额补偿

荣格 · 发表于 2010-12-19 19:09

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安省政府从2010年9月1日起对汽车事故赔偿制度进行改革，新政策规定哪些在车祸中受轻伤的人士最多只能获得$3,500元的医疗费用。
　　On Sept. 1, 2010, the Ontario government implemented a new car accident benefits system and imposed a $3500 cap on medical expenses for those suffering minor car injuries.

　　据安省金融服务委员会（FSCO）网站信息，按照新的轻伤赔偿制度，大部分在车祸中受轻伤，例如扭伤、拉伤或颈椎拧伤的人士只能获得上限为$3500元的医疗费用。
　　Under the new minor injury guideline, most people suffering minor injuries, such as sprains, strains or whiplash will be entitled to maximum medical treatment costs of $3500, according to website of Financial Services of Ontario (FSCO).

　　而车祸轻伤者在以往的汽车保险索赔中，可享受高达$10万元的治疗费用，同时还有$72,000元受伤护理津贴。
　　Prior to the new policy, a car insurance claimant used to be able to claim up to $100,000 in medical treatments and $72,000 for several attendant care and caregiver benefits.

　　Bougadis Chang律师事务所的人身伤害律师张良成表示：“新的车祸索赔制度可谓一项对车祸受伤索赔系统的重大变革。”
　　“It has changed the entire landscape of how the Accident Benefits system works,” said Gregory Chang, a personal injury lawyer with Bougadis Chang law firm.

　　《大中报》读者，56岁的林华文（Lin Huawen） 1992年从中国移民加拿大。林在2008年不幸遭遇了两起的无关联无责任车祸。两起事故使他遭到精神创伤，导致他头疼和浑身疼痛不止。
　　In 2008, 56 year-old Lin Huawen, a Chinese News reader who emigrated from China in 1992, was struck by two separate no-fault car accidents. He sustained emotional trauma in both accidents, which caused him to suffer headaches and pain all over his body.

　　据林的保险公司与他的来往信件，林所寻求治疗的几家诊所前后共向他提供了18种治疗方案，治疗费用从$78元至$4,150元不等。
　　According to the letters that Lin received from his insurance company, several healthcare clinics where Lin was seeking treatment for his injuries proposed a total of 18 treatment plans, with costs ranging from $78 to $4150.

　　林的保险公司，协邦保险公司推荐的四位医生在不同时期为他所提供了医疗检查。而根据这些诊断报告，保险公司拒绝了这些医疗诊所建议的大部分治疗方案。但是尽管遭到保险公司的拒绝，林仍然在不同的诊所继续寻求按摩师或理疗师的治疗。
　　Based on the assessments of four doctors that the insurer recommended at different times, Lin’s insurer, the Co-operators, rejected most of the treatment plans. Despite the insurer’s rejections, Lin continued to seek treatment from chiropractors or physiotherapists at different health care clinics.

　　其间，林的律师一直在为他争取被保险公司拒绝的医疗费用。2010年3月，林通过他的律师与保险公司对簿于安省金融服务委员会，林要求保险公司支付被拒绝的治疗费用以及护理津贴。最终，林从保险公司共获得$13,000元赔偿。
　　Meanwhile, Lin’s lawyer fought the bills rejected by the insurer. In Mar. 2010, the case was brought to the Financial Services Commission of Ontario (FSCO), where, through his lawyer, Lin sought payments for rejected treatment bills and further caregiver benefits. As a result, Lin obtained $13,000 in total compensation from the insurer.

　　据林的律师楼信息，林获得的$13,000元医疗费赔偿中，有大约$9,300元拨给林的治疗诊所，用于支付保险公司拒付的林的治疗费用。
　　According to his law firm, about $9,300 of his $13,000 settlement went to the health care clinics to cover Lin’s treatment bills unpaid by the insurer.

　　据林说，保险公司告诉他，他涉及的两起事故的索赔总额高达$80,000元。虽然保险公司未能核实林的信息，但林只拿到$5,000元作为家务服务费和收入损失补贴，而事故赔偿金的大部分均可能被用于支付林的治疗和康复，以及各种医疗评诊断费用。
　　Lin said he was told by the insurer that the total costs of his two accident claims ran as high as $80,000. While the amount was not confirmed by the insurer, apart from $5,000 that landed in his pockets as housekeeping and non-earning expenses, most of the money might have been spent on his treatments and recovery, as well as various medical assessment costs.

