Relying On The Public Insurance Plan Could Be A Risky Business

October 1998

Lorna Heaton arrived home from work one Friday evening to discover that her husband and their 18-month old son had been hit by a truck while out cycling earlier that day. The baby escaped with a sprained ankle, but her husband had sustained head injuries. By Saturday morning, he had fallen into a coma and the prognosis was not good. "I was told there was the possibility that he might never wake up", Ms Heaton says.

Heaton is a Plateau resident but, at the time of the accident she and her family had been living in Albuquerque, New Mexico where she was completing post-doctoral research. Fortunately, Heaton had taken the precaution of buying a family travel insurance plan which covered all her family's medical expenses in the US as well as air fare return to Quebec. Without the insurance plan, Heaton admits, "We would have been in debt for the rest of our lives."

What the couple did not have was disability insurance to replace lost income in case of injury or illness. Although they had subscribed to such a plan, they had decided to cancel it. Heaton says, at the time, she just couldn't imagine what could keep them from earning an income. "The accident made me realize," she concedes, "just how permanent a disability could be."

Several months later, her husband has regained consciousness and is making a miraculous recovery. It is still too soon to say how long it will be before he is fully recovered. In the meantime, because the injuries were the result of a road accident, the SAAQ (Société de l'assurance automobile du Québec) will pay compensation equal to 90 percent of his previous after-tax income plus other related expenses.

Although Heaton had no difficulty obtaining full compensation for her husband, not everyone has the chance to do so. Navigating through the labyrinth of SAAQ bureaucracy can be a harrowing experience. In some cases, the link between an accident and the resulting disability is not self-evident. One's professional status at the time of the accident can also be a source of contention. What's more, benefits can be arbitrarily cut off if the SAAQ determines there is employment which you are able to hold.

According to Denise Gauthier, President and founder of La Fondation des Accidentes de la Route, a decision from the SAAQ on one's claim can take months, a year or even more. "How are people supposed to pay their rent and survive in the meantime?" asks Gauthier, herself a victim of a car accident which has left her with continued back and neck problems as well as fibromyalgia. It was her own nightmarish experience with the SAAQ that motivated her to start the Foundation. "Unless you are paraplegic or quadriplegic or suffer from traumatic brain injury, you have to fight for benefits from the SAAQ," Gauthier declares.

SAAQ statistics show that on average 12 percent of decisions are contested by the victim. According to lawyer Janick Perreault, there is another story these numbers do not reveal. She has devoted most of her law practice to defending victims of road accidents and says the cost of contesting is a big deterrent. Medical evidence and legal fees can quickly run up a bill of $5,000 or more. In addition, the whole process can easily take two years with no guarantee you will get anything for your trouble. In sum, it takes a lot of courage and perseverance to go to battle with the SAAQ and many who have just reason to contest choose not to.

Bottom line: Disability can happen to anyone. Although publicly funded insurance plans like the SAAQ provide a safety net, getting your just dues is a right you might have to fight for. If your ability to earn an income is crucial to you and your family, beware that relying exclusively on public insurance is a risky business.