　　林称，他在不同的诊所接受了逾十二次治疗，而他的律师楼所建议他进行的某些治疗并没有必要。林称：“我认为后期的有些治疗是在浪费钱和时间，但是我的律师说如果我不去，我就得不到赔偿，所以我还是去了。”
　　Lin said that he went through over a dozen treatment sessions at different clinics, and alleged that some sessions suggested by his law firm were unnecessary. “I do consider that the later treatment sessions were a waste of time and money,” said Lin. “But my law firm said that if I didn’t go, I could not have claimed anything, so I went.”

　　林的律师并未回复《大中报》有关就林上述指控的询问。据张良成律师，在某些治疗方案被保险公司拒绝后，律师应该建议伤痛仍然未愈者前往不同的医生处寻求治疗。
　　Lin’s lawyer has not responded to Chinese News about Lin’s allegations. According to Chang, lawyers should advise clients who, after some treatment plans were rejected by the insurer, are still suffering pain and hardship to seek treatments from different doctors.

　　但张律师同时指出，如果林的事故是发生在新车祸制度生效后，保险公司决不会支付其高达近8万元的医疗费用。
　　But if Lin’s accidents happened after the new guideline became effective, the insurance company would not have allowed his medical costs to run as high as almost $80,000, according to Chang.

　　张律师表示：“他只能进行一或两次治疗，每次费用约为$1,000至$1,500元，仅此而已。”
　　“He could go for one or two treatments that cost about $1000 to $1500 each, and that would be it,” said Chang.

　　据FSCO网站称，安省政府提供了全国最好的事故赔偿制度。新制度旨在解决一些受伤者治疗费用超支的问题。
　　The Ontario government offers the best accident benefits system in the country, according to the FSCO website, and the new guideline intends to address the issue of overspending on some victims’ medical coverage.

　　张良成律师表示，赔偿制度改革是安省政府的5年检查计划的一部分。“由于过去数年来保险公司因为处理个人索赔超支而陷入财政困境，因此实施该项改革不足为奇。”
　　The changes come as part of the government’s designated five-year review plan, according to Chang. “Given the insurer’s financial difficulties with the cost control of handling individual claims over the past years, the changes were expected,” said Chang.

　　但安省政府应该在减轻费用超支和帮助车祸受伤者恢复伤痛之间寻找新的平衡点？对于那些在车祸中受到严重精神创伤，并且伤势较为严重者，例如骨折，内出血和背部疼痛，但自己又没有私人医疗保险计划去支付治疗账单的人来说，$3,500元的医疗费用上限意味着什么呢？
　　Between overspending and alleviating distress for car accident victims, where should the government draw the line? What would the $3500 cap on medical expenses mean to those who receive massive emotional shocks and suffer more serious injuries such as broken bones, internal bleeding and back pain, and who don’t have a private health plan to foot the treatment bills?

　　张律师表示：“告诉他们忍着伤痛折磨的确有些残酷。$3,500元的上限可能会令许多人遭受伤痛折磨。”
　　“Telling them to live through the pain would be tough advice to give,“ said Chang. “The $3500 cap may cause a lot of people to suffer from the pain.”

　　当然，这些客户也可以选择向过肇事方提起民事赔偿。但是打官司既耗费时间由费金钱，并且可能会无形中给那些在车祸中已受重创的人士带来更大压力。
　　Apparently, these clients can choose to launch a tort claim against the at-fault party. But a lawsuit takes time and costs money, and may put an additional stress on those who had already been through hell due to the car accident.

　　且新的索赔制度同时要求理疗师和按摩师提供更多书面资料。
　　And the new guideline places more paperwork responsibilities on physiotherapists and chiropractors.

　　张律师表示：“这些理疗适和按摩师们恐怕要多做些工作了……至少，他们必须提供更多有关患者状况的阶段报告。”
　　“These medical service providers now have to jump through quite a few hoops… At least, they have to provide more interim reports on patients’ status,” said Chang.

　　

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